Retooling the Pharmacist to Improve Health Literacy

1. Retooling the Pharmacist to Improve Health Literacy Jennifer O’Callaghan, PharmD PGY1 Community Pharmacy Resident University of Wisconsin Hospital and Clinics

2. Disclosure Statement I have no conflict of interest to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation.

3. Learning Objectives • Identify ways pharmacy staff and other healthcare providers can recognize patients with low health literacy. • Define the Wisconsin Pharmacy Quality Collaborative (WPQC) program. • Describe ways the Wisconsin Pharmacy Quality Collaborative (WPQC) is identifying patients with low health literacy and implementing services aimed at improving medication adherence.

4. Health Literacy • Ability to understand: • prescription drug bottles • educational brochures • doctor’s directions • consent forms • Ability to calculate medication dosages • Ability to interpret test results

5. Identification of Patient with Low Health Literacy • “Even very literate people may have trouble obtaining, understanding, and using health information:  a surgeon may have trouble using an insurance form, a science teacher may not understand information about a test of brain function, and an accountant may not know when to get a mammogram.”

6. Identification of Patient with Low Health Literacy • Ask for medications by color or shape • Unable to explain purpose or dosing of medication • Non-compliance with medications • Lack of follow through on labs • Incomplete registration forms

7. Identification of Patient with Low Health Literacy • May need more time to make health care decisions • Patients may hide their lack of understanding or may not even realize they have trouble understanding

8. Take 2 tablets twice daily • Low health literacy • 71% believed they understood the directions • 35% able to demonstrate properly • Marginal health literacy • 84% believed they understood the directions • 63% able to demonstrate properly • Adequate health literacy • 89% believed they understood the directions • 80% able to demonstrate properly

9. Creating the Right Environment for Health Literacy

10. Fostering Open and Welcoming Attitudes • Smile and acknowledge the patient • Always introduce yourself • Speak in a slow, relaxed pace in a conversational tone • Listen and be empathetic • Encourage patients to ask questions • Ask “Am I clear?”

11. Fostering Open and Welcoming Attitudes • Use interpreter services if available • Use signs with pictures to tell patients where to go and what they need • Provide a waiting area • Decorate the pharmacy

12. Maintaining Consistency • Use larger prints • Use 12-point Times or 11-point Arial • Include brand and generic names • Include medication purpose • Use the same generic if possible • Post questions to ask pharmacist • What is this medication for? • What are the side effects?

13. Incorporating Basic Healthcare Information • Use multiple types of learning styles • People typically only remember 50% of what they hear • Create written materials at 8th grade or lower (Goal for 5th grade reading level is best) • Average reading level: 8-9th grade • Patient education materials in chain pharmacies • 2% of materials at 7-8th grade • 69% of materials at 9-12th grade • 29% of materials at 12th grade or higher

14. Incorporating Basic Healthcare Information • Avoid difficult medical terminology

15. Incorporating Basic Healthcare Information • 2012 United States Pharmacopeial (USP) Convention Standards • Use explicit directions • Avoid from necessity of numerical skills • Examples • “Take 2 tablets in the morning and take 2 tablets in the evening” “Take 2 tablets twice daily” “Take 1 tablet every 4 to 6 hours” “Take 1 tablet 4 to 6 times daily” “Take 1 tablet at the same time every morning” “Take 1 tablet at 8am”

16. Incorporating Basic Healthcare Information • Use a Pill Chart Afternoon Morning Evening Night

17. Incorporating Basic Healthcare Information • Focus on how to incorporate medications and health changes into the patient’s current lifestyle • Create a medication list for patients to bring to all appointments • Give patients a plan for their goals or other healthy lifestyle changes

18. Wisconsin Pharmacy Quality Collaborative (WPQC) • WPQC is an initiative of the Pharmacy Society of Wisconsin (PSW) that is designed to engage health plans and pharmacy providers in a collaborative effort to improve medication use in Wisconsin • WPQC has established a credentialing Process and uniform set of pharmacist-provided medication therapy management services for participating Wisconsin pharmacy providers.

19. Show and Tell • Showing the patient what the medication looks like

20. What your pharmacist did for you today • Updated your information • Checked your records • Allergies • Interactions • Safe and effective medications for your age and conditions • Ways to save you money • Reviewed with you • Why you are taking your medication • How to take your medication • How you can monitor your own therapy • When to contact your doctor

21. Teach-back Method • Teach-back is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands • Ask the patient to explain to you what you taught them

22. Common Questions to Use for Teach Back • “I want to be sure that I explained your medication correctly. Can you tell me how you are going to take this medicine?” • “We covered a lot today about your diabetes, and I want to make sure that I explained things clearly. So let’s review what we discussed. What are three strategies that will help you control your diabetes?” • “What are you going to do when you get home?”

23. WPQC and Health Literacy • Offers customized patient services and private medication appointments to ensure patients best understand their medications

24. Health Literacy Criteria • Requires the use of a trained medical translator • Is unable to demonstrate pill count(s) • Is familiar with personal medications by color only • Is unable to read or is suspected to have very low literacy • Is suspected to have adherence problems due to low literacy • Takes medications obtained from another country

25. WPQC Interventions • Focused adherence intervention • Use lifestyle cues • Set medications by kitchen if taken with food • Set medications by bedside table if taken at bedtime • Use pill boxes • Use alarms • Create a schedule

26. WPQC Interventions • Comprehensive medication review and assessment • Personalized medication appointment • Medications use, directions, and side effects teaching • Device technique review • Adherence consult

27. How to refer your patients for a medication appointment • Patients with Medicaid, Unity, UnitedHealth Care, and Network Health are eligible • Check out pswi.org for a list of all participating pharmacies

28. Questions? Jennifer O’Callaghan, PharmD PGY1 Community Pharmacy Resident University of Wisconsin Hospital and Clinics