Addressing the Health Literacy Needs of an Elderly Patient Population

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Addressing the Health Literacy Needs of an
Elderly Patient Population

• LifeLong Medical Care
• Health Literacy for Elders Project
• Paula De Leon Molinsky, MPH
• Rahima Jan Gates, PhD
• Lyn Paleo, MPAConsultant
• For more information contact Paula D. Molinsky at
  pdmolinsky_at_netscape.net
• Funded by Archstone Foundation

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Background

• LifeLong Medical Care Inc. (LMC) operates six
  community health centers in Berkeley, CA
• The Health Literacy for Elders Project targeted
  LMCs three Over 60 Health Centers
• In 1999 the Over 60 Health Centers provide
  medical, social, and mental health services to
  3,158 geriatric patients
• 83 were low income
• 74 were non-White

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Premises for Project Design

• Studies suggest that health literacy skills
  greatly impact health care outcomes
• Health literacy skills decrease with increasing
  age and decreasing income
• Racial minority groups are more greatly impacted
  by low health literacy skills than are
  non-minorities
• Over 60 Health Center patients may be at risk
  because of age, race/ethnicity and income status
• Even patients with adequate health literacy
  skills appreciate easy to use health care
  information

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Purpose of Project

• Develop organizational protocol to ensure that
  patients are able to read, understand and act on
  their health care information so that they are
  able to participate as fully as possible in their
  health care

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Project Goals

• Increase the awareness understanding of the
  health literacy needs of the Over 60 patient
  population
• Assist clients in maximizing the benefits of
  their healthcare visits
• Enhance provider-patient communication
• Increase awareness in the health care community
  of literacy issues and related negative health
  outcomes

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Project Provided

• Assessment of health literacy and other
  communication needs of patients
• Developed and implemented Patient Advocate role
  with the primary purpose of reviewing health care
  information
• Health literacy workshop for staff providers
• Newsletters addressing information on health
  literacy, resources and updates on project
• Assessment of patient education materials for
  cultural and literacy demand appropriateness and
  recommendations for replacements for materials if
  needed
• Collaboration with other community organizations

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Needs Assessment

• Random sample of 137 Over 60 Health Centers
  patients
• 30 were White, 58 African American, 4 Latino
• Average level of education was 12.8 years range
  of 6 21 years
• Range of ages was 60 to 96 years mean of 74.3
• Of the 115 who shared income information, 64 had
  incomes of no more than 120 PL 10 were above
  200 PL
• Respondents interviewed following medical
  appointment received 5 for participating

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Needs Assessment

• Instruments
• Short Test of Functional Health Literacy in
  Adults (STOFHLA) a standardized assessment tool
• Score of inadequate indicates unable to read
  interpret health texts marginal indicates has
  difficulty reading interpreting health texts
  adequate indicates can read interpret most
  health texts
• administered to 120 of the assessment
  participants
• Project developed questionnaire assessing
• Patient satisfaction
• Patient perspective of communication with
  provider during that days health care encounter
• Knowledge of his/her prescriptive medicine

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STOFHLA Results
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STOFHLA Scores Ethnicity
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STOFHLA Scores Educational Levels
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STOFHLA Scores Age
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Other Findings

• Regarding STOFHLA
• Age, education language spoken as a child
  accounted for 34 of the variation in scores
• 17 needs assessment participants declined to do
  the test nine individuals scored zero
• Only 36 of participants were able to complete
  the test in the time allotted by the tool
• Regarding Other Questions on Survey
• All Over 60 patients receive a reminder call
  are asked to bring all meds to appointment to
  review with provider only 36 of survey
  participants had done so, of these 79 had
  reviewed meds with provider but 20 still did not
  know whether or not meds might have side effects
• 85 of participants stated their provider was
  very easy to understand 45 felt they did not
  need more time for discussing their health care
  49 received some type of written materials
  during their health care visit

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Implications of Findings

• Because of the strong association between health
  literacy and the immutable characteristics of
  age, ethnicity and educational level,
  interventions should focus on providers verbal
  and written patient health care information
• STOFHLA scores suggest that verbal communication
  is an essential source of health care information
  for many of this patient population
• Techniques for checking patients understanding
  of information should be developed routinely
  used

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Project Evaluation

• Instruments
• Pre and post intervention surveys for staff
  providers assessing knowledge and behaviors
• Post intervention interviews of key informant
  providers and staff
• Post intervention interviews of select group of
  patients who participated in pre intervention
  survey

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Providers/Staff Evaluation of Usefulness of
Project Components
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Lessons Learned from Interviews

• Poor Health Literacy Skills Impact
• Patient Participation
• I know why Im taking the medications. Im
  taking them because the doctors say to take them,
  thats why. Patient
• it really does relegate the patient to a passive
  role in their healthcare which then interferes
  with all the things that you want them to have an
  active role in. -Provider
• Compliance
• I think it has an impact on the motivation for
  patients to comply with their medications. It
  makes it harder for them to be clear about side
  effects -Provider
• Access
• I said cancel them then. So she did, so she
  screwed me and I screwed myself, I messed up -
  Patient who accidentally cancelled his coverage.
• Healthcare Outcomes
• Oh, you know, he said, I thought I would get
  better. And he didnt. Well, he ended up having
  a pneumothorax Provider regarding patient who
  did not understand the significance of his
  symptoms

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Recommendations

• Recommendations are based on the implementation
  experience of the Health Literacy for Elders
  Project, the rationale and suggestions that
  emerged from the patient and providers/staff
  interviews and studies of health literacy.
• Seek funding to support, prioritize and maintain
  a health literacy/health education unit
• Encourage participation of providers in
  developing and implementing a practical and
  systematic check to assess patients
  understanding of and ability to act on their
  health care information and referral to support
  services if indicated
• Recognize accommodate the impact that change in
  routine has on patients and their ability for
  self-care

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Recommendations Continued

• Discuss the possibility, advantages and
  disadvantages of incorporating a health literacy
  assessment into the new patient intake and
  continuing patient profile
• Consider the feasibility of obtaining grant funds
  to staff a health literacy cross disciplinary
  team consisting of a supervising physician,
  patient advocate, nurse case manager and medical
  assistant
• Explore the possibility of having medical
  assistants assume responsibility for identifying
  and distributing health education materials to
  patients after their healthcare visits
• Support provider-purposed efforts to incorporate
  Health Literacy standards into the indicators of
  performance of the Health Plan Employer Data and
  Information Set (HEDIS)