1. Effective Use of “Play It Safe…With Medicine!” AAFP Toolkit and Health Literacy Resources Charles P. Mouton, MD, MS Professor, Dept of Community and Family Medicine Howard University College of Medicine 2008

2. OBJECTIVES Upon completion of this session participants will be able to: –Implement improved methods of verbal and written communication –Assist patients in understanding how to take medications as prescribed –Incorporate practical strategies to create a shame- free environment –Assess health literacy using clinically validated instruments –Determine readability of documents using the Flesch- Kincaid reading level

3. Issue of Health Literacy Functional health literacy is a measure of a person’s capacity to function effectively in the health care setting as determined by their comprehension of written health care materials and by their ability to understand and act on numerical health care instructions up to 50% of the U.S. population has some level of health ILLITERACY

4. HEALTH ILLITERACY associated unfavorable health outcomes: –higher prevalence of chronic diseases –greater use of emergency care –higher incidence of hospitalization and longer hospital stays –higher incidence of unfavorable reactions to prescribed medications TRANSLATION: $$$

5. Health Literacy in the Office Setting Impacts doctor-patient communication Impacts adherence to treatment plans Impacts patient satisfaction Leads to poor quality indicators Leads to unnecessary hospitalizations Health literacy researchers have recommended that prevention efforts to educate and improve treatment of chronic disease, especially in low literacy patients should be designed and implemented

6. Toolkits Useful to improve health literacy patients around medication usage PLAY IT SAFE with Medicine Components: Patient Education Brochure: English & Spanish Education CDs: Patient &Physician Prescription pad sample Pill Bottle stickers Demonstration pill box

7. Patient Education Brochures 100 English and 50 Spanish Word Meaning “Patient Power” Understanding how to take medication Medication Safety ideas

8. Education CDs Patient Education DVD –Meant to be played in waiting room Physician Education –The ETHNIC mnemonic to assist you in interviewing patients –A listing of cultural considerations –Resources

9. Other stuff Prescription Pad Sample Cover –Adds language to Rx for labeling Cartoon pill bottle stickers –Heart, lung, stomach, hand, diabetes (sugar) Pill Box for demonstration

10. AMA Foundation Toolkit Health literacy and patient safety: Help patients understand DVD instructional video CD-ROM educational video Tear off educational pads for doctor visits Campaign Buttons Manual for Clinicians

11. Survey Instruments TOFHLA –Test of Functional Health Literacy in Adults REALM –Rapid Estimate of Adult Literacy in Medicine Newest Vital Sign

12. R apid E stimate of A dult L iteracy in M edicine Developed in early 1990’s by Davis and colleagues Comparable to formal reading assessments ( corr coef 0.8-0.9) Cronbach’s alpha 0.96 EXAMPLE: pg 18

13. Newest Vital Sign Developed by Weiss et al. in 2005 Comparable to TOFHLA Corr coef of 0.64 Cronbach’s alpha of 0.78 EXAMPLE: pg 20

14. Flesch-Kincaid Reading Level The Flesch-Kincaid Reading level measures textual difficulty and tells you the grade level of a text.textual difficultytext The Flesch-Kincaid index tells how easy something is to read. It does this by counting the number of syllables in every word and the number of words in every sentence. readsyllables The formula used to calculate the level is as follows: (0.39 x Average No. of words in sentences) + (11.8 x Average No. of syllables per word) - 15.59 The number will represent a grade-school level –For example, a sentence with a score of 8.0 means that someone in 8th grade could understand. Normal writing is usually between a 7 and an 8. EXAMPLE

15. Conclusion Health literacy is important to patient safety and good quality of care Physician offices need to be prepared to assist their patients with health illiteracy Simple toolkits are available from AAFP and AMA Simpler test of literacy are available Educational material need to have a reading level appropriate for patients