Preventive Medicine and Patient Education Committee

We are changing the readiness to learn and patient education reminders to:  Readiness to learn/Clear Communication reminder  Patient Education/ Clear Communication

The new Patient Education/ Clear Communication reminder will help to change the focus from patient’s “ readiness to learn” to the shared patient /clinician goal of Clear Communication.

 Overcoming barriers to communication  Cultural Competence  Health Literacy  Appropriate teaching strategies

Health literacy is defined by Healthy People 2010 and the Institute of Medicine (IOM) as : “The degree to which individuals have the capacity to obtain, process and understand basic health information”

 90 million Americans scored Basic or Below Basic (functionally illiterate) (10)  Source of Perceived Noncompliance

Solar neutrinos from 8 B decay have been detected at the Sudbury Neutrino Observatory via the charged current (CC) reaction on deuterium and the elastic scattering (ES) of electrons. The flux of ν e ’s is measured by the CC reaction rate to be φ CC (ν e ) = 1.75±0.07(stat) (syst)±0.05(theor)×10 6 cm -2 s -1. (4)

There is an ethical obligation to provide health information in a manner that can be understood and acted upon by patients. (17)

 Lower patient satisfaction (16)  Less use of preventive service (15)  Less well controlled chronic diseases (14)  Increased charges (19)

Recent studies have demonstrated that health literacy is almost always overestimated by providers.  Physicians (9)  Residents (3)

 Increased awareness and removal of barriers to communication:  Visual Impairment  Difficulty Hearing  Low English Proficiency

Culturally Competent Care: The ability to effectively care for patients from any cultural background (5)

 Education  Career  Age  Gender  Sexual Orientation  Lifestyle  Background

Sources: Spencer, G., & Hollmann, F. W. (1998). National population projections. In U.S. Census Bureau, Population profile of the United States: U.S. Census Bureau (2004). International Data Base, Table Projected Growth of Population by Ethnicity: 1990, 2000 and 2050

 L isten with sympathy and understanding to the Patient’s perception of the problem.  E xplain your perception of the problem  A cknowledge and discuss differences and similarities  R ecommend treatment  N egotiate care (5)

 Rapid Estimate of Adult Literacy in Medicine- Revised (2)  This screen has been shown to be a reliable estimate of patients’ health literacy level. (14)  Based on the longer REALM (7)

The screener will say the following: “Sometimes in the healthcare system medical words are used that many people are not familiar with. I would like to get and idea of what medical words you’re are familiar with” Please say the words on this list:

 Fat  Flu  Pill  Allergic  Jaundice  Anemia  Fatigue  Directed  Colitis  Constipation  Osteoporosis

This patient reports: Adequate vision Hearing impairment /wears an hearing aid English proficiency Cultural Competence : Remember to use LEARN (can click on box to display LEARN information) Health Literacy: This patient will do well with verbal review and illustration (low health literacy Prompt)

Patient education was completed that was appropriate for this patient’s clear communication profile. Communication/Patient Education included:  Teach Back  Demonstration  Reading instructions aloud  Plain Language  Speaking slowly  Printed materials  Written instructions  Pictures/drawings  Including family members

There is a need for clear communication  Barriers must be overcome  Culture competence must be reinforced  Clinicians need the tools to provide information in a way that can be understood by patients

1. American Society on Aging and American Society of Consultant Pharmacists. (2006). Adultmeducation. Retrieved November 10,2008, from Bass, P., Wilson, J., & Griffith, C. (2003, December 1). A shortened instrument for literacy screening. Journal Of General Internal Medicine, 18(12), Bass, P., Wilson, J., Griffith, C., & Barnett, D. (2002, October 1). Residents' ability to identify patients with poor literacy skills. Academic Medicine, 77(10), Becker-Szendy, R., Bratton, C., Casper, D., Dye, S., Gajewski, W., Goldhaber, M. et al. (1992, March 19). Electron- and muon-neutrino content of the atmospheric flux. Physical Review Online Archive, 46(9), Berlin, E., & Fowkes, W. (1983). A teaching framework for cross cultural health care application in family practitioner, in cross- cultural medicine. Western Journal If Medicine, 6(139),

6. Castro, C. M., Wilson, C., Wang, F., & Schillinger, D. (2007, October 1). Babel babble: Physicians use of unclarified medical jargon with patients. American Journal of Health Behavior, Supplemental, 17, S Davis, T., Crouch, M., Long, S., Jackson, R., Bates, P., George, R. et al. (1991, August 23). Rapid assesment of literacy level of adult primary care patients. Family Medicine, 6, Institute of Medicine (National Academies Press). (2004, March 1). Health Literacy: A Prescription to End Confusion. Washington D. C. 9. Kelly, P., & Haidet, P. (2007, April 1). Physician overestimation of patient literacy: A potential source of health care disparities. Patient Education and Counseling, 66(1), Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NCES ). Retrieved February 8, 2008, from U.S. Department of Education:

11. Mayer, G. (2003). Confessions of a health illiterate. Healthcare Advances, 5(2), National Academy on an Aging Society. (1998, October 1). Understanding heallth literacy:New estimates of the cost of inadequate health literacy. [Paper]. In Promoting health literacy: A call to action. Pfizer Conference, Washington, D.C. 13. Osborn, C., Paasche-Orlow, M., Davis, T., & Wolf, M. (2007, November 1). Health Literacy: An overlooked factor in understanding HIV health disparities. American Journal Preventive Medicine, 33, 5, Schillinger, D., Grumach, K., Piette, J., Wang, F., Osmond, D., Daher, C. et al. (2002, July 24). Association of health literacy with diabetic outcomes. Journal Of The American Medical Association, 288, 4, Scott, T. L., Gazmararian, J. A., Williams, M. V., & Baker, D. W. (2002, May 1). Health literacy and preventative health care use among Medicare enrollees in a managed care organization. Medical Care, 40(5),

16. Shea, J. A., Guerra, C. E., Ravell, K. L., McDonald, V. J., Henry, C. A., & ACH, D. A. (2001, February 1). Health literacy weakly but consistently predicts primary care patients dissatisfaction. International Journal of Health Care, 19(1), Volandes, A., & Paasche-Orlow, M. (2007, November 7). Health literacy, health inequality and a just healthcare system. American Journal of Bioethics, 77(11), Weiss, B., & Coyne, C. (1997). Communicating with patients who can cannot read. New England Journal of Medicine, 337(4), Weiss, B., & Palmer, R. (2004). Relationship Between Health Care Costs and Very Low Literacy Skills in a Medically Needy and Indigent Medicaid Population [Electronic version]. Journal Of The American Board of Family Medicine, 17.