2010 USPHS Scientific and Training Symposium

1. 2010 USPHS Scientific and Training Symposium Dana Abbey, MLS Wednesday – May 26, 2010 2:30-3:00p

2. Learning Objectives • Recognize the impact low health literacy has on patient care • Name five resources and strategies to improve health information literacy • Describe the health literacy services offered by the library

3. What is 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.” Healthy People 2010

4. Skills Needed for Health Literacy • Evaluating information for credibility and quality • Analyzing relative risks and benefits • Calculating dosages • Interpreting test results • Locating health information

5. Skills Also Include • Visually literate (able to understand graphs or other visual information) • Computer literate (able to operate a computer) • Information literate (able to obtain and apply relevant information) • Numerically or computationally literate (able to calculate or reason numerically)

6. What Factors Affect Health Literacy? • Health literacy is dependent on individual and system factors • Communication skills • Information and knowledge • Culture and language • Demands of the system • Learning disabilities • Cognitive declines in older adults • Lack of educational opportunity

7. Why is Health Literacy Important? • Low health literacy is linked to… • Under-utilization of services • Increased medication errors • Poor knowledge about health • Increased hospitalizations • Poor health outcomes • Increased healthcare costs

8. Who is at High Risk? • Elderly • Low Income • Unemployed • Less than High School education • Minority Ethnic Group • Recent Immigrant • English as a Second Language You can’t tell by looking!

9. Health Literacy and Cancer Screening Women with low health literacy are less likely to have had a mammogram or Pap test than women with higher health literacy skills Source: Davis, et al (1996). Caner. Lindau, et al (2002). Am J Obstet Gynecol.

10. Health Literacy and HIV/AIDS Knowledge Source: Kalichman, et al (2000). Am J Prev Med.

11. Health Literacy and Diabetes Management Low Need to Know: symptoms of low blood sugar (hypoglycemia) Need to Do: correct action for hypoglycemic symptoms Moderate High Low Moderate High Percent of patients with diabetes correctly answering questions according to literacy level (low, moderate, high) Source: Williams, et al (1998). Arch Int Med.

12. Health Literacy and Healthcare Costs Annual Healthcare Costs of Medicaid Enrollees $10,688 $2,891 (<3rd-grade reading level) (>4th-grade reading level) Source: Weiss, et al (2004). J Am Board Fam Pract.

13. How is Information Critical to Health Literacy? • Health information is key to: • Patient and provider communication • Shared health care decision making • Understanding and following directions • Recognizing when to seek care • Learning and adopting healthy behaviors

14. What are the Challenges? • Health literacy in the U.S. • Readability of health materials • Health information and the Internet

15. Health Literacy in the U.S. 93 million adults have basic or below health literacy skills 13% Proficient 44% 14% Below Basic Intermediate Basic 29% Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics (2006). http://nces.ed.gov/naal/health.asp

16. Readability of Health Information • Adults, on average, read at an 8th grade level • Health care information is generally written at a college level • Over 300 studies show health-related materials far exceed the reading ability of U.S. adults • Increasing number of studies show similar results when looking at the readability of online health information Source: NLM Bibliography—Understanding Health Literacy and Its Barriers (2004). www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html

17. Effective Communication Strategies • Plain, non-medical language • Speak slowly and clearly • Limit content to 3-5 key points • Repeat key points • Be concrete – draw pictures, use illustrations and/or models • Encourage patients to ask questions • Use the Teach-back method

18. Enhancing Patient Understanding • 40-80 percent of the medical information patients receive is forgotten immediately1 and nearly half of the information retained is incorrect • Teach-back method is a way to confirm that your patient understands what they need to know

19. Strategies to Improve Health Literacy • Use “living room” language • Limit information (3-5 key points) • Use easy-to-read print materials • Practice teach-back • Use Information Rx • Address culture and language needs

20. “Living Room” Language Name common terms for… • Hypertension • Insomnia • Benign • Hazardous • Disorder • Option • Poultry • Routinely

21. Information Rx • Health literacy intervention • Empowers patients • Reduce the number of poor quality Internet searches http://www.informationrx.org

22. Brown Bag Medication Review • Improve communication about medications • “Out of 10-15 brown bag reviews, only 2 were accurate.” • “Out of five brown bag reviews, we found three that had duplicate medicine bottles resulting in double dosing and one discontinued medicine that was still being taken.” • “We found errors in every review, including one where a patient stopped the provider did not know about, and others where the medicines did not match what was in the chart.”

23. Medication Safety • Prescriptions filled • Average number per year: 11.5 • Average number for persons 60 and over: 15.6 • 10% of all hospital admissions are the result of patients not taking medications correctly • 28% of all hospital admissions for those over 65 are caused by medical non-compliance • $414 billion projected sales

24. Medication Identification • Drug Digest –www.drugdigest.org/ • Pill Identification Wizard - http://www.drugs.com/imprints.php • Pillbox beta –http://pillbox.nlm.nih.gov/ • DailyMed – http://dailymed.nlm.nih.gov/dailymed/prdsearch.cfm • Drug Information Portal –http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp

25. Health Literacy Universal Precautions Toolkit • http://www.nchealthliteracy.org/toolkit/ After implementing some of these tools, we really felt like we were more able to connect with our parents about the health of their child. ”-MD, urban pediatric practice “This toolkit made us more aware of the challenges that our patients face and guided us to make meaningful changes throughout our practice.”-Office manager, rural family practice clinic

26. MedlinePlus • www.medlineplus.gov • Over 800 health topics • NIHSeniorHealth • In English and Spanish • 165 interactive tutorials on procedures and conditions in easy-to read language • 47 other languages • No advertising • No endorsements • Anatomy videos • Medical pictures • Prescription information • Alternative medicine/therapies

27. Refugee Health Information Network • http://rhin.org/ • Collaboration of health professionals serving refugee populations • Identify, collect and archive materials produced in refugee languages • Brochures, fact sheets, audio, and video formats • FREE!

28. SPIRAL • http://spiral.tufts.edu/ • 9 Asian languages • Search by topic or language • Links to Asian-language patient care documents • Materials created by non-profit health agencies and organizations • FREE!

29. How Can Librarians Help? • Free access to the Internet • Information Rx Program • Patient information packets • Consumer health collection • Native language resources • Teaching and training • Virtual chat / email assistance • Health literacy workgroup

30. “The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care.” The Joint Commission Source: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety. The Joint Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm

31. Take Home Points • Accurate and reliable health information is critical to health literacy • Health literacy practices improve health outcomes • There are numerous free consumer health resources to improve health information literacy • Librarians are a valuable resource in helping patients and caregivers locate appropriate consumer health information

32. Learning Objectives Revisited • Recognize the impact low health literacy has on patient care • Name five resources and strategies to improve health information literacy • Describe the health literacy services offered by the library

33. Thank You! Dana Abbey, MLS National Network of Libraries of Medicine, MidContinental Region University of Colorado Denver, Anschutz Medical Campus Toll Free 1-800-338-7657, select option 1, then option 2, then option 3 http://nnlm.gov/mcr/