1. Retooling the Pharmacist to Improve Health Literacy Jennifer O ’ Callaghan, PharmD PGY1 Community Pharmacy Resident University of Wisconsin Hospital and Clinics

2. Disclosure Statement I have no conflict of interest to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation.

3. Learning Objectives  Identify ways pharmacy staff and other healthcare providers can recognize patients with low health literacy.  Define the Wisconsin Pharmacy Quality Collaborative (WPQC) program.  Describe ways the Wisconsin Pharmacy Quality Collaborative (WPQC) is identifying patients with low health literacy and implementing services aimed at improving medication adherence.

4. Health Literacy  Ability to understand: prescription drug bottles educational brochures doctor ’ s directions consent forms  Ability to calculate medication dosages  Ability to interpret test results

5. Identification of Patient with Low Health Literacy  “ Even very literate people may have trouble obtaining, understanding, and using health information: a surgeon may have trouble using an insurance form, a science teacher may not understand information about a test of brain function, and an accountant may not know when to get a mammogram. ”

6. Identification of Patient with Low Health Literacy  Ask for medications by color or shape  Unable to explain purpose or dosing of medication  Non-compliance with medications  Lack of follow through on labs  Incomplete registration forms

7. Identification of Patient with Low Health Literacy  May need more time to make health care decisions  Patients may hide their lack of understanding or may not even realize they have trouble understanding

8. Take 2 tablets twice daily  Low health literacy 71% believed they understood the directions 35% able to demonstrate properly  Marginal health literacy 84% believed they understood the directions 63% able to demonstrate properly  Adequate health literacy 89% believed they understood the directions 80% able to demonstrate properly

9. Creating the Right Environment for Health Literacy

10. Fostering Open and Welcoming Attitudes  Smile and acknowledge the patient  Always introduce yourself  Speak in a slow, relaxed pace in a conversational tone  Listen and be empathetic  Encourage patients to ask questions  Ask “ Am I clear? ”

11. Fostering Open and Welcoming Attitudes  Use interpreter services if available  Use signs with pictures to tell patients where to go and what they need  Provide a waiting area  Decorate the pharmacy

12. Maintaining Consistency  Use larger prints  Use 12-point Times or 11-point Arial  Include brand and generic names  Include medication purpose  Use the same generic if possible  Post questions to ask pharmacist What is this medication for? What are the side effects?

13. Incorporating Basic Healthcare Information  Use multiple types of learning styles People typically only remember 50% of what they hear  Create written materials at 8 th grade or lower (Goal for 5 th grade reading level is best) Average reading level: 8-9 th grade Patient education materials in chain pharmacies  2% of materials at 7-8 th grade  69% of materials at 9-12 th grade  29% of materials at 12 th grade or higher

14. Incorporating Basic Healthcare Information  Avoid difficult medical terminology ScreeningOralMental HealthMonitor DermatologistDiabetesAnnuallyCardiovascular ImmunizationDietDepressionReferral ContraceptionHygeineRespiratory problems Eligible HypertensionPreventionCommunity Resources Arthritis

15. Incorporating Basic Healthcare Information  2012 United States Pharmacopeial (USP) Convention Standards Use explicit directions Avoid from necessity of numerical skills  Examples “ Take 2 tablets twice daily ” “ Take 2 tablets in the morning and take 2 tablets in the evening ” “ Take 1 tablet every 4 to 6 hours ” “ Take 1 tablet 4 to 6 times daily ” “ Take 1 tablet at 8am ” “ Take 1 tablet at the same time every morning ”

16. Incorporating Basic Healthcare Information  Use a Pill Chart Morning Afternoon EveningNight Name: Sarah Smith Date Created: 12/15/12 Pharmacy phone number: 123-456-7890 NameUsed ForInstructions Simvastatin 20mg CholesterolTake 1 pill at night Furosemide 20mg FluidTake 2 pills in the morning and 2 pills in the evening Insulin 70/30 High blood sugars Inject 24 units before breakfast and 12 units before dinner 24 units12 units

17. Incorporating Basic Healthcare Information  Focus on how to incorporate medications and health changes into the patient ’ s current lifestyle  Create a medication list for patients to bring to all appointments  Give patients a plan for their goals or other healthy lifestyle changes

18. Wisconsin Pharmacy Quality Collaborative (WPQC)  WPQC is an initiative of the Pharmacy Society of Wisconsin (PSW) that is designed to engage health plans and pharmacy providers in a collaborative effort to improve medication use in Wisconsin  WPQC has established a credentialing Process and uniform set of pharmacist- provided medication therapy management services for participating Wisconsin pharmacy providers.

19. Show and Tell  Showing the patient what the medication looks like

20. What your pharmacist did for you today  Updated your information  Checked your records  Allergies  Interactions  Safe and effective medications for your age and conditions  Ways to save you money  Reviewed with you  Why you are taking your medication  How to take your medication  How you can monitor your own therapy  When to contact your doctor

21. Teach-back Method  Teach-back is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands  Ask the patient to explain to you what you taught them

22. Common Questions to Use for Teach Back  “ I want to be sure that I explained your medication correctly. Can you tell me how you are going to take this medicine? ”  “ We covered a lot today about your diabetes, and I want to make sure that I explained things clearly. So let ’ s review what we discussed. What are three strategies that will help you control your diabetes? ”  “ What are you going to do when you get home? ”

23. WPQC and Health Literacy  Offers customized patient services and private medication appointments to ensure patients best understand their medications

24. Health Literacy Criteria  Requires the use of a trained medical translator  Is unable to demonstrate pill count(s)  Is familiar with personal medications by color only  Is unable to read or is suspected to have very low literacy  Is suspected to have adherence problems due to low literacy  Takes medications obtained from another country

25. WPQC Interventions  Focused adherence intervention Use lifestyle cues  Set medications by kitchen if taken with food  Set medications by bedside table if taken at bedtime Use pill boxes Use alarms Create a schedule

26. WPQC Interventions  Comprehensive medication review and assessment Personalized medication appointment  Medications use, directions, and side effects teaching  Device technique review  Adherence consult

27. How to refer your patients for a medication appointment  Patients with Medicaid, Unity, UnitedHealth Care, and Network Health are eligible  Check out pswi.org for a list of all participating pharmacies

28. Questions? Jennifer O ’ Callaghan, PharmD PGY1 Community Pharmacy Resident University of Wisconsin Hospital and Clinics