1. Health Literacy: A Prescription to End Confusion Rose Marie Martinez, Sc.D Improving Patient Outcomes in Primary Care Howard University April 26, 2008

2. Health Literacy In 2004 the IOM released Its report. Today’s presentation will focus on: 1. A visual summary of report highlights 2. Discussion of and report impact and Roundtable on Health Literacy activities

3. Health Literacy Committee Charge: Define the scope of the problem of health literacy. Identify the obstacles to a creating a health literate public. Assess the approaches that have been attempted to address the problem. Identify the gaps in research and programs Identify goals for health literacy efforts and suggest approaches.

4. Health Literacy Start Video Clip Summarizing the IOM Report on Health Literacy: A Prescription to End Confusion

5. Report Recommendations

6. Health Literacy: A Prescription to End Confusion 16 recommendations issued in the report –16 departments or agencies specifically named in the recommendations Recommendations focused on: –Developing approaches to improve health communication –Developing measures of health literacy –Increasing research activities and research support funding –Encouraging integration of health literacy in curriculum K-12, profession schools, CME –Supporting convening activities

7. Health Literacy—Impact of Report The IOM report has stimulated continued interest and action in the area of improving health literacy. Creation of the IOM Roundtable on Health Literacy Objective: To continue the dialogue, share knowledge, and stimulate action

8. Health Literacy Roundtable Organized in September/October 2005 27 members –Academia –Industry –Media –Government –Foundations and associations –Representatives of patient and consumer interests

9. Roundtable Sponsors HHS/Office of Disease Prevention and Health Promotion National Cancer Institute Health Resources and Services Administration Centers for Medicare and Medicaid Service Kaiser Permanente Affinity Health Plan Academy for Educational Development American College of Physicians Foundation American Academy of Family Physicians Foundation American Heart Association GlaxoSmithKline Pfizer Merck

10. Report Impact 16 follow-up letters were sent to federal agencies and other entities to assess response to recommendations. Findings: Most agencies participating in government working group on health literacy - Federal interagency health literacy working group - NIH-wide health literacy working group (40 members) Many activities in the area of improving communication materials

11. IMPACT: Improving Communication Department of Defense --“Plain language” set as goal for health benefit plan information and education (TRICARE) --Patient safety communication initiatives including cultural and linguistic requirements --Health self-management information evaluated for ability to inform adequately and appropriately Joint Commission Accreditation of Healthcare Organizations --New requirement to document patient language and communication needs (Standard IM.6.20)

12. IMPACT: Improving Communication Centers for Disease Control and Prevention --CDC/ATSDR programs address health literacy and cultural competency (National Diabetes Wellness Program, National Diabetes Education Program, Resources for Heart Disease, Stroke ) --Emergency Preparedness materials for West Nile Virus and Katrina and Rita Hurricanes tailored to be address health literacy levels Veterans Administration --Provides readability formulas for written materials and other tools for use with patients with low literacy --My HealtheVet

13. IMPACT: Improving Communication National Institutes of Health --Redesigning National Cancer Institute’s “Clear and Simple” guidance for developing publications for people with limited-literacy skills to be a NIH-wide publication --Rewards plain language objective within NIH through “Plain Language Awards” Centers for Medicare and Medicaid Services --Developing Toolkit for “Making Written Material Clear and Effective” Agency for Healthcare, Research & Quality --Informed consent and research authorization toolkit

14. Indian Health Service --Developing assessment tool to evaluate IHS website --Patient education kiosks featuring culturally appropriate information for American Indian/American Natives --National Information Resource Access Point --Preparing for JACHO accreditation standards by assessing patient readiness to learn, learning preferences and barriers to learning in patients --IHS Plan of Action on Health Literacy (HP 2010) IMPACT: Improving Communication

15. IMPACT: Measurement/Assessment Agency for Healthcare, Research & Quality --Health literacy measurement project—measures of how well health plans and clinician groups address health literacy --Measuring Patient Satisfaction: Low Literacy Populations --Spanish Health Literacy Assessment Tool National Inst. Child Health and Development --Developing assessment of health literacy needs of parents with special needs children

16. Impact: Research on Health Literacy NIH --Issued Research Program Announcement “Understanding and Promoting Health Literacy” (along with AHQR) 4 RO1 and 15 R03 grants --Health literacy Principal Investigators Meeting --NIH Public Trust Initiative helps inform the public on how NIH conducts and supports clinical research and to access and understand results, outreach to populations with limited health literacy --NIH Clinical Research Awareness Effort (better understand consent to research) Agency for Healthcare, Research & Quality --Supports a number of research projects on health literacy and interventions to improve health literacy Pharmacy Intervention for Limited Literacy

17. HRSA --Internal working group on health literacy --Strategic plan includes specific objectives that address health literacy --Health literacy viewed as part of performance measure to increase access to high quality, effective and safe health care. --Bureau of Health Professions Grantee Performance Measure includes written institutional policy addressing health literacy. Measure will be tracked --Funds grant projects that support recommendations IMPACT: Integration in organizational objectives

18. IMPACT: Convening Activities --CDC Expert Panel on Populations at Risk for Poverty, Low SES and No Health Insurance convened to address health communication issues of vulnerable populations --JCAHO Roundtable on Health Literacy and Patient Safety (2005) and Symposium on Health Literacy: The Foundation for Patient Safety, Empowerment,& Quality Health Care—June 2006 --Surgeon General's Workshop on Improving Health Literacy (September 2006) (published Jan. 2008) -- U.S. Department of Health and Human Services' launches Town Halls on Improving Health Literacy (New York City on October 16, 2007

19. IOM Roundtable Convening Activities Health Literacy for Activated and Engaged Patients Informed Consent for Populations with Low Health Literacy and Implementing the National Health Education Standards in K-12 (2006) Organizational Change for Improving Health Literacy: Exploring Quality Management and Pay for Performance Strategies (2007) Changing Prescription Medication Use Container Instructions to Improve Health Literacy and Medication Safety (2007) Workshop on Health Literacy, eHealth, and Communication: Putting the Consumer First (2008)

20. Can We Confuse Patients Less?

21. Changing Prescription Medication Use Container Instructions to Improve Health Literacy and Medication Safety (2007) A Broken System Findings of the ACPF White Paper on Drug Labeling Michael S. Wolf, MA MPH PhD Assistant Professor and Director Health Literacy and Learning Program Division of General Internal Medicine Institute for Healthcare Studies Northwestern University

22. ACP Paper Findings Finding 1: Inadequate patient understanding of prescription medication instructions and warnings is prevalent and a significant safety concern. Finding 2: Lack of universal standards and regulations for medication labeling is a “root cause” for misunderstanding and medication error. Finding 3: Evidence should guide all label content and format. Finding 4: Instructions on the container label should be clear and concise. Language should be standardized. Finding 5: Drub labeling should be viewed as part of an integrated system of patient information.

23. Wolf: Summary Rx container label most important to patients (‘last line of information support’) Variability a likely root cause of med errors Dosage instructions primary focus for change View labeling as a system of patient information Seek improvement, set evidence–based standards

24. A Potential Solution? Simplifying Medication Scheduling Can We Confuse Patients Less? Alastair J.J. Wood, M.D., F.A.C.P. Symphony Capital LLC

25. Possible Solution? Uniform Medication Schedule

26. Possible Solution? Unified Medication Schedule Simplifies dosing schedule No loss of efficacy Improves patient understanding Improves patient adherence Reduces errors Reduces variability Improves outcome

27. Response to Recommendations-IMPACT www.nap.edu

28. Other Resources You Should Know About HRSA Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency - free on-line learning experience to help you improve your patient communication skills increase your awareness and knowledge of the three main factors that affect your communication with patients: health literacy, cultural competency and low English proficiency implement patient-centered communication practices that demonstrate cultural competency and appropriately address patients with limited health literacy and low English proficiency www.train.org or http://www.hrsa.gov/healthliteracy/training.htm www.train.org

29. Resources You Should Know About Assessing Health Literacy in Clinical Practice http://www.medscape.com/viewprogram/8203 (A one-time, free registration is required to view content on Medscape.) http://www.medscape.com/viewprogram/8203 Assuring Quality Care for People With Limited Health Literacy http://www.medscape.com/viewprogram/8603 (A one-time, free registration is required to view content on Medscape.) http://www.medscape.com/viewprogram/8603

30. Roundtable on Health Literacy www.iom.edu/healthliteracyroundtable