Effective Use of “Play It Safe…With Medicine!”

AAFP Toolkit and Health Literacy Resources

Charles P. Mouton, MD, MS

Professor, Dept of Community and Family Medicine

Howard University College of Medicine

2008

OBJECTIVES

• Upon completion of this session participants will be able to:– Implement improved methods of verbal and written

communication– Assist patients in understanding how to take

medications as prescribed– Incorporate practical strategies to create a shame-

free environment– Assess health literacy using clinically validated

instruments– Determine readability of documents using the Flesch-

Kincaid reading level

Issue of Health Literacy

• Functional health literacy is a measure of a person’s capacity to function effectively in the health care setting as determined by their comprehension of written health care materials and by their ability to understand and act on numerical health care instructions

• up to 50% of the U.S. population has some level of health ILLITERACY

HEALTH ILLITERACY

• associated unfavorable health outcomes:– higher prevalence of chronic diseases– greater use of emergency care– higher incidence of hospitalization and longer

hospital stays– higher incidence of unfavorable reactions to

prescribed medications

• TRANSLATION: $$$

Health Literacy in the Office Setting

• Impacts doctor-patient communication• Impacts adherence to treatment plans• Impacts patient satisfaction• Leads to poor quality indicators• Leads to unnecessary hospitalizations• Health literacy researchers have recommended

that prevention efforts to educate and improve treatment of chronic disease, especially in low literacy patients should be designed and implemented

Toolkits

Useful to improve health literacy patients around medication usage

PLAY IT SAFE with MedicineComponents:

Patient Education Brochure: English &

SpanishEducation CDs: Patient &PhysicianPrescription pad samplePill Bottle stickersDemonstration pill box

Patient Education Brochures

100 English and 50 Spanish

• Word Meaning

• “Patient Power”

• Understanding how to take medication

• Medication Safety ideas

Education CDs

• Patient Education DVD– Meant to be played in waiting room

• Physician Education– The ETHNIC mnemonic to assist you in

interviewing patients– A listing of cultural considerations– Resources

Other stuff

• Prescription Pad Sample Cover– Adds language to Rx for labeling

• Cartoon pill bottle stickers– Heart, lung, stomach, hand, diabetes (sugar)

• Pill Box for demonstration

AMA Foundation ToolkitHealth literacy and patient safety:

Help patients understand

• DVD instructional video

• CD-ROM educational video

• Tear off educational pads for doctor visits

• Campaign Buttons

• Manual for Clinicians

Survey Instruments

• TOFHLA– Test of Functional Health Literacy in Adults

• REALM– Rapid Estimate of Adult Literacy in Medicine

• Newest Vital Sign

Rapid Estimate of Adult Literacy in Medicine

• Developed in early 1990’s by Davis and colleagues

• Comparable to formal reading assessments ( corr coef 0.8-0.9)

• Cronbach’s alpha 0.96

EXAMPLE: pg 18

Newest Vital Sign

• Developed by Weiss et al. in 2005

• Comparable to TOFHLA

• Corr coef of 0.64

• Cronbach’s alpha of 0.78

• EXAMPLE: pg 20

Flesch-Kincaid Reading Level

• The Flesch-Kincaid Reading level measures textual difficulty and tells you the grade level of a text.

• The Flesch-Kincaid index tells how easy something is to read. It does this by counting the number of syllables in every word and the number of words in every sentence.

• The formula used to calculate the level is as follows:(0.39 x Average No. of words in sentences) + (11.8 x Average No. of syllables per word) - 15.59

• The number will represent a grade-school level– For example, a sentence with a score of 8.0 means that

someone in 8th grade could understand. Normal writing is usually between a 7 and an 8.

EXAMPLE

Conclusion

• Health literacy is important to patient safety and good quality of care

• Physician offices need to be prepared to assist their patients with health illiteracy

• Simple toolkits are available from AAFP and AMA

• Simpler test of literacy are available• Educational material need to have a

reading level appropriate for patients