Communication is essential for the effective delivery of healthcare. Unfortunately, too often there is a mismatch between a clinician's level of communication and a patient's ability to understand. The lack of understanding can lead to medication errors and adverse medical outcomes.
"Health literacy" is an individual's ability to read, understand and use healthcare information to be able to make effective healthcare decisions and follow instructions for treatment. Research has shown that a significant portion of the US population - perhaps as many as one half of American adults-lacks sufficient health literacy to effectively undertake and execute medical treatments. The lack of health literacy affects all segments of the population, although it is more prominent in certain demographic groups.
The impact from low health literacy on both the health of individuals and the entire healthcare system is significant. The strongest predictor of an individual's health status is not a person's age, income, employment status, education, race or ethnic group-it is their health literacy. It is estimated that the economic consequences nationally of low health literacy are between $50 and $73 billion per year.
The SCMS "Improving Health Literacy" project
The Seminole County Patient Safety Initiative has made the need to improve awareness about health literacy one of its major projects. Resources provided by the American Medical Association and the "Ask Me 3" program will be utilized to educate both physicians and patients county-wide. The Initiative's "Improving Health Literacy" project will consist of:
A presentation on "Health Literacy and Patient Safety: Ask Me 3 and the Newest Vital Sign" by Dr. Ana Rita Gonzalez, Sc.D., at the April 22nd Seminole County Patient Safety Summit.
An article written by Dr. Gonzalez about health literacy in the "Patient Safety in Seminole County" magazine (the article and information about Dr. Gonzalez are at the bottom of this page).
An advertisement (seen below - click to enlarge) about health literacy to be in the Seminole County section of the Wednesday, June 7th Orlando Sentinel.
Posters about the "Ask Me 3" program (seen below - click to enlarge) put in prominent places in each of the three Seminole County hospitals.
Public service announcements about the need for improved healthcare communications on multiple radio stations.
The distribution over 500 "Ask Me 3" posters and handout information to as many physician offices in Seminole County as possible.
What offices can do to help:
When a patient has been identified as having low health literacy:
Identify the patient's chart with a sticker so everyone in the office will know extra time is needed when explaining instructions.
Limit the number of issues raised each visit.
Use pictures or drawings for certain instructions.
Ask the patient to repeat instructions back.
Encourage the patient to have someone else present any time instructions are given.
Make follow-up phone calls to make sure instructions are being followed.
Use patient support services to assist in home monitoring.
A presentation on health literacy:
- By Dr. Ana Rita Gonzalez, Sc.D.
-Over the last five years Dr. Ana Rita Gonzalez, Sc.D., has led the effort to develop a health literacy campaign for Pfizer pharmaceuticals. Dr. Gonzalez has an extensive background in healthcare, including serving as a health systems adviser for nine years in the World Health Organization's Pan-American Health Organization (WHO-PAHO).
During this tenure she developed marketing programs for prescription drug use, family planning, developmental pediatrics, AIDS, responsible use of health services and medical devices, breast-feeding, high-risk pregnancies, and dental health. Dr. Gonzalez shares important information about a new initiative that involves both physicians and patients in an effort to reduce medical mistakes due to low health literacy.
Health Literacy and Patient Safety: Ask Me 3 & the Newest Vital Sign
[Published in the April 2006 Patient Safety in Seminole County magazine]
Some of the most hazardous situations for a patient are ironically the instances when they should be the safest - in their doctor's office, at the pharmacy counter, speaking to a social worker to name a few. The harm and danger is the result of poor communication between a health care consumer and a health care provider.
Imagine a patient is told by a physician that he has "diabetic neuropathy," "hypertension" or "coronary disease." How do you think this patient will react? Would he know what this means?
What if, instead, the physician tells him that he has "nerve problems," "high blood pressure," or "heart disease?" The patient may recognize these terms, but does he understand how these words will affect his health or what he needs to do treat these conditions?
Health care visits should not leave patients with more questions than answers. Unfortunately, for many people, this is what happens. Medical information is complex for many people to understand - no matter what their education level or socioeconomic background. Not being able to understand or act upon health information is known as low health literacy. According to the Institute of Medicine, low health literacy impacts 90 million Americans - nearly one in every two adults. It can hit any population segment, regardless of age, race, education or income.
People with low health literacy are more likely to make medication errors, fail to seek preventive care, and miss physician appointments. All of these occurrences place patients' health and safety at risk and yet all can be eliminated or improved with clear communications. According to Dr. Paul A. Gluck, MD, depositions of malpractice cases are evidence of this disconnect. He believes that the discrepancies between what the doctor said and what the patient heard is a result of low health literacy and poor communication between the two.
Clear health communication is now recognized as an effective approach to improving low health literacy. This means improving communication between physicians and patients, as well as providing written materials that are easy to read and understand.
A growing number of physician offices and clinics are using the "Ask Me 3" program to encourage better dialogue between the patient and the health care provider. "Ask Me 3" focuses on three simple questions that patients should ask in every health care interaction:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do this?
The "Ask Me 3" program features patient brochures and posters that can be placed in office waiting rooms and examination rooms to encourage patients to ask the three questions during their exam. To ensure that health care providers feel prepared to use clear health communication techniques and to create an office environment that encourages questions, the "Ask Me 3" program also includes communication tips, presentations and other health literacy information for providers. The materials are available free of charge through the non-profit organization, the Partnership for Clear Health Communication, at www.askme3.org .
Health care providers now have a new tool they can use to quickly assess their patients' health literacy skills. This tool is called the Newest Vital Sign, and is the only rapid health literacy assessment tool available in English and Spanish. By knowing the patients' ability to understand and act upon health information, the physician (and other providers) can tailor communication to ensure patient understanding and safety. The test can be administered in about three minutes, preferably at the time the other vital signs are being taken.
The Newest Vital Sign uses a nutrition label from an ice cream container, which is given to the patient, who is then asked six questions about it. The responses are then recorded on a score sheet containing the correct answers. Based on the number of correct responses, the health care provider can asses the patient's health literacy level. Providers can then adjust their language and communication techniques to meet their patients' needs. In a clinical study of 1,000 patients, the Newest Vital Sign was validated against the two previously existing health literacy assessment tests, the TOFHLA and the REALM. The Newest Vital Sign can be ordered free of charge from www.newestvitalsign.org .
Both "Ask Me 3" and the Newest Vital Sign are just two of the solutions available to improve clear health communication. Low health literacy has been called a silent epidemic and contributes to higher health care costs, due to preventable ER visits and hospitalizations. By learning about this issue and the tools and solutions available, patients and providers can work together to improve understanding, compliance and health outcomes. Health literacy is everyone's right...and everyone's responsibility.