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Health Literacy in Pharmacy: Communication Strategies

Health Literacy in Pharmacy: Communication Strategies. Curricular Modules for Pharmacy Faculty Content adapted from Kripalani and Jacobson (2007). Overview. Health Literacy in Pharmacy Communication Strategies Recognizing Low Health Literacy Improving Communication.

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Health Literacy in Pharmacy: Communication Strategies

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  1. Health Literacy in Pharmacy: Communication Strategies Curricular Modulesfor Pharmacy Faculty Content adapted from Kripalani and Jacobson (2007)

  2. Overview • Health Literacy in Pharmacy • Communication Strategies • Recognizing Low Health Literacy • Improving Communication

  3. Health literacy in pharmacy

  4. Health Literacy: An Interaction

  5. Patient-Level Consequences • Poorer health outcomes • Increased hospitalizations • Greater use of emergency care • Missed prescription refills • Difficulty understanding medication instructions and warning labels • Inappropriate dosing or timing of meds • Failure to recognize side effects or drug interactions SOURCE: 1) Agency for Healthcare Research and Quality. Health Literacy Interventions and Outcomes: An Updated Systematic Review. March 2011. 2) American Medical Association Foundation. Health Literacy and Patient Safety: Help Patients Understand. August 2007.

  6. Societal and Pharmacy-Level Consequences Societal Consequences • Nonadherence • Missed refills • Inappropriate dosing or timing of meds • Failure to recognize side effects or drug interactions • Increased emergency department costs among low health literacy patients • Undermines efforts to increase patient self-management and engagement in care Pharmacy-Level Consequences • Impact on customer loyalty/satisfaction • Decreased profits due to missed refills • Liability—NYS settlement for LEP patients SOURCES: 1) AMA (2007) 2) AHRQ (2011)

  7. communication strategies

  8. Opportunity: Pharmacists are Trusted Resources Opportunities for Interactions • Medication Therapy Management (MTM) • Dispensing • Counseling • Other Pharmacy Services

  9. Apply Universal Precautions Everyone benefits when communication is clear: • Looks can be deceiving. Offer help to all. • Worry or illness can cloud understanding. • Offer clear explanations. • Check to see if you have been clear. SOURCE: DeWalt D.A., Callahan L.F., Hawk V.H., Broucksou K.A., Hink A., Rudd R., Brach C. Health Literacy Universal Precautions Toolkit. AHRQ Publication No. 10-0046-EF. Rockville, MD. Agency for Healthcare Research and Quality. April 2010.

  10. Recall the Findings from Education Studies Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available in our health care facilities, retail outlets, media, and communities. (Kutner et al., 2006)

  11. Recognize Patients Who Need Extra Help Look for Common Signs Patients who… • Do not know the name of their medicine but rely instead on shape, size, or color • “Forgot their glasses” • Delay in picking up medicines or renewals • Have problems asking questions or explaining their concerns Help out • “A lot of people have trouble reading labels and remembering how to take their medications. • Is this a problem for you? • How can I help?” SOURCE: 1) Weiss, BD. Epidemiology of Low Health Literacy. In: Schwartzberg JG, VanGeest JB, Wang CC, eds. Understanding Health Literacy: Implications for Medicine and Public Health. AMA Press; 2005:19. 2) Katz MG, Jacobson TA, VeledarE, Kripalani S. Patient Literacy and Question-Asking Behavior During the Medical Encounter: A Mixed-Methods Analysis. Journal of General Internal Medicine 2007;22(6):782-786.8 Found in: Kripalani, Jacobson (2007)

  12. Recommended Strategies to Improve Communication • Explain things using everyday words. • Focus on and repeat key messages/actions. • Use a “teach back” or “show me” technique to check clarity and understanding. • Encourage questions. • Use patient-friendly educational materials. SOURCE: 1) Weiss BD. Health Literacy: A Manual for Clinicians. American Medical Association and American Medical Association Foundation; 2003. 2) Kripalani S, Henderson LE, Chiu EY, Robertson R, Kolm P, Jacobson TA. Predictors of Medication Self-management Skill in a Low-literacy Population. Journal of General Internal Medicine. 2006;21(8):803-900. Found in: Kripalani, Jacobson (2007). 3) AHRQ Health Literacy Universal Precautions Toolkit.

  13. 1. Explain Things Clearlyin Everyday Words • Slow down the pace of your speech. • Use plain, non-medicallanguage. • “Blood pressure pill” [instead of “antihypertensive”] • Include key information about timing. • Morning, noon, night, bedtime [instead of 4X a day] • Avoid jargon. • “Take 2 hours before lunch or 2 hours after lunch[ instead of “Take on an empty stomach”] SOURCE: 1) Kripalani, Jacobson (2007); 2) AHRQ Universal Precautions Toolkit (2010)

  14. Use Everyday Words: Instead of:  Choose • Utilize……………….…...Use • Adverse reaction…..…...Side effect • Hypoglycemia……..……Low sugar • PRN………………….….When you need it • Suppository………….….Medication that goes in your bottom • Topical……………….….On the skin SOURCE: Kripalani, Jacobson (2007

  15. 2. Focus on & Repeat KeyMessages/Actions • Limit information • Focus on 1-3 key points • Develop short explanations for common medical conditions and side effects • Discuss specific behaviors rather than general concepts • What the patient needs to do • Review each key point at the end SOURCE: 1) Kripalani, Jacobson (2007). 2) AHRQ Health Literacy Universal Precautions Toolkit.

  16. 3. Use a “Teach-Back” – Check for Clarity & Understanding SOURCE: Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K; Castro C, Bindman AB. Closing the Loop: Physician Communication With Diabetic Patients Who Have Low Health Literacy. Arch Intern Med. 2003;163:83-90. Found in: Kripalani, Jacobson (2007)

  17. Teach-Back Scripts • I want to make sure I explained everything clearly. If you were trying to explain to your husband how to take this medicine, what would you say? • I want to be sure I mentioned the main side effects of this new medicine. Could you tell me the two things to watch out for? • Show me how you would use this inhaler so I can make sure I explained it well. SOURCE: Kripalani, Jacobson (2007)

  18. 4. Encourage Questions & Interaction DO ASK: DON’T ASK: Do you have any questions? Questions? SOURCE: Kripalani, Jacobson (2007) What questions do you have? How can I make it easier for you to take your medicines? Did anyone explain what to do if you miss a dose?

  19. 5. Use Patient-Friendly Materials Characteristics: • Key information is offered • The material is a tool for action • The content is designed to help action steps • Everyday words are used • The design eases reading • Relevant illustrations are used [show how-to] • Evidence that the designers tested it with audience members SOURCE: Kripalani, Jacobson (2007)

  20. Patient-Friendly Materials Simplify Tasks How do we make it easier for a patient who must manage all this?

  21. Use Patient Friendly Materials How can we improve this tool? John Smith Dr. Red Take two tablets by mouth twice daily. Humibid LA 600MG 1 refill

  22. Use Patient Friendly Materials(cont’d) Are these directions an improvement? John Smith Dr. Red Take 2 pills by mouth at 8 am and 2 pills at 6 pm. Humibid LA 600MG 1 refill

  23. Summary To make sure I’ve explained things clearly so far… • How do you know if a patient has limited or low health literacy? • Name at least 2 techniques to improve communication with low-literacy patients. • Provide an example of the teach-back.

  24. Active Learning Exercise • Divide into groups of three. Each person in the group will have a role to play: • Pharmacist • Patient • Observer • Refer to the handouts for instructions for each role. • After each round, the “observer” will provide feedback to the “pharmacist.” • Switch roles after each round. Each person should have a chance to play the pharmacist.

  25. Role Play Discussion • What was different? • Was it hard? • What did you learn?

  26. Wrap Up • Build on existing trust • Encourage dialogue and questions • Adopt Universal Precautions • Improve Communication • Plain Language (everyday words, no jargon) • Focus on Key Messages • Teach Back

  27. References • Agency for Healthcare Research and Quality. Health Literacy Interventions and Outcomes: An Updated Systematic Review. March 2011. Available at http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacyup.pdf • American Medical Association Foundation. Health Literacy and Patient Safety: Help Patients Understand. August 2007. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf • Centers for Disease Control and Prevention Health Literacy Training for Public Health Professionals: http://www2a.cdc.gov/TCEOnline/registration/detailpage.asp?res_id=2074 • Davis T.C., Wolf M.S., Bass P.F. 3rd, Thompson J.A., Tilson H.H., Neuberger M., Parker R.M.. Literacy and misunderstanding prescription drug labels. Annals of Internal Medicine. December 2006. 19;145(12). • DeWalt D.A., Callahan L.F., Hawk V.H., Broucksou K.A., Hink A., Rudd R., Brach C. Health Literacy Universal Precautions Toolkit.(Prepared by North Carolina Network Consortium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF) Rockville, MD. Agency for Healthcare Research and Quality. April 2010.

  28. References (cont’d) • Kirsch, I., Jungeblut A., Jenkins, L. and Kolstad, A. (1993) ‘Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey (NALS)’, National Center for Education Statistics, US Department of Education Washington, DC. • Kutner, M., Greenberg, E. and Baer, J. (2005) ‘A First Look at the Literacy of America’s Adults in the 21st Century’, National Center for Education Statistics, NCES 2006–2470, Washington, DC. • Kripalani, S. & Jacobson, K. L. (2007). Strategies to improve communication between staff and patients: Training program for pharmacy staff. Rockville, MD: Agency for Healthcare Research and Quality. • Spector S.L. and Youdelman, M. Analysis of State Pharmacy Laws: Impact of Pharmacy Laws on the Provision of Language Services. National Health Law Program (2010). • Warholak T.L., Nau D., (Editors). Quality & Safety in Pharmacy Practice. New York, NY: McGraw- Hill Medical; 2010 • Warholak T.L, West D., Holdford D.A. Educating Pharmacy Students and Pharmacists to Improve Quality. Journal of the American Pharmacists Association (2003). 2010 Jul-Aug;50(4):534-8.

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