Transcript Developing Easy-to-Read Patient Education Materials

Exploring the Business and Clinical
Cases for Screening for Health
Literacy in Primary Care: A Case
Study Using the NVS
Jonathan B. VanGeest, PhD
School of Community Health
and Policy
Morgan State University
Verna L. Welsh, PhD, MPH
Rollins School of Public
Health
Emory University
Verna L. Welch, PhD, MPH, Rollins School of Public Health, Emory University (co-PI)
Gregory Strayhorn, MD, Morehouse School of Medicine, Department of Family Medicine
(co-I)
Overview
1.Define limited health literacy
2.Discuss the role of health literacy in health
care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk
patients
4.Outline clinical intervention to improve care
for patients with limited health literacy
5.Study outcomes
Overview
1.Define limited health literacy
2.Discuss the role of health literacy in health
care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk
patients
4.Outline clinical intervention to improve care
for patients with limited health literacy
5.Study outcomes
Health Literacy Is…
“The degree to which individuals have the capacity to
obtain, process, and understand basic health information and services needed to make appropriate health
decisions.”
-Healthy People 2010
Ability to perform essential health care
tasks:
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–
–
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Understand appointment slips
Follow health instructions
Obtain information about an illness
Participate in discussions of informed consent
Enroll in health insurance plan
Not Simply a “Patient Problem”
• One with implications for quality shared
by the provider, healthcare system, and
community in partnership with the
patient
• Implications for treatment as well as
disease prevention/health promotion
Overview
1.Define the scope of limited health literacy
2.Discuss the role of health literacy in health
care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk
patients
4.Outline clinical intervention to improve care
for patients with limited health literacy
5.Study outcomes
Health Literacy Is Needed to
Navigate Health “Systems”
• Most patient instructions are written
• Verbal instructions
– Often complex
– Delivered rapidly
– Easy to forget in stressful situation
• Increasingly complex health system
–
–
–
–
More medications
More tests and procedures
Greater self-care requirements
Participatory/informed decision-making
• Disease prevention/health promotion
messages
Outcomes Associated
with Health Literacy
Health Outcomes
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General health status
Hospitalization
Emergency department use
Prostate cancer stage
Depression
Diabetes control
HIV control
Mammography
Pap smear
Pneumococcal immunization
Influenza immunization
STD screening
Cost
Behaviors Only
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Substance abuse
Breastfeeding
Behavioral problems
Adherence to medication*
Smoking*
Knowledge Only
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Birth control knowledge
Cervical cancer screening
Emergency department
instructions
Asthma knowledge
Hypertension knowledge
DeWalt, JGIM 2004
Overview
1.Define the scope of limited health literacy
2.Discuss the role of health literacy in health
care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk
patients
4.Outline clinical intervention to improve care
for patients with limited health literacy
5.Study outcomes
Recommended Approaches
for Health Care Providers
• Use simple, everyday language
• Stick to a 2-3 key points
• Draw pictures, write down key instructions
for patients to take home
• Effectively solicit questions:
“What questions do you have?”
• Ask patients to “teach-back” the main
points to confirm understanding
Problems
• Most clinicians often unaware of patient’s
health literacy
• Unable to tailor the clinical encounter to
the needs of patients
• Often identified solely as a patient
education issue
Patient Perspective
• Improve literacy
• Patient Education
• Empowerment in the clinical encounter
– Ask Me 3
Problems
• Complexity
– Health literacy in context
• Expert Authority
• Universal rather than targeted approach
Overview
1.Define the scope of limited health literacy
2.Discuss the role of health literacy in health
care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk
patients
4.Outline clinical intervention to improve care
for patients with limited health literacy
5.Study outcomes
Patient Outcomes
Health
Communication
Training
Level of Health
Literacy (Score)
Clinical
Intervention
AHL
AHL
Nurses
E
M
R
Patient
Physicians
LHL
LHL
Immed.
Post
6 Mth.
Post
S
u E
r M
v R
e
y
S
u E
r M
v R
e
y
Improve Care
Reduce Disparities
Identifying At-Risk Patients
 A bilingual (English and
Spanish) screening tool
that identifies patients at
risk for limited health
literacy
 Developed by Barry Weiss
(University of Arizona)
 Based on a nutrition label
from an ice cream
container
Process
 Patient is given the label
 Asked 6 questions about how they would
interpret and act on the information
 Responses are recorded by a clinical staff
member, scored, and entered into the EMR
 Based on the number of correct responses,
the health care provider can assess the
patient’s health literacy level
Overview
1.Define the scope of limited health literacy
2.Discuss the role of health literacy in health
care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk
patients
4.Outline clinical intervention to improve care
for patients with limited health literacy
5.Study outcomes
Outcomes – Patient
Characteristics
Outcomes – Health Literacy
At-risk for Limited
Health Literacy
 Physicians were not identifying at-risk
patients or using recommended
communication practices
Outcomes – Patient Reaction
 Patients’ Reactions to Screening
 Over 95% of patients did not have problems with
screening for health literacy in primary care.
 No difference in the reported prevalence of
shame (p<0.33) by literacy level (Fisher’s Exact
Test)
Outcomes – Patient Reaction
 Patient Recommendations Regarding
Screening (n= 135)
Outcomes - Patient
 Fff
Outcomes – Business Case
Outcomes – Physician Utilization
 Staff training increased awareness of the
importance of health literacy and clear health
communication
 A majority (66.7%) also felt that using the NVS
to identify patients with limited health
literacy improved their quality of care they
were able to deliver
Outcomes – Physician Utilization
 Over 60% also felt that scores helped in
customizing their communication with
patients
 Observed tendency to revert back to their
normal – pre-intervention – care processes
and behaviors