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FHSLA 2009 Creating Connections Annual Meeting

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HEALING BEGINS WITH KNOWLEDGE: THE INCREASING IMPORTANCE OF HEALTH CARE LITERACY IN THE MEDICAL TEAM FHSLA 2009 Creating Connections Annual Meeting – PowerPoint PPT presentation

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Title: FHSLA 2009 Creating Connections Annual Meeting


1

HEALING BEGINS WITH KNOWLEDGE THE INCREASING
IMPORTANCE OF HEALTH CARE LITERACY IN THE MEDICAL
TEAM
  • FHSLA 2009 Creating Connections Annual Meeting
  • Erin M. Dunbar, MD

2
Objectives
  • Multi-disciplinary Medicine Example at UF
  • Increasing Tasks Decreasing Time Tools
  • Huge Unmet Need
  • Health Care Literacy From For All
  • Health Care Literacy Around the World
  • Health Care Literacy Initiatives at UF
  • Current Future
  • Discussions Questions
  • How librarians can collaborate with patients
    health care professionals in YOUR area

3
Multiple Modalities
4
Multiple Locations
5
Multiple Tools
6
Increasing Tasks Decreasing Tools
  • Diagnosis
  • Anatomy Function
  • Disease Course
  • Treatments (2nd opinions, multimodality,
    standard, trials)
  • Medical Terminology
  • Symptom Management
  • Prognosis
  • Financial Assistance
  • Coping Emotional
  • Work-related Issues
  • Caregiver Children
  • Family Dynamics
  • Increasing Complexity of Care
  • Decreasing Continuity of Care
  • Travel difficulties
  • Money
  • Immobility
  • Working caregiver
  • Declining Reimbursement
  • Vanishing Time Allowance
  • 15 minute office visit!
  • Long distances between Loves ones
  • Unregulated Enormous Resources
  • Internet
  • Blogs

7
HEALING BEGINS WITH KNOWLEDGE..
8
.THE INCREASING IMPORTANCE OF HEALTH CARE
LITERACY IN THE MEDICAL TEAM
9
Huge Unmet Need
  • Policymaker Goals improve the quality of care
    reduce costs.
  • Medicare claims data from 20032004 (11 million)
  • 19.6 were re-hospitalized within 30 days.
  • In 50.2, there was no bill for a visit to a
    physicians office between the time of discharge
    and re-hospitalization.
  • 34.0 were re-hospitalized within 90 days.
  • Unplanned re-hospitalizations cost Medicare 17.4
    billion in 2004 alone.
  • Lack of education during discharge planning and
    subsequent physician office visits were
    implicated as causative factors.
  • Re-hospitalizations among Patients in the
    Medicare Fee-for-Service Program, NEJM, 1/09,
    Stephen F. Jencks, M.D., M.P.H., Mark V.
    Williams, M.D.,and Eric A. Coleman, M.D., M.P.H.

10
Huge Unmet Needs
  • A new diagnosis can have deep and long-lasting
    effects
  • Care support are of utmost importance to
    coping.
  • Identification of educational needs is important.
  • Emotional, social, and physical limitations were
    identified as most important.
  • Formal information and support services are
    needed.
  • Major themes
  • Communication of the diagnosis to them
  • Information Needs
  • Uncoordinated services after their diagnosis
  • Reaction to the diagnosis Formal support
  • Time before diagnosisFamily/careersFuturePhysic
    al disabilities
  • Little is known about how recommended practices
    influence patients' experience.
  • Importance of a multi-disciplinary, coordinated
    approach.

1. Patient care at diagnosis a planned education
approach. Vile C, Nurs Stand. 3/04 2. How does
current care practice influence the experience of
a new diagnosis of motor neuron disease? A
qualitative study of current guidelines-based
practice. Hugel H, et al, Amyotroph Lateral
Scler. 9/06 3. Identifying the educational needs
and concerns of newly diagnosed patients with
breast cancer after surgery. Stephens PA, et al
Clin J Oncol Nurs. 4/08
11
Health Care Literacy From For All
  • Heath Literacy is defined by the WHO as 'the
    cognitive and social skills which determine the
    motivation and ability of individuals to gain
    access to, understand, and use information in
    ways which promote and maintain good health.
  • Studies have increased dramatically
  • Gap between the conceptual definition of HL and
    its application.
  • Three levels functional, communicative and
    critical.
  • Further research is needed to develop measures of
    HL, including those measuring the interaction of
    the patient HL with the health and social
    contexts in which the patient lives.

Patient health literacy and participation in the
health-care process. Ishikawa H, Yano E Health
Expect. 6/2008 Health literacy revisited what
do we mean and why does it matter? Peerson A,
Saunders M, Health Promot Int. 4/09
12
Health Care Literacy From For All
  • Information Technology (IT)
  • Advances knowledge skills for health care
    professionals
  • Studies show only basic computer skills are
    needed
  • Efforts still needed to enhance computer skills
    awareness.
  • Attitudes of health care professional to the
  • development of IT in practice matters!
  • Need for flexibility and usability
  • Appropriate education and training
  • Need for the software to be 'fit for purpose
  • Emphasizes the need to carefully plan the
    introduction of IT-based systems into work
    practices.

1. Information literacy-what it is about?
Literature review of the concept and the context.
Saranto K,et al. Int J Med Inform. 6/04. 2. The
attitudes of health care staff to information
technology a comprehensive review of the
research literature. Ward R, et al. Health Info
Libr J. 6/08
13
Health Care Literacy From For All
  • Internet other virtual media
  • Critical factors in optimizing cancer
    communication for diverse audiences
  • literacy, cultural, and linguistic issues
  • Significant unmet needs
  • low-literate, multicultural and
    non-English-speaking populations
  • Emphasizes the importance of understanding the
    strengths and weaknesses of online cancer
    communication for vulnerable groups
  • guide patients to better Websites
  • supplement that information with oral and
    tailored communication.
  • Development Introduction of Technologies
  • Requires the acquisition and use of a complex set
    of skills
  • Ability to access understand the technology
  • Ability to locate and critically evaluate
    relevant material
  • Benefits of health sciences librarians

1. Online cancer communication meeting the
literacy, cultural and linguistic needs of
diverse audiences. Neuhauser L, Patient Educ
Couns. 6/08 2. Evidence-based resources and the
role of librarians in developing evidence-based
practice curricula. Klem ML. J Prof Nurs. 12/05
14
Health Care Literacy From For All
  • Health Care Professionals need trusted resources
  • Both for themselves and to give to patients.
  • Trainees need to be competent in health care
    literacy.
  • Benefit themselves and those they serve
  • Residents, nurses, pharmacists, etc.
  • Example ACGME Core Competencies
  • Patient Care
  • Medical Knowledge
  • Practice-based Learning and Improvement
  • appraise and assimilate scientific evidence
  • improve patient care based on life-long learning
  • Interpersonal and Communication Skills
  • effective exchange of information and
    collaboration with patients, their families, and
    health professionals
  • Professionalism
  • Systems-based Practice
  • responsiveness to the system of health care, as
    well as the ability to call effectively on other
    resources and optimize inter-professional teams

1. Patient-doctor communication. Teutsch C. Med
Clin North Am 2003 2. ww.acgme.org/outcome/comp/G
eneralCompetenciesStandards21307.pdf
15
Health Care Literacy From For All
  • Patient Caregiver
  • Caregivers play a significant role in diagnosis
    treatment.
  • The extent to which caregivers can comprehend the
    health information they receive is critical.
  • Targeted, practical cancer information should be
    provided directly to caregivers
  • Health interactions between caregivers and
    patients should be improved
  • Modern healthcare demands a high level of health
    literacy to successfully manage disease
  • Older adults may be at a distinct disadvantage
  • physiological, cognitive, psychological
    communicative factors.
  • New strategies are needed to compensate for these
    losses
  • creating a health care environment of shared
    meaning and understanding tailored to the aging
    patient.

1. Understanding the impact of family caregiver
cancer literacy on patient health outcomes. Bevan
JL, Patient Educ Couns. 6/08 2. Health literacy
and cancer communication with older adults.
Sparks L, Patient Educ Couns. 4/08
16
Health Care Literacy From For All
  • Health Sciences Librarian
  • Identifying optimizing skills
  • Basis for a training program model that reflects
    changes in both health care delivery
    information technology
  • All surveyed groups rated as most important
  • Personality characteristics
  • Skills
  • Understanding of the health sciences
  • Education
  • Research
  • Technical skills
  • Continuing professional development is required.
  • Emphasis on teaching skills, outreach work,
    marketing and promotion, research skills and
    methods, subject knowledge and terminology, and
    management skills.

1. Preparing librarians to meet the challenges of
today's health care environment. Giuse NB, et al.
J Am Med Inform Assoc. 1/97. 2. The education and
training needs of health librarians - the
generalist versus specialist dilemma. Petrinic T,
Health Info Libr J. 9/07
17
Health Care Literacy From For All
  • Health Science Librarians
  • Provide information literacy training to health
    care professionals.
  • (AND SO MUCH MORE)
  • Research is needed to demonstrate that this
    improves clinicians' information skills or
    patient care.
  • Selecting appropriate measures to evaluate the
    impact of training
  • Demonstrating validity and reliability
  • Providing guidance to health librarians health
    care system

Evaluating information skills training in health
libraries a systematic review. Brettle A Health
Info Libr J. 12/07
18
Health Care Literacy Around the World
19
Health Care Literacy Around the World
  • Academic Examples of Health Literacy Programs
  • University of Wisconsin, Madisons Comprehensive
    Health Enhancement Support System (CHESS)
  • http//chess.wisc.edu/chess/
  • Computer-based system of integrated services
    designed to help individuals cope with a health
    crisis or medical concern.
  • There research has demonstrated an increased
    quality of life in groups of cancer patients
  • http//chess.wisc.edu/chess/publications/archives_
    prj.aspx
  • Dartmouth-Hitchkock Medical Centers Shared
    Decision Making Center
  • http//www.dhmc.org
  • Many others........

20
Health Care Literacy Initiatives at UF
Gwen Lombard, Erin Dunbar, Beth Layton, Nita
Ferree
21
Health Care Literacy Initiatives at UF
  • Identification of Needs
  • Patient, caregiver, trainees, health care
    professionals, librarians, hospital, library, etc
  • Pilot data
  • Focused groups, surveys
  • Create Promote Connections
  • Implement Programs
  • Measure Effects Scientifically
  • Refinement
  • Advisory committees, research results
  • Establish Best Practice Model
  • Funding

22
Health Care Literacy Initiatives at UF
  • Needs Goals of UF
  • Create unique learning partnerships
  • Preston A. Wells, Jr. Center for Brain Tumor
    Therapy UF Health Sciences Library (and
    others!)
  • Promote proactive inquiry self-directed
    learning
  • Information Prescription
  • Comprehensive, High-quality, Up-to-date
  • Clinical Informationalist (Health Information
    Engineer)
  • Point-of-need, help for diverse needs
  • Immersed Librarian (Sewell Foundation Grant)
  • Virtual, Transferable
  • Mobile unit of information for patients,
    caregivers, staff, trainees
  • Informed Cancer Patients Website novel
    educational materials

23
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24
Information Prescription Circle one a
patient___ Caregiver/Family member___
Interested person___ Description of information
request Disease ______________________ Id
like information about Risk factors
diagnosis staging treatment at diagnosis
recurrence Specific medicines or treatments
monitoring prognosis other___________ Patient
or caregiver questions about Talking to
relatives or health care provider Memory and
personality Changes in self-perception or how
others perceive you Emotional wellbeing, coping
Energy/Fatigue Nutrition Other Patients,
please let us know if____________________________
____ I would like assistance and/or education
with Finding health information, example, how
to look for clinical trials other______
Community, state or national resources (please
describe) Shands-UF resources (please
describe) I would like to be contacted in the
future for ___________________ I would like to
see the following resources and/or services
available
25
Health Care Literacy Initiatives at UF
  • Diverse Collaborations
  • Health Professions
  • College of Public Health Health Professions
  • Department of Behavioral Science and Community
    Health
  • Journalism Communication
  • Preston A. Wells, Jr. Center for Brain Tumor
    Therapy
  • Department of Neurological Surgery
  • UF Shands Cancer Center Education Resource
    Center
  • Health Science Libraries
  • Volunteer patient or caregiver
  • Resident or other trainee
  • Social worker
  • Department of Pharmacy
  • Nursing Services, etc.

26
Health Care Literacy Initiatives at UF
  • Potential outcomes
  • improved sharing of information between patient,
    caregiver and medical providers
  • increased legitimization of the impact of
    effective consumer health literacy programs
  • resource justification for an immersed librarian
  • economic impact and resource utilization analyses
  • improved satisfaction and quality for all
    involved
  • improved healthcare outcomes
  • new models of interdisciplinary collaboration
  • novel use of the librarian in quality assurance,
    quality control, risk management, workflow and
    resource utilization, etc.

27
Current Future
  • Creating Expanding Connections
  • Developing Services
  • Scientifically Measuring Effects
  • Getting the word out
  • Committees Advisory Groups
  • Preparations for hospital extramural grants

28
Discussion Questions
  • How librarians can collaborate with patients
    health care professionals in YOUR area
  • Hospital Websites Education Program
  • Patient Staff Satisfaction Surveys
  • Education Support Groups
  • Creating Connections
  • Nurses, administrators, providers, social
    workers,
  • clergy, counselors, training programs, community
  • vendors, advocacy groups..
  • Pick a pilot project
  • Have Fun!
  • Build on each others Successes

29
Thank you for all you do!The End
Erin M. Dunbar, MD 352-273-9000 edunbar_at_neurosurge
ry.ufl.edu
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