National Network of Libraries of Medicine MidContinental Region 2010 USPHS Scientific and Training Symposium Dana Abbey, MLS Wednesday – May 26, 2010 2:30-3:00p

National Network of Libraries of Medicine

MidContinental Region

2010 USPHS Scientific and Training Symposium

Dana Abbey, MLSWednesday – May 26, 2010

2:30-3:00p



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



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



Skills Needed for Health Literacy Evaluating information for credibility and

quality Analyzing relative risks and benefits Calculating dosages Interpreting test results Locating health information



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)



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



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



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!



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.



Health Literacy and HIV/AIDS Knowledge

Source: Kalichman, et al (2000). Am J Prev Med.



0 20 40 60 80 100

Percent of patients with diabetes correctly answering questions according to literacy level (low, moderate, high)

Need to Know: symptoms of low blood sugar (hypoglycemia)

Need to Do: correct action for hypoglycemic symptoms

LowModerate

High

LowModerat

e High

Source: Williams, et al (1998). Arch Int Med.

Health Literacy and Diabetes Management



$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

Low-literacy Better literacy

$2,891

$10,688

Annual Healthcare Costs of Medicaid Enrollees

Source: Weiss, et al (2004). J Am Board Fam Pract.

(<3rd-grade reading level) (>4th-grade reading level)

Health Literacy and Healthcare Costs



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



What are the Challenges?

Health literacy in the U.S.

Readability of health materials

Health information and the Internet



Health Literacy in the U.S.

Intermediate

Basic

Below Basic

Proficient

14%

13%

44%

29%

93 million adults have basic or below health literacy skills

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



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



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



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



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



“Living Room” Language

Name common terms for…

Hypertension Insomnia Benign Hazardous Disorder Option Poultry Routinely



Information Rx

Health literacy intervention

Empowers patients Reduce the

number of poor quality Internet searches

http://www.informationrx.org



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.”



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



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



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



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



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!



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!



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



“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 Source: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety. The Joint Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm



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



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



Thank You!

Dana Abbey, MLSNational Network of Libraries of Medicine, MidContinental Region

University of Colorado Denver, Anschutz Medical CampusToll Free 1-800-338-7657, select option 1, then option 2, then option 3

http://nnlm.gov/mcr/

Documents

National Network of Libraries of Medicine MidContinental Region 2010 USPHS Scientific and Training Symposium Dana Abbey, MLS Wednesday – May 26, 2010 2:30-3:00p