Transcript 5 Slawson - ETSU.edu

Deborah Slawson, PhD, RD, LDN
East Tennessee State University
College of Public Health
Conference on Practical Strategies in
Medication Adherence
June 2012
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Health Literacy: partnering with patients to
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Cultural Competency: interacting effectively
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For Your Tool Kit: essentials to help your
ensure understanding
with people from diverse cultures
patients get the most out of medication & diet
regimes
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“The degree to which individuals can obtain,
process, and understand the basic health
information and services they need to make
appropriate health decisions.”
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Print literacy
Numeracy
Oral literacy
ARRQ, Evidence Report/Technology Assessment; No. 199, 2011
•
2006 Institute of Medicine Report,
Preventing Medication Errors
• Each year: 1.5 million adverse drug events in U.S.
• 33% of these are in outpatient settings
• Poor patient understanding and unintentional
misuse of Rx drugs (specifically poor
understanding of drug labeling) is a root cause of
med errors, poor adherence and poor health
outcomes.
Health Literacy – Prescribing and Medication Management
NC Program on Health Literacy
Betsy Bryant Shilliday, PharmD, CDE, CPP
Ref in Davis TC, et
al.inJGIM
24(1):57-62
.
Ref
Davis2008;
TC, et
al. JGIM 2008;
24(1):57-62.
Health Literacy: an essential first step
American Medical Association
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One in three English-speaking adults in the
United States are limited in health literacy.
Low health literacy is associated with:
◦ More emergency room visits
◦ More use of inpatient care
◦ Among older adults:
 Poorer health status
 Higher risk of death
◦ Poor ability to interpret health messages
ARRQ, Evidence Report/Technology Assessment; No. 199, 2011
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Social support, patient self-efficacy, and
stigma may impact the relationship between
health literacy and health outcomes.
Health literacy has been shown to mediate
the effect of key characteristics on health
outcomes:
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Education level
Race
Income
Urbanicity
ARRQ, Evidence Report/Technology Assessment; No. 199, 2011
Number of Adults in Each Prose Literacy Level
National Assessment of Adult Literacy, 2003
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Present essential information
by itself
Present the most important
points first
Use direct, plain wording
Lower reading level text
Use pictures & videos where
appropriate
Achieving clarity is an art…
ARRQ, Evidence Report/Technology Assessment; No. 199, 2011
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Tips and tools to enhance your practice
How to enhance:
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Spoken communication
Written communication
Patient self-management
Engaging your community
AHRQ Pub. No. 10-0046-EF, April 2010
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Limit to 3-5 key points
Plain, non-medical language
Watch your pace
Encourage participation – ask open-ended
questions
Use graphics: draw pictures, use 3-D models
Use Teach-Back
AHRQ Pub. No. 10-0046-EF, April 2010
NC Program on Health Literacy
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LEARN:
◦ What did you learn?
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CONCERN:
◦ We covered several important topics. What may
have confused or concerned you?
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DO:
◦ What are you going to do now as a result of what
we talked about?
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Ask patients to bring in medications and
supplements as well as herbal remedies and
OTC’s
Consider providing a special bag for meds
Ask open-ended questions
Clarify med instructions; i.e. teach-back
Bill for medication review
(ICD-9 V58.69)
AHRQ Pub. No. 10-0046-EF, April 2010
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Well-designed printed materials must be
used thoughtfully
◦ Front desk personnel should be trained in literacy
awareness:
 Understand that low literacy is common
 Work with patients to ensure understanding in a
sensitive manner
◦ Review materials fully with patients
◦ Ask patients to Teach Back what was discussed
◦ Review and reinforce key points
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Short sentences
Few multi-syllable
words
Avoid medical jargon: a
“positive” test is not
always good!
Use white space &
chunk information in
sections
Add graphics
Bulleted lists
Bold key terms
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Clear, concise
formatting eases
understanding
AHRQ Pub. No. 10-0046-EF, April 2010
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Medication adherence tips
◦ Ask patients how they remember to take their meds.
◦ Use non-judgmental verbiage.
“Most people forget to take their pills
sometimes. When was the last time you forgot
to take medicine?”
◦ Give precise instructions
◦ Provide a pill chart with times and details
◦ Will generics will look different?
Use pictures to inform patients.
AHRQ Pub. No. 10-0046-EF, April 2010
Cultural Competency
Awareness of patients’ ethnic, cultural and
religious backgrounds leads to greater
understanding and clearer communication.
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One approach = CLAS standards
◦ Standards that define cultural competency in health
care delivery and practice
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Source of CLAS standards
◦ Developed by US Department of Health and Human
Services, Office of Minority Health
◦ Derived from analysis of current practice and policy
on cultural competence
◦ Shaped by input of health providers, advocates,
policymakers, researchers, and consumers
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Consists of 14 standards in 3 themes
◦ Culturally Competent Care (standards 1-3)
◦ Language Access Services (standards 4-7)
◦ Organizational Supports for Cultural Competence
(standards 8-14)
DHHS Office of Minority Health
Center for Linguistic and Cultural Competency in Health Care
CULTURALLY & LINGUISTICALLY
APPROPRIATE SERVICES (CLAS)
Sample standards
“Health care organizations should…”
1 ensure that patients/consumers receive from all staff
member's effective, understandable, and respectful care
that is provided in a manner compatible with their
cultural health beliefs and practices and preferred
language.
7 Health care organizations must make available easily
understood patient-related materials and post signage
in the languages of the commonly encountered groups
and/or groups represented in the service area.
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Health beliefs and customs
Ethnic customs
Religious beliefs
Dietary customs
Interpersonal relations
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Culture Clues Tip Sheets
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AHRQ Pub. No. 10-0046-EF, April 2010
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“I am not familiar with your cultures and
beliefs. Can you teach me what I might need
to know so I can better treat you?”
“What do you call your illness? What do you
think caused your illness? How do you think
it should be treated?”
“Do any traditional healers advise you about
your health?”
AHRQ Pub. No. 10-0046-EF, April 2010
A Physician’s Practical Guide to Culturally Competent Care
She believes that entering
the hospital will kill her, and
opts for traditional
therapies. Her family
physician desperately wants
to work with the patient to
manage her diabetes better.
But how?
Cultural Fact
Some American Indian
cultures, the Navajo for
example, believe that
mentioning an illness will
cause the illness.
DHHS Office of Minority Health
Center for Linguistic and Cultural Competency in Health Care
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Practices participating in
Medicare/Medicaid are legally
required to provide equal access to
services for patients who do not
speak or understand English well.
AHRQ Pub. No. 10-0046-EF, April 2010
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Use an “I speak” card:
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Use an interpreter:
◦ American Translators Association
AHRQ Pub. No. 10-0046-EF, April 2010
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Don’t rely on children of patients, family
members, patient’s friends
Assure patient that all staff are bound by
confidentiality
Speak directly to the patient
ALL communications must be interpreted
Avoid jargon, slang, metaphors
Debrief with interpreter: additional cultural
considerations?
Ethnomed.org, 2005
“Ensuring that people understand health care
information is critical to a high-quality, safe health
care system. Improving health literacy will be a
major step in the nation's efforts to enhance health
care quality and safety."