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Health Literacy: A Prescription to End Confusion


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Title: Health Literacy: A Prescription to End Confusion

Health Literacy A Prescription to End Confusion
  • Rose Marie Martinez, Sc.D
  • Improving Patient Outcomes in Primary Care
  • Howard University
  • April 26, 2008

Health Literacy
  • In 2004 the IOM released Its report.
  • Todays presentation will focus on
  • A visual summary of report
  • highlights
  • 2. Discussion of and
  • report impact and Roundtable on
  • Health Literacy activities

Health Literacy
  • Committee Charge
  • Define the scope of the problem of health
  • Identify the obstacles to a creating a health
    literate public.
  • Assess the approaches that have been attempted to
    address the problem.
  • Identify the gaps in research and programs
  • Identify goals for health literacy efforts and
    suggest approaches.

Health Literacy
  • Start Video Clip Summarizing the IOM Report on
    Health Literacy A Prescription to End Confusion

Report Recommendations
Health Literacy A Prescription to End Confusion
  • 16 recommendations issued in the report
  • 16 departments or agencies specifically named in
    the recommendations
  • Recommendations focused on
  • Developing approaches to improve health
  • Developing measures of health literacy
  • Increasing research activities and research
    support funding
  • Encouraging integration of health literacy in
  • K-12, profession schools, CME
  • Supporting convening activities

Health LiteracyImpact of Report
  • The IOM report has stimulated continued interest
    and action in the area of improving health
  • Creation of the IOM Roundtable on Health Literacy
  • Objective To continue the dialogue, share
    knowledge, and stimulate action

Health Literacy Roundtable
  • Organized in September/October 2005
  • 27 members
  • Academia
  • Industry
  • Media
  • Government
  • Foundations and associations
  • Representatives of patient and consumer interests

Roundtable Sponsors
  • HHS/Office of Disease Prevention and Health
  • National Cancer Institute
  • Health Resources and Services Administration
  • Centers for Medicare and Medicaid Service
  • Kaiser Permanente
  • Affinity Health Plan
  • Academy for Educational Development
  • American College of Physicians Foundation
  • American Academy of Family Physicians Foundation
  • American Heart Association
  • GlaxoSmithKline
  • Pfizer
  • Merck

Report Impact
  • 16 follow-up letters were sent to federal
    agencies and other entities to assess response
    to recommendations.
  • Findings
  • Most agencies participating in government working
    group on health literacy
  • - Federal interagency health literacy working
  • - NIH-wide health literacy working group (40
  • Many activities in the area of improving
    communication materials

IMPACT Improving Communication
  • Department of Defense
  • --Plain language set as goal for health
    benefit plan information and education (TRICARE)
  • --Patient safety communication initiatives
    including cultural and linguistic requirements
  • --Health self-management information evaluated
    for ability to inform adequately and
  • Joint Commission Accreditation of Healthcare
  • --New requirement to document patient language
    and communication needs (Standard IM.6.20)

IMPACT Improving Communication
  • Centers for Disease Control and Prevention
  • --CDC/ATSDR programs address health literacy and
    cultural competency (National Diabetes Wellness
    Program, National Diabetes Education Program,
    Resources for Heart Disease, Stroke )
  • --Emergency Preparedness materials for West Nile
    Virus and Katrina and Rita Hurricanes tailored to
    be address health literacy levels
  • Veterans Administration
  • --Provides readability formulas for written
    materials and other tools for use with patients
    with low literacy
  • --My HealtheVet

IMPACT Improving Communication
  • National Institutes of Health
  • --Redesigning National Cancer Institutes Clear
    and Simple guidance for developing publications
    for people with limited-literacy skills to be a
    NIH-wide publication
  • --Rewards plain language objective within NIH
  • Plain Language Awards
  • Centers for Medicare and Medicaid Services
  • --Developing Toolkit for Making Written
    Material Clear and Effective
  • Agency for Healthcare, Research Quality
  • --Informed consent and research authorization

IMPACT Improving Communication
  • Indian Health Service
  • --Developing assessment tool to evaluate IHS
  • --Patient education kiosks featuring culturally
    appropriate information for American
    Indian/American Natives
  • --National Information Resource Access Point
  • --Preparing for JACHO accreditation standards by
    assessing patient readiness to learn, learning
    preferences and barriers to learning in patients
  • --IHS Plan of Action on Health Literacy (HP

IMPACT Measurement/Assessment
  • Agency for Healthcare, Research Quality
  • --Health literacy measurement
    projectmeasures of how well health plans and
    clinician groups address health literacy
  • --Measuring Patient Satisfaction Low Literacy
  • --Spanish Health Literacy Assessment Tool
  • National Inst. Child Health and Development
  • --Developing assessment of health literacy needs
    of parents with special needs children

Impact Research on Health Literacy
  • NIH
  • --Issued Research Program Announcement
    Understanding and Promoting Health Literacy
    (along with AHQR) 4 RO1 and 15 R03 grants
  • --Health literacy Principal Investigators
  • --NIH Public Trust Initiative helps inform the
    public on how NIH conducts and supports clinical
    research and to access and understand results,
    outreach to populations with limited health
  • --NIH Clinical Research Awareness Effort (better
    understand consent to research)
  • Agency for Healthcare, Research Quality
  • --Supports a number of research projects on
    health literacy and interventions to improve
    health literacy
  • Pharmacy Intervention for Limited Literacy

IMPACT Integration in organizational objectives
HRSA --Internal working group on health
literacy --Strategic plan includes specific
objectives that address health literacy --Health
literacy viewed as part of performance measure to
increase access to high quality, effective and
safe health care. --Bureau of Health Professions
Grantee Performance Measure includes written
institutional policy addressing health literacy.
Measure will be tracked --Funds grant projects
that support recommendations
IMPACT Convening Activities
  • --CDC Expert Panel on Populations at Risk for
    Poverty, Low SES and No Health Insurance convened
    to address health communication issues of
    vulnerable populations
  • --JCAHO Roundtable on Health Literacy and Patient
    Safety (2005) and Symposium on Health Literacy
    The Foundation for Patient Safety, Empowerment,
    Quality Health CareJune 2006
  • --Surgeon General's Workshop on Improving Health
    Literacy (September 2006) (published Jan. 2008)
  • -- U.S. Department of Health and Human Services'
    launches Town Halls on Improving Health Literacy
    (New York City on October 16, 2007

IOM Roundtable Convening Activities
  • Health Literacy for Activated and Engaged
  • Informed Consent for Populations with Low Health
    Literacy and Implementing the National Health
    Education Standards in K-12 (2006)
  • Organizational Change for Improving Health
    Literacy Exploring Quality Management and Pay
    for Performance Strategies (2007)
  • Changing Prescription Medication Use Container
    Instructions to Improve Health Literacy and
    Medication Safety (2007)
  • Workshop on Health Literacy, eHealth, and
    Communication Putting the Consumer First (2008)

Can We Confuse Patients Less?
Changing Prescription Medication Use Container
Instructions to Improve Health Literacy and
Medication Safety (2007)
  • A Broken System Findings of the ACPF White Paper
    on Drug Labeling

Michael S. Wolf, MA MPH PhD Assistant Professor
and Director Health Literacy and Learning
Program Division of General Internal
Medicine Institute for Healthcare
Studies Northwestern University
ACP Paper Findings
  • Finding 1 Inadequate patient understanding of
    prescription medication instructions and warnings
    is prevalent and a significant safety concern.
  • Finding 2 Lack of universal standards and
    regulations for medication labeling is a root
    cause for misunderstanding and medication error.
  • Finding 3 Evidence should guide all label
    content and format.
  • Finding 4 Instructions on the container label
    should be clear and concise. Language should be
  • Finding 5 Drub labeling should be viewed as part
    of an integrated system of patient information.

Wolf Summary
  • Rx container label most important to patients
  • (last line of information support)
  • Variability a likely root cause of med errors
  • Dosage instructions primary focus for change
  • View labeling as a system of patient information
  • Seek improvement, set evidencebased standards

A Potential Solution?
  • Simplifying Medication Scheduling Can We Confuse
    Patients Less?
  • Alastair J.J. Wood, M.D., F.A.C.P. Symphony
    Capital LLC

Possible Solution? Uniform Medication Schedule
Possible Solution?
  • Unified Medication Schedule
  • Simplifies dosing schedule
  • No loss of efficacy
  • Improves patient understanding
  • Improves patient adherence
  • Reduces errors
  • Reduces variability
  • Improves outcome

Response to Recommendations-IMPACT

Other Resources You Should Know About
  • HRSA Unified Health Communication 101 Addressing
    Health Literacy, Cultural Competency, and Limited
    English Proficiency - free on-line learning
    experience to help you
  • improve your patient communication skills
  • increase your awareness and knowledge of the
    three main factors that affect your communication
    with patients health literacy, cultural
    competency and low English proficiency
  • implement patient-centered communication
    practices that demonstrate cultural competency
    and appropriately address patients with limited
    health literacy and low English proficiency
  • or http//

Resources You Should Know About
  • Assessing Health Literacy in Clinical
    Practice http//
    (A one-time, free registration is required to
    view content on Medscape.)
  • Assuring Quality Care for People With Limited
    Health Literacy http//
    m/8603 (A one-time, free registration is required
    to view content on Medscape.)

Roundtable on Health Literacy