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

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Presentation on theme: "Advancing Health Literacy Ruth M. Parker, M.D. Professor of Medicine, Pediatrics and Public Health; Emory University."— Presentation transcript:

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 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 HEALTH LITERACY CHALLENGES

5 Meet Dave.  Husband  Father (2 children)  Employed full time  Commute = 45 min.  Occasional travel  Type 2 diabetes  Hypertension  High Cholesterol  Two prescribers  5 Rx medications daily  Quarterly MD visits  Overweight (BMI = 27)  Variable diet  Variable activity  Frequently misses meds

6 Meet Dave.  Husband  Father (2 children)  Employed full time  Commute = 45 min.  Occasional travel  Type 2 diabetes  Hypertension  High Cholesterol  Two prescribers  5 Rx medications daily  Quarterly MD visits  Overweight (BMI = 27)  Variable diet  Variable activity  Frequently misses meds  Inconsistently controlled.  No plan for improvement.  Not activated, not empowered. -Inadequate knowledge -Inadequate skills = Overwhelmed

7 A $200 Billion Problem 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) HL

8 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 The Forecast for 2030

9 Health Literacy Framework (Parker) Skills/Ability Demands/Complexity

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 Skills/Ability Demands/Complexity

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

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

14 Michael Wolf 04/29/71 Glyburide 5mg Take for Diabetes Take: 2 pills in the morning 2 pills in the evening Noon 11-1 PM Evening 4-6 PM Bedtime 9-11 PM 22 Morning 7-9 AM Do not drink alcoholic beverages while taking this medicine Carry or wear medical identification stating you are taking this medicine You should avoid prolonged or excessive exposure to direct and/or artificial sunlight while taking this medicine Rx #: /8/2009 You have 11 refills 180 pills Discard after 9/8/2010 Provider: RUTH PARKER, MD Emory Medical Center (414) Pharmacy: NoVA ScriptsCentral Sunset Blvd. Reston, VA (713) NDC # Reprogramming the R x Label.

15 Davis et al J Gen Intern Med, 2010; Wolf et al Arch Intern Med 2011; Med Care 2011; Bailey J Gen Intern Med 2012 UMS LabelStandard Label Understanding2.1 ( ) 74% % Adherence (3 months) 1.9 ( ) 49% % Figure 5.

16 William H. Shrank, MD, MSHS, Nov What Constitutes the Label? 1) Container Label 2) Consumer Medication Information (CMI) 3) Package Insert 4) Medication Guide

17 A Prescription for Confusion. Mother Master’s degree health educator Father General internist Daughter 6 years old with diagnosis of H1N1 influenza (‘swine flu’)

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

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

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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 Round Table Joint Commission (JCAHO) “What Did the Doctor Say?”: Improving Health Literacy to Protect Patient Safety Agency for Healthcare Quality and Research (AHRQ) AMA Toolkit


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