1. 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

2. National Network of Libraries of Medicine MidContinental Region 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

3. National Network of Libraries of Medicine MidContinental Region 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

4. National Network of Libraries of Medicine MidContinental Region Skills Needed for Health Literacy Evaluating information for credibility and quality Analyzing relative risks and benefits Calculating dosages Interpreting test results Locating health information

5. National Network of Libraries of Medicine MidContinental Region 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)

6. National Network of Libraries of Medicine MidContinental Region 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

7. National Network of Libraries of Medicine MidContinental Region 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

8. National Network of Libraries of Medicine MidContinental Region 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!

9. National Network of Libraries of Medicine MidContinental Region 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.

10. National Network of Libraries of Medicine MidContinental Region Health Literacy and HIV/AIDS Knowledge Source: Kalichman, et al (2000). Am J Prev Med.

11. National Network of Libraries of Medicine MidContinental Region 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 Low Moderate High Low Moderate High Source: Williams, et al (1998). Arch Int Med. Health Literacy and Diabetes Management

12. National Network of Libraries of Medicine MidContinental Region $2,891 $10,688 Annual Healthcare Costs of Medicaid Enrollees Source: Weiss, et al (2004). J Am Board Fam Pract. (<3 rd -grade reading level) (>4 th -grade reading level) Health Literacy and Healthcare Costs

13. National Network of Libraries of Medicine MidContinental Region 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

14. National Network of Libraries of Medicine MidContinental Region What are the Challenges? Health literacy in the U.S. Readability of health materials Health information and the Internet

15. National Network of Libraries of Medicine MidContinental Region 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

16. National Network of Libraries of Medicine MidContinental Region Readability of Health Information Adults, on average, read at an 8 th 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 www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html

17. National Network of Libraries of Medicine MidContinental Region 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

18. National Network of Libraries of Medicine MidContinental Region Enhancing Patient Understanding 40-80 percent of the medical information patients receive is forgotten immediately 1 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

19. National Network of Libraries of Medicine MidContinental Region 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

20. National Network of Libraries of Medicine MidContinental Region “Living Room” Language Name common terms for… Hypertension Insomnia Benign Hazardous Disorder Option Poultry Routinely

21. National Network of Libraries of Medicine MidContinental Region Information Rx Health literacy intervention Empowers patients Reduce the number of poor quality Internet searches http://www.informationrx.org

22. National Network of Libraries of Medicine MidContinental Region 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.”

23. National Network of Libraries of Medicine MidContinental Region 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

24. National Network of Libraries of Medicine MidContinental Region Medication Identification Drug Digest – www.drugdigest.org/ www.drugdigest.org/ Pill Identification Wizard - http://www.drugs.com/imprints.php http://www.drugs.com/imprints.php Pillbox beta – http://pillbox.nlm.nih.gov/ http://pillbox.nlm.nih.gov/ DailyMed – http://dailymed.nlm.nih.gov/dailymed/prdsearch.cfm http://dailymed.nlm.nih.gov/dailymed/prdsearch.cfm Drug Information Portal – http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp

25. National Network of Libraries of Medicine MidContinental Region Drug Digest www.drugdigest.org/ Non-commercial, evidence-based, consumer-oriented Easy-to-read reference materials on drugs, vitamins and herbs, with audible pronunciation 6,000 images Drug interaction database

26. National Network of Libraries of Medicine MidContinental Region Pill Identification Wizard http://www.drugs.com/im prints.php http://www.drugs.com/im prints.php Match pill based on size, shape, color and imprint Check for potential interactions with other medications and food Find drugs by disease or condition and Over 5,000 veterinary pharmaceuticals for pets, livestock and numerous exotic species

27. National Network of Libraries of Medicine MidContinental Region Pillbox Beta http://pillbox.nlm.nih.gov/ Designed for consumers, emergency physicians, first responders, Poison Control Centers Identify based on imprint, shape, color Contains 5,693 records – 779 have images NLM working with FDA to begin large-scale photography

28. National Network of Libraries of Medicine MidContinental Region Drug Information Portal http://druginfo.nlm.nih.gov/drugportal/ 17,000 drugs – from clinical trials to marketplace Links to research resources, including LactMed, AIDSinfo, Hazardous Substance Databank, Dietary Supplements Database Links to consumer health information from MedlinePlus, and patient counseling information from DailyMed Some images available via Pillbox beta

29. National Network of Libraries of Medicine MidContinental Region 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

30. National Network of Libraries of Medicine MidContinental Region 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

31. National Network of Libraries of Medicine MidContinental Region 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!

32. National Network of Libraries of Medicine MidContinental Region 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!

33. National Network of Libraries of Medicine MidContinental Region 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

34. National Network of Libraries of Medicine MidContinental Region “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 Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm www.jointcommission.org/PublicPolicy/health_literacy.htm

35. National Network of Libraries of Medicine MidContinental Region 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

36. National Network of Libraries of Medicine MidContinental Region 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

37. National Network of Libraries of Medicine MidContinental Region Thank You! Dana Abbey, MLS National Network of Libraries of Medicine, MidContinental Region University of Colorado Denver, Anschutz Medical Campus Toll Free 1-800-338-7657, select option 1, then option 2, then option 3 http://nnlm.gov/mcr/