HEALTH LITERACY. Michael Wolf, MA MPH PhD
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1 HEALTH LITERACY A Matter of Healthcare Quality & Equity Michael Wolf, MA MPH PhD Health Literacy and Learning Program Feinberg School of Medicine School of Education & Social Policy Northwestern University
2 Presentation Overview Education ~ Literacy ~ Health The Value of a Health Literacy Perspective - HL as an issue of equity - HL as an issue of quality A Looming Epidemic Call to Action - defining a comprehensive response - example strategies
3 Presentation Overview Education ~ Literacy ~ Health The Value of a Health Literacy Perspective - HL as an issue of equity - HL as an issue of quality A Looming Epidemic Call to Action - defining a comprehensive response - example strategies
4 Presentation Overview Education ~ Literacy ~ Health The Value of a Health Literacy Perspective - HL as an issue of equity - HL as an issue of quality A Looming Epidemic Call to Action - defining a comprehensive response - example strategies
5 Presentation Overview Education ~ Literacy ~ Health The Value of a Health Literacy Perspective - HL as an issue of equity - HL as an issue of quality A Looming Epidemic Call to Action - defining a comprehensive response - example strategies
6 Presentation Overview Education ~ Literacy ~ Health The Value of a Health Literacy Perspective - HL as an issue of equity - HL as an issue of quality A Looming Epidemic Call to Action - defining a comprehensive response - example strategies
7 Presentation Overview Education ~ Literacy ~ Health The Value of a Health Literacy Perspective - HL as an issue of equity - HL as an issue of quality A Looming Epidemic Call to Action - defining a comprehensive response - example strategies
8 Presentation Overview Education ~ Literacy ~ Health The Value of a Health Literacy Perspective - HL as an issue of equity - HL as an issue of quality A Looming Epidemic Call to Action - defining a comprehensive response - example strategies
9 Presentation Overview Education ~ Literacy ~ Health The Value of a Health Literacy Perspective - HL as an issue of equity - HL as an issue of quality A Looming Epidemic Call to Action - defining a comprehensive response - example strategies
10 Education, Literacy, & Health Years of schooling linked to health (Kitigawa & Hauser, 1973; Pappas et al, 1993; Lantz et al, 1998) Low literacy predicts poorer health outcomes (Schillinger et al, 2002; Baker et al., 2002; Wolf et al., 2005; Baker et al. 2007) Literacy ~ Education (Gazmararian, et al., 1999) Prevalence (%) Figure 1. Literacy Levels by Years of School Completed Adequate Marginal Inadequate 0 0 to 8 9 to > 12 Years of School
11 Literacy and Mortality Risk Percent Alive Adequate Marginal Inadequate Months Baker DW, Wolf MS, Feinglass J, Gazmararian JA, Thompson JA. Arch Intern Med 2007; 167:
12 Literacy and Mortality Risk Percent Alive STRONGER INDICATOR OF MORTALITY RISK THAN YEARS OF SCHOOLING Adequate Marginal Inadequate Months Baker DW, Wolf MS, Feinglass J, Gazmararian JA, Thompson JA. Arch Intern Med 2007; 167:
13 An Issue of Equity
14 Literacy and Education Disparities Below Basic Basic Limited Literacy High School Drop Out Rates in 2005*: 6% White 10% Black 22% Hispanic *16-24 year olds w/o H.S. diploma or equivalent. Source: U.S. Department of Education, National Center for Education Statistics 0 Total AA Hispanic White National Assessment of Adult Literacy (NAAL) Survey. Kutner et al., 2005.
15 Literacy Helps Explain Racial Disparities Advanced Stage of Presentation (Bennett et al., 1998; Wolf et al. 2006) Medication Adherence (Osborn et al., 2007) Health Status (Howard et al., 2006; Sentell et al, 2006)
16 An Issue of Quality
17 An Unstandardized System Percent Distribution of Hand-Written Sig Messages in a Public Hospital ways to say 1 tablet a day Percent Distribution of Electronically-Generated Sig Messages in an Academic Practice Bailey et al., under review, Arch Intern Med, 2008
18 An Unstandardized System Lipitor 10 mg tabs Take one tab QD Dispense #30 Indication: for high cholesterol No refills Fosamax 5 mg tabs Take one tab QD Dispense #30 Indication: osteoporosis prevention Do not lie down for at least 30 minutes Bactrim DS tabs Take one tab BID Dispense #6 Indication: UTI No refills Ibuprofen 200 mg tabs Take 1-2 tabs TID PRN pain Dispense #30 No refills - "Take one tablet daily. - "Take 1 tablet by mouth for high cholesterol. - "Take one (1) tablet(s) by mouth once a day. - Take one tablet by mouth every day for high cholesterol." - Take 1 tablet by mouth daily. - "Take one tablet by mouth every day for osteoporosis prevention. Do not lie down for at least 30 minutes after taking. - "Take 1 tablet every day, 30 minutes before breakfast with a glass of water. Do not lie down. - Take one tablet every day. - "Take one tablet by mouth twice daily for UTI - "Take one tablet by mouth twice daily for urinary tract infection. - "Take 1 tablet by mouth 2 times a day. - "Take 1 tablet twice daily for 3 days." - "Take 1 to 2 tablets by mouth as needed for pain. - "Take 1 to 2 tablets by mouth three times daily as needed for pain. - "Take 1 to 2 tablets by mouth as needed for pain ** Not to exceed 4 times a day - "Take 1 to 2 tablets 3 times a day as needed for pain." Wolf et al., under revision Medical Care, 2008
19 Patient Communication Consumer Rx materials written > 12th grade level Less than one third routinely review (Wolf et al., 2006) Physicians, pharmacists missing opportunities to counsel patients (Metlay et al., 2005; Tarn et al., 2006)
20 Not Necessarily Patient-Centered Physicians most trusted source of health information (Makoul & Arnston, 2001) Often only source for patients with limited health literacy (Wolf et al., 2004) Medical encounters often incomplete, without review (Schillinger et al., 2003 ;Wolf et al., 2007) Consequence: patient understanding, informed decisions health behaviors, health outcomes, adverse events (Schillinger et al., 2003; Davis et al., 2006; Persell et al., 2007; Khankari et al., 2007; McCaffery 2008)
21 A Health Literacy Perspective Simplify the health care experience Individual Ability Support comprehension, action Clear Maintain communication Concise Consistent Health Literacy Health Literacy = Patient-Centered Care Health System Demands
22 A Looming Epidemic
23 Perfect Storm 2030 Prediction Excerpt from America s Perfect Storm: Three forces changing our nation s future. Educational Testing Service, January 2007.
24 Reasons for Literacy Decline Failures in Education System - stagnant H.S. grad rates Shifting Demographics - new, larger immigrant population Changing Economy - growth in knowledge-intensive jobs
25 A Call to Action
26 Quality Improvement Targets Patient skills Health materials Clinician skills Health system design
27 Quality Improvement Targets Patient skills General Bridge Education System Specific Chronic Care Management Health materials Clinician skills Health system design
28 Quality Improvement Targets Patient skills Health materials Clinician skills Health system design
29 Quality Improvement Targets Patient skills Health materials Clinician skills Health system design
30 Quality Improvement Targets Patient skills Health materials Clinician skills Health system design
31 Enhanced Rx Label Design Enhanced Precription Drug Label Design to Support Patient Understanding and Use (R01 HS ; PI Wolf) Overall Objective: to test the efficacy of an evidence-based, enhanced prescription drug container label design to improve older patients understanding of instructions for use.
32 Early Prototype Glyburide 50mg 09/26/2007 This medicine is for Michael Wolf To treat Diabetes Prescribed by Ruth Parker, MD Filled by Target Pharmacy 123 State Street St. Paul, MN (312) You have 11 refills Refer to Rx# Take 2 tablets in the morning, and 2 tablets at bedtime Breakfast Lunch Dinner Bedtime 2 2 Take with a meal Swallow tablet whole Do not drink alcohol UMS Identification/Information Side Instructions Side
33 Begin at Point of Prescribing Alastair Wood, MD 1234 Springfield Drive Nashville, TN (302) Dose: Dose: Dose: Take for: Take for: Take for: Schedule Schedule Schedule Morning Noon Evening Bedtime Morning Noon Evening Bedtime Morning Noon Evening Bedtime Additional Instructions Take with a meal Swallow whole Do not drink alcohol Limit your time in the sun Other Additional Instructions Take with a meal Swallow whole Do not drink alcohol Limit your time in the sun Other Additional Instructions Take with a meal Swallow whole Do not drink alcohol Limit your time in the sun Other
34 Health Literacy and the EMR (Promoting Health Literacy for Newly Prescribed Medications via the EMR; 1R21 CA ; PI Wolf) Overall Objective: to improve patient understanding and use of newly prescribed drugs via distribution of enhanced print instructions generated by the electronic medical record.
35
36 Diabetes Guide American College of Physicians Foundation, MFH Clinical Trial (N=1,080) 9 Missouri Clinics Question: Can you embed patient education in clinical practice? Carve-in vs. Carve-Out - Practice responsibility - Care management model
37 Moving Forward What are we asking of patients? How are we supporting them? Multi-disciplinary approach needed
38 Summary Simplify Health Care for Patients Develop Strategies with Target Population Seek Sustainable Solutions Comprehensive Strategies Needed!
39 Contact Information: Michael S. Wolf, PhD MPH Assistant Professor of Medicine and Learning Sciences Director, Health Literacy and Learning Program Division of General Internal Medicine Institute for Healthcare Studies Northwestern University Feinberg School of Medicine 750 N. Lake Shore Drive, 10 th Floor Chicago, IL (312)
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