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National Network of Libraries of Medicine
MidContinental Region
2010 USPHS Scientific and Training Symposium
Dana Abbey, MLSWednesday – May 26, 2010
2:30-3:00p
National Network of Libraries of Medicine
MidContinental Region
Learning Objectives
Recognize the impact low health literacy has on patient care
Name five resources and strategies to improve health information literacy
Describe the health literacy services offered by the library
National Network of Libraries of Medicine
MidContinental Region
What is Health Literacy?
“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
Healthy People 2010
National Network of Libraries of Medicine
MidContinental Region
Skills Needed for Health Literacy Evaluating information for credibility and
quality Analyzing relative risks and benefits Calculating dosages Interpreting test results Locating health information
National Network of Libraries of Medicine
MidContinental Region
Skills Also Include
Visually literate (able to understand graphs or other visual information)
Computer literate (able to operate a computer)
Information literate (able to obtain and apply relevant information)
Numerically or computationally literate (able to calculate or reason numerically)
National Network of Libraries of Medicine
MidContinental Region
What Factors Affect Health Literacy? Health literacy is dependent on individual
and system factors Communication skills Information and knowledge Culture and language Demands of the system Learning disabilities Cognitive declines in older adults Lack of educational opportunity
National Network of Libraries of Medicine
MidContinental Region
Why is Health Literacy Important? Low health literacy is linked to…
Under-utilization of services Increased medication errors Poor knowledge about health Increased hospitalizations Poor health outcomes Increased healthcare costs
National Network of Libraries of Medicine
MidContinental Region
Who is at High Risk?
Elderly Low Income Unemployed Less than High School education Minority Ethnic Group Recent Immigrant English as a Second Language
You can’t tell by looking!
National Network of Libraries of Medicine
MidContinental Region
Health Literacy and Cancer Screening
Women with low health literacy are less likely to have had a mammogram or Pap test than women with higher health literacy skills
Source: Davis, et al (1996). Caner. Lindau, et al (2002). Am J Obstet Gynecol.
National Network of Libraries of Medicine
MidContinental Region
Health Literacy and HIV/AIDS Knowledge
Source: Kalichman, et al (2000). Am J Prev Med.
National Network of Libraries of Medicine
MidContinental Region
0 20 40 60 80 100
Percent of patients with diabetes correctly answering questions according to literacy level (low, moderate, high)
Need to Know: symptoms of low blood sugar (hypoglycemia)
Need to Do: correct action for hypoglycemic symptoms
LowModerate
High
LowModerat
e High
Source: Williams, et al (1998). Arch Int Med.
Health Literacy and Diabetes Management
National Network of Libraries of Medicine
MidContinental Region
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
Low-literacy Better literacy
$2,891
$10,688
Annual Healthcare Costs of Medicaid Enrollees
Source: Weiss, et al (2004). J Am Board Fam Pract.
(<3rd-grade reading level) (>4th-grade reading level)
Health Literacy and Healthcare Costs
National Network of Libraries of Medicine
MidContinental Region
How is Information Critical to Health Literacy? Health information is key to:
Patient and provider communication Shared health care decision making Understanding and following directions Recognizing when to seek care Learning and adopting healthy behaviors
National Network of Libraries of Medicine
MidContinental Region
What are the Challenges?
Health literacy in the U.S.
Readability of health materials
Health information and the Internet
National Network of Libraries of Medicine
MidContinental Region
Health Literacy in the U.S.
Intermediate
Basic
Below Basic
Proficient
14%
13%
44%
29%
93 million adults have basic or below health literacy skills
Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics (2006). http://nces.ed.gov/naal/health.asp
National Network of Libraries of Medicine
MidContinental Region
Readability of Health Information Adults, on average, read at an 8th grade level Health care information is generally written at a
college level Over 300 studies show health-related materials
far exceed the reading ability of U.S. adults Increasing number of studies show similar
results when looking at the readability of online health information
Source: NLM Bibliography—Understanding Health Literacy and Its Barriers (2004). www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html
National Network of Libraries of Medicine
MidContinental Region
Effective Communication Strategies Plain, non-medical language Speak slowly and clearly Limit content to 3-5 key points Repeat key points Be concrete – draw pictures, use
illustrations and/or models Encourage patients to ask questions Use the Teach-back method
National Network of Libraries of Medicine
MidContinental Region
Enhancing Patient Understanding 40-80 percent of the medical information
patients receive is forgotten immediately1
and nearly half of the information retained is incorrect Teach-back method is a way to confirm that
your patient understands what they need to know
National Network of Libraries of Medicine
MidContinental Region
Strategies to Improve Health Literacy Use “living room” language
Limit information (3-5 key points)
Use easy-to-read print materials
Practice teach-back
Use Information Rx
Address culture and language needs
National Network of Libraries of Medicine
MidContinental Region
“Living Room” Language
Name common terms for…
Hypertension Insomnia Benign Hazardous Disorder Option Poultry Routinely
National Network of Libraries of Medicine
MidContinental Region
Information Rx
Health literacy intervention
Empowers patients Reduce the
number of poor quality Internet searches
http://www.informationrx.org
National Network of Libraries of Medicine
MidContinental Region
Brown Bag Medication Review Improve communication about medications
“Out of 10-15 brown bag reviews, only 2 were accurate.”
“Out of five brown bag reviews, we found three that had duplicate medicine bottles resulting in double dosing and one discontinued medicine that was still being taken.”
“We found errors in every review, including one where a patient stopped the provider did not know about, and others where the medicines did not match what was in the chart.”
National Network of Libraries of Medicine
MidContinental Region
Medication Safety
Prescriptions filled Average number per
year: 11.5 Average number for
persons 60 and over: 15.6
10% of all hospital admissions are the result of patients not taking medications correctly
28% of all hospital admissions for those over 65 are caused by medical non-compliance
$414 billion projected sales
National Network of Libraries of Medicine
MidContinental Region
Medication Identification
Drug Digest –www.drugdigest.org/
Pill Identification Wizard - http://www.drugs.com/imprints.php
Pillbox beta –http://pillbox.nlm.nih.gov/
DailyMed – http://dailymed.nlm.nih.gov/dailymed/prdsearch.cfm
Drug Information Portal –http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp
National Network of Libraries of Medicine
MidContinental Region
Health Literacy Universal Precautions Toolkit http://www.nchealthliteracy.org/toolkit/
After implementing some of these tools, we really felt like we were more able to connect with our parents about the health of their child. ” -MD, urban pediatric practice
“This toolkit made us more aware of the challenges that our patients face and guided us to make meaningful changes throughout our practice.”-Office manager, rural family practice clinic
National Network of Libraries of Medicine
MidContinental Region
MedlinePlus
www.medlineplus.gov Over 800 health topics NIHSeniorHealth In English and
Spanish 165 interactive
tutorials on procedures and conditions in easy-to read language
47 other languages No advertising No endorsements Anatomy videos Medical pictures Prescription
information Alternative
medicine/therapies
National Network of Libraries of Medicine
MidContinental Region
Refugee Health Information Network http://rhin.org/ Collaboration of health professionals
serving refugee populations Identify, collect and archive materials
produced in refugee languages Brochures, fact sheets, audio, and video
formats FREE!
National Network of Libraries of Medicine
MidContinental Region
SPIRAL http://spiral.tufts.edu/ 9 Asian languages Search by topic or language Links to Asian-language patient care
documents Materials created by non-profit health
agencies and organizations FREE!
National Network of Libraries of Medicine
MidContinental Region
How Can Librarians Help? Free access to the Internet Information Rx Program Patient information packets Consumer health collection Native language resources Teaching and training Virtual chat / email assistance Health literacy workgroup
National Network of Libraries of Medicine
MidContinental Region
“The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care.”
The Joint Commission
Source: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety. The Joint Source: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety. The Joint Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm
National Network of Libraries of Medicine
MidContinental Region
Take Home Points
Accurate and reliable health information is critical to health literacy
Health literacy practices improve health outcomes
There are numerous free consumer health resources to improve health information literacy
Librarians are a valuable resource in helping patients and caregivers locate appropriate consumer health information
National Network of Libraries of Medicine
MidContinental Region
Learning Objectives Revisited Recognize the impact low health literacy
has on patient care Name five resources and strategies to
improve health information literacy Describe the health literacy services
offered by the library
National Network of Libraries of Medicine
MidContinental Region
Thank You!
Dana Abbey, MLSNational Network of Libraries of Medicine, MidContinental Region
University of Colorado Denver, Anschutz Medical CampusToll Free 1-800-338-7657, select option 1, then option 2, then option 3
http://nnlm.gov/mcr/
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