communicating with patients: information that matters
DESCRIPTION
Brief review about health literacy, communicating with patients, and shared decision makingTRANSCRIPT
Communicating with Patients: Information that MattersLisa F. Han, MPHPartner, Insight Therapeutics
April 19, 2013
Objectives Define health literacy and describe
those at highest risk Recognize barriers for patients with low
literacy Discuss strategies for improving
communication with patients and family caregivers
April 19, 2013
Health literacy the degree to which an individual has
the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.
Patient Protection and Affordable Care Act of 2010, Title V
April 19, 2013
Poor health literacy Lack basic skills to
execute recommended preventive care and treatment – 1/3 of US population, only 12% considered proficient
April 19, 2013
Groups at higher risk of poor literacy
Elderly, poor, minorities English not first language Low education (poor
surrogate though)
Source: ihealthtran.com
April 19, 2013
Execute
proper inhaler
use techniq
ues
Modify insulin dose based on
food intake/fingerstick
s
Manage administration of
multiple medications Recogn
ize hypoglycemia sympto
ms
ProficientHealth
Literacy
Take two tablets by mouth twice daily
States correctly
Health literacylevel*
Demonstrated correctly
71% Low (6th grade or below)
35%
84% Marginal 63%
89% Adequate 80%
April 19, 2013
Davis T, Wolf MS, Bass PF et al. Ann Intern Med 2006
Almost half of patients misunderstood 1 or more of prescription label instructions
* REALM Score
Poor literacy leads to…
April 19, 2013
Missed appointments
Medication errors and adverse events
Low use of preventive services
Preventable hospital visits and admissions
High cost – $106-$238 billion annually
Higher mortality
You can’t tell by looking
whether someone has skills to adequately understand health concepts and carry out health care instructions.
April 19, 2013
Signals – indicators of possible limited health literacy Incomplete forms Nonadherence with treatment
regimens Excuses
Forgot my glasses Need to bring home to discuss with
family member Does not know medications names or
what they are for Many missed appointments Poor follow-through
Referral appointments, labs, imaging
Many people show no signals
April 19, 2013
Factors Related to Understanding General ability to read and write Experience in the health care system Complexity of information presented Culture Method of communication
36% of American adults have basic or below basic skills; about 60% of those age 65 and
older have basic or below basic skills
April 19, 2013
Weiss B. Health literacy and patient safety: Help patients understand. AMA Foundation 2007.
How can we improve? Simple, plain language (for all
patients) Slow down Visual images are helpful for
many patients Limit information quantity Repetition Teach-back Encourage questions
April 19, 2013
Weiss B. Health literacy and patient safety: Help patients understand. AMA Foundation 2007.
Shared Decision Making
is the goal
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So what is Shared Decision Making
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Must include o Options (including
no treatment)o Potential risks and
benefitso Patient preferenceso Should be balanced
and unbiased
“Collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available as well a the patient’s values and preferences”
Rationale for shared decision making Many decisions have no 'best choice'—more
than one appropriate option Evidence uncertain Need to consider
Benefits and harms Values & preferences Practical aspects
April 19, 2013
PCORI1. “Given my personal characteristics,
conditions and preferences, what should I expect will happen to me?”
2. “What are my options and what are the potential benefits and harms of those options?”
3. “What can I do to improve the outcomes that are most important to me?”
4. “How can clinicians and the care delivery systems they work in help me make the best decisions about my health and healthcare?”
April 19, 2013
Decision Aids
April 19, 2013
http://shareddecisions.mayoclinic.org/files/2011/08/Diabetes-Choice-Pamphlet.pdf
Adjunct to prepare patients for decision making
Provides information on the alternatives, benefits, and risks appropriate for patients' clinical condition
http://summaries.cochrane.org/CD001431/decision-aids-to-help-people-who-are-facing-health-treatment-or-screening-decisions
Health Decisions
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Good decisions Informed Supported by best
evidence Compatible with
patients values Considers patient
preferences Weigh pros and cons Practical
Poor decisions Inadequate objective
data Too few options
considered Alternatives unclear Values and preferences
unexplored Roles unclear Poor communication May be impractical
Cornelia Rulandhttp://people.dbmi.columbia.edu/~cmr7001/sdm/html/shared_decision_making.htm
Shared Decision Making Month – March 2013-We missed it!
http://informedmedicaldecisions.org/about-sdm-month/
April 19, 2013
Resources PCORI – Patient Centered Outcomes Research
Institute |www.pcori.org
US Department of Veterans Affairs | http://www.va.gov/geriatrics/guide/longtermcare/Shared_Decision_Making.asp
AHRQ | http://www.innovations.ahrq.gov/issue.aspx?id=85
Dartmouth Hitchcock Center for Shared Decision Making |http://patients.dartmouth-hitchcock.org/shared_decision_making.html
Informed Medical Decisions Foundation |http://informedmedicaldecisions.org/
April 19, 2013