ROR Conference 10-20-2017 Steven Sparks Health Literacy Director Oct. 20, 2017 Improving Communication with Parents: Using AHRQ Health Literacy Universal Precautions Toolkit Steven Sparks Health Literacy Director

It’s just another toolkit. Why should you care? ROR Conference 10-20-2017 It’s just another toolkit. Why should you care? One of our pediatric patients was prescribed oxycodone 5 mg/5ml. Even though the directions said to take 1 ml every 4 hours as needed for pain, the patient’s mother gave her 5 ml because she though the strength of the medication as supposed to be the dose she gave her child. The pharmacy gave me the wrong medicine for my child. It was a very strong anti-psychotic instead of antibiotic. Thankfully I read the label carefully and caught it. One of our providers prescribed Miralax for a child’s constipation. The directions said mix with water. The mother put it in a bath tub and had the child sit it in. It didn’t say to drink it. “My great aunt was discharged on oral antibiotics. The course of treatment was 21 days and she took the medication 2 capsule, 3x per day. The quantity of meds required was large and the pharmacy put the pills in 3 bottles. She took two capsules from EACH BOTTLE 3x per day. She developed C difficile and was hospitalized again several days after being released.   “My mother was given pain patches for your severe arthritis and was instructed to place the patch somewhere on her body. At a Thanksgiving dinner, we notice that she became drowsy and was slurring her words....when we looked at her more carefully we discovered that she had place a pain patch every where she was hurting” “My mom had a prescription for Lomotil, it said to take for diarrhea, she did not take is as she already had diarrhea and felt that the pill would make it worse. Is should have said to "stop diarrhea". Some people are literal.”

Health literacy can affect: Use of medicines Understanding and follow-through on discharge instructions Accessing best health care Using health insurance Asking questions Engagement in health decisions

What’s it like? Allotted Time: 4 minutes Explain to the audience that you are going to conduct an exercise with them. Set the scene: You’re in the exam room, and the doctor hands you this sheet with instructions, he/she tells you to take a moment to read it and ask any questions you might have about them. Ask people to read the passage aloud and try to stay together – choral reading. Ask comprehension questions about what they just read: What is this passage about? Ask people how they felt during the exercise. Encourage them to remember back to how it FELT, not what they were THINKING 8) Mention how this activity is to help people understand and/or empathize with clients who may have low health literacy.

Everyone has difficulty with health literacy at some time ROR Conference 10-20-2017 Everyone has difficulty with health literacy at some time Health and/or life stress Medication Illness

Everyone has difficulty with health literacy at some time ROR Conference 10-20-2017 Everyone has difficulty with health literacy at some time Medical studies show most people suffer a 68% hearing loss when naked.

1 of 3 struggle with low health literacy ROR Conference 10-20-2017 1 in 3 Adults: Low Only 12% proficient! 1 of 3 struggle with low health literacy (NAAL, 2003)

A silent problem Percent who never told: Parikh, N.S., et al. ROR Conference 10-20-2017 A silent problem Percent who never told: Parikh, N.S., et al. Patient Educ Couns, 1996.

Who is most at risk for low health literacy? ROR Conference 10-20-2017 Who is most at risk for low health literacy? Low literacy Poor health status Low education level Seniors Racial and ethnic groups

Improving health literacy can make a difference 8000 books distributed: 4 of 5 parents dealt with a health care problem at home instead of calling a hospital or clinic 3 of 5 parents dealt with a problem at home instead of going to the Emergency Department or Urgent Care

What are Health Literacy Universal Precautions? Simplifying communications for everyone to reduce the risk of miscommunication

What are Health Literacy Universal Precautions? Making the office environment and health care system easier to navigate Supporting patients’ efforts to improve their health

Start on the path of improvement Improve spoken communication Improve written communication Improve self-management and empowerment Improve supportive systems

What’s included Videos and moderator’s guides PowerPoint presentations Forms Posters and flyers Checklists and worksheets Surveys

A sampling of Tools and Tips…

Tool 3: Raise Awareness Show a video, lead a discussion Conduct Presentation

Tool 4: Communicate Clearly ROR Conference 10-20-2017 Tool 4: Communicate Clearly Use plain, non-technical language Use the patient’s words Slow down Limit content Be specific and concrete Show pictures, graphics

Be sure to come to the Breakout Session at 1:15! ROR Conference 10-20-2017 Tool 5: Use Teach-Back Be sure to come to the Breakout Session at 1:15!

Tool 7: Improve Phone Access ROR Conference 10-20-2017 Tool 7: Improve Phone Access Ask patients what they think Carefully design automated menus Use health-literate language Use Teach-Back

Tool 8: Conduct Brown Bag Medicine Review ROR Conference 10-20-2017 Tool 8: Conduct Brown Bag Medicine Review Ask patients to bring medicines (not “medications”) Ask: What do you take this for? When do you take this? Show me how much you take each time

Tool 9: Address language differences ROR Conference 10-20-2017 Tool 9: Address language differences Assess language preferences and needs Use acceptable language assistance services Provide written material in preferred language

Tool 11: Assess, select & create easy-to-understand materials ROR Conference 10-20-2017 Tool 11: Assess, select & create easy-to-understand materials Use assessment tools PEMAT CDC SMOG

Tool 11: Assess, select & create easy-to-understand materials ROR Conference 10-20-2017 Tool 11: Assess, select & create easy-to-understand materials Involve patients Watch for numbers Consistent denominators (1 of 10 vs. 4 of 10) Do the math Remember: There are 3 kinds of people in this world… Those who are good at math and those who are not.

Tool 14: Encourage questions ROR Conference 10-20-2017 Tool 14: Encourage questions “What questions do you have?” “Tell me your questions.” “We discussed a lot of information. What can we review again?” (NOT) Do you have any questions?

Tool 18: Link patients with non-medical support ROR Conference 10-20-2017 Tool 18: Link patients with non-medical support Ask: “Is there anything in your daily life that makes it hard to take care of your health?” Maintain updated list of community resources Use Community Referral Form

Tool 20: Connect patients with literacy and math resources ROR Conference 10-20-2017 Tool 20: Connect patients with literacy and math resources Ask parents about literacy skills; stress importance of parent literacy on children Provide information on programs WisconsinLiteracy.org

Lots and lots of resources ROR Conference 10-20-2017 Lots and lots of resources For example: www.JustPlainClear.com

Lots and lots of resources 9 pages to be exact

How to get started Download all or part of Toolkit: Google: Health Literacy Universal Precautions Toolkit

How to get started

What questions do you have? ROR Conference 10-20-2017 What questions do you have? Steve Sparks Health Literacy Director steve@wisconsinliteracy.org