1. Preventive Medicine and Patient Education Committee

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

3. 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.

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

5. 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”

6.  90 million Americans scored Basic or Below Basic (functionally illiterate) (10)  Source of Perceived Noncompliance

7. 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) +0.12 (syst)±0.05(theor)×10 6 cm -2 s -1. (4)

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

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

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

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

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

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

14. Sources: Spencer, G., & Hollmann, F. W. (1998). National population projections. In U.S. Census Bureau, Population profile of the United States: 1997. U.S. Census Bureau (2004). International Data Base, Table 094 http://www,census.gov/ipc/www.idbprint.html> Projected Growth of Population by Ethnicity: 1990, 2000 and 2050

15.  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)

16.  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)

17. 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:

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

19. 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)

20. 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

21. 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

22. 1. American Society on Aging and American Society of Consultant Pharmacists. (2006). Adultmeducation. Retrieved November 10,2008, from http://www.adultmeducation.com/. http://www.adultmeducation.com/ 2. Bass, P., Wilson, J., & Griffith, C. (2003, December 1). A shortened instrument for literacy screening. Journal Of General Internal Medicine, 18(12), 1036-38. 3. Bass, P., Wilson, J., Griffith, C., & Barnett, D. (2002, October 1). Residents' ability to identify patients with poor literacy skills. Academic Medicine, 77(10), 1039-41. 4. 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), 3720-3724. 5. 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), 934-38.

23. 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, S85-95. 7. 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, 433-5. 8. 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), 119-22. 10. 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 2006-483). Retrieved February 8, 2008, from U.S. Department of Education: http://nces.ed.gov/pubs2006/2006483.pdf.

24. 11. Mayer, G. (2003). Confessions of a health illiterate. Healthcare Advances, 5(2), 2. 12. 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, 374-8. 14. 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, 475-82. 15. 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), 395-404.

25. 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), 45-49. 17. Volandes, A., & Paasche-Orlow, M. (2007, November 7). Health literacy, health inequality and a just healthcare system. American Journal of Bioethics, 77(11), 5-10. 18. Weiss, B., & Coyne, C. (1997). Communicating with patients who can cannot read. New England Journal of Medicine, 337(4), 272-274. 19. 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.