When: March 28, 2013, 1 pm – 4 pm

Where: George and Dolores Eccles Institute of Human Genetics Auditorium, 15 North 2030 East, 1st Floor

Keynote Speaker, Andrew Pleasant, PhD. “Health Literacy: Applications for Enhanced Health System Performance OR . . . How to Change the World with Health Literacy”

Friday morning Workshop: March 29, 2013.

Find more at  Priscilla M. Mayden  Lecture

1. Register a team by March 4th.
Email Erica Lake: erica.lake@utah.edu

2. Create a 30-second to 1-minute public service announcement.

Choose any health literacy issue, such as:

• Failure to take medications correctly
• Overuse of the emergency room
• Medical diagnoses being made at later stages

3.  Submit your video to Erica Lake by March 25th.

Contest winners will have their PSA aired on a local TV station, featured on Dr. Vivian Lee’s blog, and promoted on university websites and social media outlets. All participants will be entered into a drawing for a new Kindle.

Contact Erica Lake for more information
erica.lake@utah.edu :: 801-581-4685

Health Literacy: A Vital Pathway to Healthcare Transformation

When: March 28, 2013, 1 pm – 4 pm

Where: George and Dolores Eccles Institute of Human Genetics Auditorium, 15 North 2030 East, 1st Floor

Keynote Speaker, Andrew Pleasant, PhD. “Health Literacy: Applications for Enhanced Health System Performance OR . . . How to Change the World with Health Literacy”

Friday morning Workshop: March 29, 2013.

Find more at  Priscilla M. Mayden  Lecture

Available in English and Spanish.

For more information, contact either

• Alice Weber, Alice.weber@utah.edu or 801-587-9247
• Eccles Library front desk, ehsl-reference@lists.utah.edu or 801-581-8772.

• The communication gap between physician and patient
• Encouraging full participation by patients
• The complexity of the healthcare system itself.

Talking to my doctor

In an article in the New York Times’ “Health” section, Pauline Chen, M.D., describes talking to a friend informally about her friend’s health condition and the latest research in the area. But when Chen suggested her friend discuss options with her primary care provider, her friend went quiet.

When she finally spoke again, her once-confident voice sounded nearly childlike. “I don’t really feel comfortable bringing it up,” she said. While her doctor was generally warm and caring, “he seems too busy and uninterested in what I feel or want to say.”

“I don’t want him to think I’m questioning his judgment,” she added. “I don’t want to upset him or make him angry at me!”

For many, including this writer, doctors are so highly regarded that it borders on intimidation. Couple that with a reimbursement system that necessitates seeing as many patients as possible in order to be successful, and you have a recipe for the physician-patient relationship demonstrated above. Recent efforts to make the healthcare decision making process a joint effort has improved medical visits, but it has failed to take into account the patient’s perspective. A recent study using patient focus groups sheds light on why some patients are reluctant to speak up for themselves:

• Even well-educated and well-to-do patients feel pressure to conform to social expectations, trapped into responding in certain ways to doctors
• Some physicians can be authoritarian
• Patients fear being labeled as a “difficult” patient

While most of the participants in this study were over 50 and lived in relatively affluent areas, it stands to reason that others from different socio-economic backgrounds would feel the same way.

Chen effectively sums up what’s needed:

Care organizations and doctors’ practices must be restructured to allow more in-depth conversations; clinicians need to be reimbursed for the time required for more meaningful conversations; and health care systems must adopt rigorous quality standards that measure and value real patient engagement in decisions.

Supporting healthy lifestyles

As we work to transform our healthcare system to improve patient-doctor communication, it must also undergo radical change to support wellness, rather than profiting by the quantity of sick people treated. As noted recently in The Atlantic, more research is needed on how to successfully motivate people to live healthier lives.

This is not as easy as it seems, for it requires walking a fine line between encouraging behavioral change and individual freedom. “For example, a program could let diabetic patients earn points toward more affordable insurance coverage by completing a self-taught module on diabetes” (from article in The Atlantic). There are even mobile tools to help manage diabetes, as previously noted in this column. Such methods for improving health literacy show promise, yet need confirmation by research with large samples over long periods of time.

Yet some people will not change their behavior no matter what positive incentives are offered. For these patients, it would be all-too tempting to tie insurance rates to blood test results obtained while visiting one’s primary care physician. While no one is currently suggesting turning doctors into health police, if it could be made profitable, somewhere it would be tried.

In a sense, what is needed is a kind of health literacy for physicians and insurers. They need to know and understand what works and what does not in encouraging healthier lifestyles in patients: modes of education, treatment regimens and combinations, incentives and more. Redistribute profitability so a greater share of reward is earned for wellness, rather than sickness.

A better system

No matter your political persuasion, most seem to agree that the current system should be made better. Simplifying the process of obtaining, utilizing and keeping health insurance coverage. We pay far more for healthcare than other industrialized countries, and yet our system is ranked 37th in the world. Reforms to the health care system are a step in the right direction, and more are needed. T. R. Reed’s book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, shows five different systems in other countries that provide a better healthcare system than we currently offer. Many in this country pride themselves on their ability to “go it alone.” It’s time we started learning from others successes.

Move your mouse over a region (one or more provinces) and it turns a darker shade of grey. Click on the region, and it takes you to a map of that region. Using the map tools (zoom, move, etc.), you can zoom quite far in to a given area.

A tool like this could help show patterns in areas needing additional education and outreach. And if the U.S. had a map like this, one could add an optional overlay to note “red” and “blue” states, which might offer additional insights for which political leaders could be enlisted to assist with raising awareness and health literacy levels.

Does the U.S. have a map like this? How else could this information be used? Tell us (in the comments)!

According to Dr. Jing Fang, an epidemiologist in CDC’s Division of Heart Disease and Stroke Prevention, the increased prevalence is largely due to lifestyle factors including obesity, high blood pressure and smoking. This report also notes that caring for stroke survivors cost our economy an estimated $18.8 billion during 2008, plus an extra $15.5 billion due to lost productivity and premature mortality.

Since higher education levels show a decreased prevalence of stroke in this report, it seems only natural to assume that health education and outreach would help combat this. As reported in a previous post, the  El Paso County Public Health department has partnered with Harrison High School to integrate health literacy education into classes beyond the traditional physical education and health offerings. If programs such as this were implemented nationwide, it could help reduce the incidence of stroke and other preventable causes of long-term disability. Such outreach efforts would probably more than pay for themselves in the long run.

What outreach efforts to improve health outcomes for U.S. citizens do you think should be better funded? Tell us!

Among participants with low HL, 28.8% self-reported as being uninsured, compared to 16% of people with adequate HL. For those respondents who reported being employed full time, ” those with low HL were less likely to have been offered employer-based health insurance than those with adequate HL (19.9 percent versus 11.4 percent).” And while participants with low HL were just as likely to be employed full-time as those with adequate HL, they were less likely to have been offered health insurance by their employer.

This study has implications for federal, state and local public policy, such as the implementation of the Affordable Care Act (ACA). Using the results as an estimate of HL levels in the U.S. population as a whole, about ten million of the thirty-two million people who will now have access to medical care under ACA will have low or poor HL, and probably many more than that. How will we implement the ACA in ways that will accommodate persons with:

• Low HL
• Inadequate computer and information literacy skills (navigating insurance exchange websites, understanding online forms, weighing pros and cons and trade-offs, etc.)
• English as their second language
• Cognitive and physical disabilities

This also has enormous implications for libraries, especially public libraries. At a time when budgets are being frozen or slashed, and branches are being closed, libraries will be hard-pressed to meet the resulting increase in demand for computer and Internet access. Library staff will be asked to help patrons navigate the myriad choices being offered by these insurance exchanges with little or no additional training. And if a librarian helps a patron successfully navigate this selection process, could the library be sued if something goes awry with insurance, medical care, etc?

While the concept of insurance exchanges seems like a good idea, without adequate preparation and support,  it may not succeed, and in a short time opponents of health insurance reform will renew their calls to “repeal Obamacare” as it is currently mis-labeled. To help people successfully access this yet-to-be created system, why not:

1. Involve librarians in the planning and organization of the insurance exchanges themselves
2. Provide additional funding to state libraries and the National Network of Libraries of Medicine to train staff at public libraries on how to assist patrons through this process.
3. Provide additional funding for computers and high-speed Internet access.

Librarians already have too much on their plate, so some things may need to be set aside as a result. But we will cope while doing our best to serve our patrons.

How else should libraries prepare for this next challenge? What have you, our fellow librarians, learned from other endeavors that would assist us in preparing? Tell us!

Reference:

1.    Weinstein D. Pre-op videos may ease recovery for cancer patients: study – Medical Marketing and Media. May 3, 2012 2012;2012(May 7):News article about recent study in the Journal of the American College of Surgeons.

2.    Crabtree TD, Puri V, Bell JM, et al. Outcomes and Perception of Lung Surgery with Implementation of a Patient Video Education Module: A Prospective Cohort Study. Journal of the American College of Surgeons. 2012;214(5):816-821.e812.

Health care professionals must become “medically bilingual,” that is, learn to speak both medical jargon and plain language. I like to ask myself, “How would I explain this to my mother?”

When a physician is explaining her/his findings and recommendations, if the patient does not understand, he/she may not even ask for clarification out of fear of appearing ignorant. While medical schools are working to train doctors to speak using everyday language, patients can take some simple steps to avoid making this mistake: ask three simple questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

And if your physician answers in a way that is confusing or loaded with unintelligible jargon, stop her/him and ask for them to explain in simpler language.

The National Patient Safety Foundation (NPSF) created the Ask Me 3^TM patient education program “to promote communication between health care providers and patients in order to improve health outcomes.” When patients clearly understand health information and instructions, they make fewer mistakes and can better manage their own healthcare. The NPSF offers patient brochures and other reference materials, and created this video to assist in improving patient-doctor communication.

While it is important that patients ask questions, and doctors answer using understandable language, it is also important to acknowledge that the current health system does not reward physicians for taking time to speak with patients. Regulation needs to be enacted or changed so that physicians can be reimbursed by health insurance, Medicare, Medicaid and other plans for the time spent. It will likely save the system money in the long run as well.

What other steps can be taken to improve doctor-patient communication? Tell us about it!

From 2006 – 2008, families in a six-site nationwide study participated in a program to enhance parenting skills. Participating parents were monitored for “depression, health- and healthcare-related practices, and surrounding family conditions at baseline and 6-month intervals for up to 36 months.” Data from this study, available in a publicly-funded AHRQ/NIH database, was recently analyzed, and while participants began with reduced health literacy skills, “after 1 year of enhanced home visitation, vulnerable parents were better able to manage personal and family health and healthcare, especially if depressed.” While the sample size (2,572 parent/child dyads) was modest, the findings demonstrate one way we can improve parental health literacy levels even among depressed parents.

In addition to demonstrating the benefits of home visitation in improving health literacy, this study provides support for those that argue for making publicly-funded research data available to all. While no less important back then, health literacy was not the burning topic in 2006-2008 as it is today. Principal investigators had no idea that their work could or would be used in this way. If this data was locked behind a publisher’s pay-wall, this study might never have happened. Because it was publicly available, it could be re-used to test new ideas and ways to help people today.

Researchers must have open access to as many data sources as possible in order to find new ways to help those in need. Access must take precedence over ownership and control when the health outcomes of vulnerable populations (in this case, children) is at stake.

What data sources should be made accessible that are not available right now? Or, what publicly available data/studies/etc. would you like to see analyzed in new and creative ways? Tell us about it!

Reference:

1.    Smith SA, Moore EJ. Health Literacy and Depression in the Context of Home Visitation. Maternal and child health journal. Nov 26 2011.

Looking for resources to improve health literacy and communication at your medical practice? The Health Literacy section of the AMA’s website toolkits, patient safety tip cards, and other resources to assist providers. Also, the Agency for Healthcare and Research Quality (AHRQ) of the U.S. Department of Health and Human Services has resources for addressing health literacy and cultural competency.

What tools have you found helpful in improving patient health literacy? Tell us about it!

Reference:

Pawlak, R. (2005). Economic considerations of health literacy. Nurs Econ, 23(4), 173-180, 147.

Villanueva-Whitman, E. (2012). Communication is key to better health care  Retrieved April 26, 2012, from http://www.DesMoinesRegister.com/article/20120410/LIFE/304100053

“there has also been criticism that this concept has been poorly defined, that it stretches the idea of “literacy” to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion.”

She goes on to select one definition of health literacy (Nutbeam, 2000) and using the concept of “critical health literacy” to determine its usefulness in improving the health of communities and individuals. This article concludes that the concept of critical health literacy connects ideas across multiple domains, yet retains “a key focus on the interaction between individuals and information about health” and how information can be used to improve health outcomes.

While much of the research around the topic of health literacy has be quantitative in measure, qualitative research is also needed to address the “socially situated nature of health literacy, involving interpersonal relationships, emotional involvement, and issues of power and resistance” (Chinn, 2011). Knowing how people utilize their personal networks to assemble an understanding of their health situation has the potential to increase the effectiveness of health literacy outreach efforts.

But we cannot stop there. It is also important to know what individuals and organizations benefit from poor health literacy, and what roadblocks and hurdles – legal, political, and more – are being put or kept in place to maintain the status quo.

What questions do you think researchers should be asking about critical health literacy? Where should academic institutions, libraries, non-profit organizations and others be focusing their resources to address this timely issue? Tell us about it!

References:

Chinn, D. (2011). Critical health literacy: a review and critical analysis. Soc Sci Med, 73(1), 60-67. doi: 10.1016/j.socscimed.2011.04.004

Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. [Article]. Health Promotion International, 15(3), 259.