retooling the pharmacist to improve health literacy

Retooling the Pharmacist to Improve Health Literacy

Jennifer O’Callaghan, PharmDPGY1 Community Pharmacy Resident

University of Wisconsin Hospital and Clinics

Disclosure Statement

I have no conflict of interest to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation.

Learning Objectives

Identify ways pharmacy staff and other healthcare providers can recognize patients with low health literacy.

Define the Wisconsin Pharmacy Quality Collaborative (WPQC) program.

Describe ways the Wisconsin Pharmacy Quality Collaborative (WPQC) is identifying patients with low health literacy and implementing services aimed at improving medication adherence.

Health Literacy

Ability to understand: prescription drug bottles educational brochures doctor’s directions consent forms

Ability to calculate medication dosages

Ability to interpret test results

Identification of Patient with Low Health Literacy

“Even very literate people may have trouble obtaining, understanding, and using health information:  a surgeon may have trouble using an insurance form, a science teacher may not understand information about a test of brain function, and an accountant may not know when to get a mammogram.”

Identification of Patient with Low Health Literacy

Ask for medications by color or shape

Unable to explain purpose or dosing of medication

Non-compliance with medications

Lack of follow through on labs

Incomplete registration forms

Identification of Patient with Low Health Literacy

May need more time to make health care decisions

Patients may hide their lack of understanding or may not even realize they have trouble understanding

Take 2 tablets twice daily

Low health literacy 71% believed they understood the directions 35% able to demonstrate properly

Marginal health literacy 84% believed they understood the directions 63% able to demonstrate properly

Adequate health literacy 89% believed they understood the directions 80% able to demonstrate properly

Creating the Right Environment for Health Literacy

Fostering Open and Welcoming Attitudes

Smile and acknowledge the patient Always introduce yourself Speak in a slow, relaxed pace in a

conversational tone Listen and be empathetic Encourage patients to ask questions Ask “Am I clear?”

Fostering Open and Welcoming Attitudes

Use interpreter services if available Use signs with pictures to tell patients

where to go and what they need Provide a waiting area Decorate the pharmacy

Maintaining Consistency

Use larger prints Use 12-point Times or 11-point Arial Include brand and generic names Include medication purpose Use the same generic if possible Post questions to ask pharmacist

What is this medication for? What are the side effects?

Incorporating Basic Healthcare Information

Use multiple types of learning styles People typically only remember 50% of what

they hear

Create written materials at 8th grade or lower (Goal for 5th grade reading level is best) Average reading level: 8-9th grade Patient education materials in chain

pharmacies 2% of materials at 7-8th grade 69% of materials at 9-12th grade 29% of materials at 12th grade or higher

Incorporating Basic Healthcare Information

Avoid difficult medical terminology

Screening Oral Mental Health Monitor

Dermatologist Diabetes Annually Cardiovascular

Immunization Diet Depression Referral

Contraception Hygeine Respiratory problems

Eligible

Hypertension Prevention Community Resources

Arthritis

Incorporating Basic Healthcare Information

2012 United States Pharmacopeial (USP) Convention Standards Use explicit directions Avoid from necessity of numerical skills

Examples

“Take 2 tablets twice daily”

“Take 2 tablets in the morning and take 2 tablets

in the evening”

“Take 1 tablet every 4 to 6 hours”

“Take 1 tablet 4 to 6 times daily”

“Take 1 tablet at 8am”“Take 1 tablet at the same

time every morning”

Incorporating Basic Healthcare Information

Use a Pill Chart

Morning Afternoon Evening Night

Name: Sarah Smith Date Created: 12/15/12Pharmacy phone number: 123-456-7890

Name Used For Instructions

Simvastatin20mg

Cholesterol

Take 1 pill at night

Furosemide20mg

Fluid Take 2 pills in the morning and 2 pills in the evening

Insulin70/30

High blood sugars

Inject 24 units before

breakfast and 12 units before

dinner

24 units 12 units

Incorporating Basic Healthcare Information

Focus on how to incorporate medications and health changes into the patient’s current lifestyle

Create a medication list for patients to bring to all appointments

Give patients a plan for their goals or other healthy lifestyle changes

Wisconsin Pharmacy Quality Collaborative (WPQC)

WPQC is an initiative of the Pharmacy Society of Wisconsin (PSW) that is designed to engage health plans and pharmacy providers in a collaborative effort to improve medication use in Wisconsin

WPQC has established a credentialing Process and uniform set of pharmacist-provided medication therapy management services for participating Wisconsin pharmacy providers.

Show and Tell

Showing the patient what the medication looks like

What your pharmacist did for you today

Updated your information Checked your records

Allergies Interactions Safe and effective medications for your age and conditions Ways to save you money

Reviewed with you Why you are taking your medication How to take your medication How you can monitor your own therapy When to contact your doctor

Teach-back Method

Teach-back is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands

Ask the patient to explain to you what you taught them

Common Questions to Use for Teach Back

“I want to be sure that I explained your medication correctly. Can you tell me how you are going to take this medicine?”

“We covered a lot today about your diabetes, and I want to make sure that I explained things clearly. So let’s review what we discussed. What are three strategies that will help you control your diabetes?”

“What are you going to do when you get home?”

WPQC and Health Literacy

Offers customized patient services and private medication appointments to ensure patients best understand their medications

Health Literacy Criteria

Requires the use of a trained medical translator

Is unable to demonstrate pill count(s) Is familiar with personal medications by

color only Is unable to read or is suspected to have

very low literacy Is suspected to have adherence problems

due to low literacy Takes medications obtained from another

country

WPQC Interventions

Focused adherence intervention Use lifestyle cues

Set medications by kitchen if taken with food

Set medications by bedside table if taken at bedtime

Use pill boxes Use alarms Create a schedule

WPQC Interventions

Comprehensive medication review and assessment Personalized medication appointment

Medications use, directions, and side effects teaching

Device technique review Adherence consult

How to refer your patients for a medication appointment

Patients with Medicaid, Unity, UnitedHealth Care, and Network Health are eligible

Check out pswi.org for a list of all participating pharmacies

Questions?

Jennifer O’Callaghan, PharmDPGY1 Community Pharmacy Resident

University of Wisconsin Hospital and Clinics