Advancing Health Literacy

1. Advancing Health Literacy Ruth M. Parker, M.D. Professor of Medicine, Pediatrics and Public Health; Emory University

2. Health Literacy ….“the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Parker/Ratzan NLM Complete Bibliographies of Medicine, 2000 Healthy People 2010

3. Health Literacy Framework

4. Health Literacy Challenges Most people cannot understand health information they need It’s hard to be a patient these days and it’s easy to mess up An issue of quality—essential for self-management, reducing disparities and reducing costs

5. Meet Dave.

6. Meet Dave. • Inconsistently controlled. • No plan for improvement. • Not activated, not empowered. • Inadequate knowledge • Inadequate skills • = Overwhelmed

7. A $200 Billion Problem HL The business case for health literacy • Inadequate/inaccurate knowledge of disease, treatment • Poorer self-care skills (medication use, monitoring, device use) • Inappropriate health services use Translates to: • Non-adherence • Costly urgent services (Unscheduled visits, ED, Hospitalizations) • Medication Errors & Adverse Events • Poorer outcomes (HTN, Diabetes, CHF, Asthma/COPD)

8. The Forecast for 2030 From the ETS report America’s Perfect Storm: Three Forces Changing Our Nation’s Future written by Irwin Kirsch, Henry Braun, Kentaro Yamamoto and Andrew Sum. The full report is available from ETS at www.ets.org/stormreport.

9. Health Literacy Framework (Parker) Health Literacy

10. A social determinant of health…and more • Essential for reducing costs, improving quality and decreasing disparities Framework for interventions reflects alignment →intervene at system/org. level-examples →What is a “health literate” organization?

11. Closer look…at medication labels Demands/Complexity Skills/Ability

12. A Current, Broken “System” of Patient Rx Information Rx Labeling

13. Medication Labels—At the Intersection of Health Literacy and Patient Safety

14. Reprogramming the Rx Label. Michael Wolf 04/29/71 Rx #: 1234567 9/8/2009 Do not drink alcoholic beverages while taking this medicine You have 11 refills 180 pills Glyburide 5mg Take for Diabetes Discard after 9/8/2010 Carry or wear medical identification stating you are taking this medicine Provider: RUTH PARKER, MD Emory Medical Center (414) 123-4567 Take: 2 pills in the morning 2 pills in the evening You should avoid prolonged or excessive exposure to direct and/or artificial sunlight while taking this medicine Pharmacy: NoVA ScriptsCentral 11445 Sunset Blvd. Reston, VA (713) 123-4567 Morning 7-9 AM Noon 11-1 PM Evening 4-6 PM Bedtime 9-11 PM 2 2 NDC # 1234567

15. Figure 5. Davis et al J Gen Intern Med, 2010; Wolf et al Arch Intern Med 2011; Med Care 2011; Bailey J Gen Intern Med 2012

16. What Constitutes the Label? Container Label Consumer Medication Information (CMI) 3) Package Insert 4) Medication Guide William H. Shrank, MD, MSHS, Nov. 2006

17. A Prescription for Confusion.

19. September 22, 2009 ¾ teaspoon dose: 5 ml (volume of teaspoon) x .75 x 12 mg per ml Tamiflu suspension = 45 mg on syringe

20. Lessons from the field Patients/consumers are the real experts… partner with them to communicate

25. What Can We Do? • Believe the numbers…health literacy is a problem. • “Clear and simple” does not offend anyone. • Know the public…their needs/ questions. Meet them where they are. --Measure how well we do this. What gets measured gets done.

26. leadership promotes

27. “We envisage a society in which people have the skills they need to obtain, interpret, and use health information effectively…and within which a wide variety of health systems and institutions take responsibility for providing clear communication and adequate support to facilitate health promoting actions”.

28. A Shared Conversation…4 Questions for Every Provider and Patient • What are my choices for health insurance? • How do I get it? • How do I use it? • How much will it cost? REQUIRES understanding: “insurance” options-private, employer-based, public (Medicaid and Medicare) “co-pay” “deductible”

29. From healthcare.gov “Deductible: The amount you must pay for covered care before your health insurance begins to pay. Insurers apply and structure deductibles differently. For example, under one plan, a comprehensive deductible might apply to all services while another plan might have separate deductibles for benefits such as prescription drug coverage.”

30. References Institute of Medicine • Health Literacy: A Prescription to End Confusion http://www.iom.edu/CMS/3775/3827/19723.aspx • Round Tablehttp://www.iom.edu/CMS/3793/31487/31799/32195.aspx Joint Commission (JCAHO) • “What Did the Doctor Say?”: Improving Health Literacy to Protect Patient Safety http://www.jointcommission.org/NewsRoom/NewsReleases/hl_020607.htm Agency for Healthcare Quality and Research (AHRQ) • http://www.ahrq.gov/qual/literacy/ AMA Toolkit • http://www.ama-assn.org/ama/pub/category/9913.html