exploring the business and clinical cases for screening for health literacy in primary care: a case...
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Exploring the Business and Clinical Cases for Screening for Health
Literacy in Primary Care: A Case Study Using the NVS
Jonathan B. VanGeest, PhDSchool of Community Health
and PolicyMorgan State University
Verna L. Welsh, PhD, MPHRollins School of Public
HealthEmory University
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Verna L. Welch, PhD, MPH, Rollins School of Public Health, Emory University (co-PI)
Gregory Strayhorn, MD, Morehouse School of Medicine, Department of Family Medicine (co-I)
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Overview1.Define limited health literacy
2.Discuss the role of health literacy in health care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk patients
4.Outline clinical intervention to improve care for patients with limited health literacy
5.Study outcomes
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Overview1.Define limited health literacy
2.Discuss the role of health literacy in health care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk patients
4.Outline clinical intervention to improve care for patients with limited health literacy
5.Study outcomes
![Page 5: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School](https://reader036.vdocument.in/reader036/viewer/2022081513/56649eb45503460f94bbc33e/html5/thumbnails/5.jpg)
Health Literacy Is…“The degree to which individuals have the capacity to obtain, process, and understand basic health infor-mation and services needed to make appropriate health decisions.”-Healthy People 2010
Ability to perform essential health care tasks:
– Understand appointment slips– Follow health instructions– Obtain information about an illness– Participate in discussions of informed consent– Enroll in health insurance plan
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Not Simply a “Patient Problem”
• One with implications for quality shared by the provider, healthcare system, and community in partnership with the patient
• Implications for treatment as well as disease prevention/health promotion
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Overview1.Define the scope of limited health literacy
2.Discuss the role of health literacy in health care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk patients
4.Outline clinical intervention to improve care for patients with limited health literacy
5.Study outcomes
![Page 8: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School](https://reader036.vdocument.in/reader036/viewer/2022081513/56649eb45503460f94bbc33e/html5/thumbnails/8.jpg)
Health Literacy Is Needed to Navigate Health “Systems”
• Most patient instructions are written• Verbal instructions
– Often complex– Delivered rapidly– Easy to forget in stressful situation
• Increasingly complex health system– More medications– More tests and procedures– Greater self-care requirements– Participatory/informed decision-making
• Disease prevention/health promotion messages
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Outcomes Associatedwith Health Literacy
Health Outcomes General health status Hospitalization Emergency department use Prostate cancer stage Depression Diabetes control HIV control Mammography Pap smear Pneumococcal immunization Influenza immunization STD screening Cost
Behaviors Only Substance abuse Breastfeeding Behavioral problems Adherence to medication* Smoking*
Knowledge Only Birth control knowledge Cervical cancer screening Emergency department
instructions Asthma knowledge Hypertension knowledge
DeWalt, JGIM 2004
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Overview
1.Define the scope of limited health literacy
2.Discuss the role of health literacy in health care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk patients
4.Outline clinical intervention to improve care for patients with limited health literacy
5.Study outcomes
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Recommended Approachesfor Health Care Providers
• Use simple, everyday language• Stick to a 2-3 key points• Draw pictures, write down key instructions
for patients to take home• Effectively solicit questions:
“What questions do you have?”• Ask patients to “teach-back” the main
points to confirm understanding
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Problems
• Most clinicians often unaware of patient’s health literacy
• Unable to tailor the clinical encounter to the needs of patients
• Often identified solely as a patient education issue
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Patient Perspective
• Improve literacy• Patient Education• Empowerment in the clinical encounter– Ask Me 3
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Problems
• Complexity– Health literacy in context
• Expert Authority• Universal rather than targeted approach
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Overview
1.Define the scope of limited health literacy
2.Discuss the role of health literacy in health care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk patients
4.Outline clinical intervention to improve care for patients with limited health literacy
5.Study outcomes
![Page 16: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School](https://reader036.vdocument.in/reader036/viewer/2022081513/56649eb45503460f94bbc33e/html5/thumbnails/16.jpg)
Nurses
Physicians
Health Communication
Training
Patient
AHL
LHL
Level of Health Literacy (Score)
EMR
Clinical Intervention
AHL
LHL
Patient Outcomes
Immed. Post
6 Mth. Post
Sur vey
EMR
Sur vey
EMR
Improve Care
Reduce Disparities
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Identifying At-Risk Patients A bilingual (English and
Spanish) screening tool that identifies patients at risk for limited health literacy
Developed by Barry Weiss (University of Arizona)
Based on a nutrition label from an ice cream container
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Process Patient is given the label Asked 6 questions about how they would
interpret and act on the information Responses are recorded by a clinical staff
member, scored, and entered into the EMR Based on the number of correct responses,
the health care provider can assess the patient’s health literacy level
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Overview1.Define the scope of limited health literacy
2.Discuss the role of health literacy in health care, outcomes, and disparities
3.Discuss approaches to improve care for at-risk patients
4.Outline clinical intervention to improve care for patients with limited health literacy
5.Study outcomes
![Page 20: Exploring the Business and Clinical Cases for Screening for Health Literacy in Primary Care: A Case Study Using the NVS Jonathan B. VanGeest, PhD School](https://reader036.vdocument.in/reader036/viewer/2022081513/56649eb45503460f94bbc33e/html5/thumbnails/20.jpg)
Outcomes – Patient Characteristics
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Outcomes – Health Literacy
At-risk for LimitedHealth Literacy
Physicians were not identifying at-risk patients or using recommended communication practices
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Outcomes – Patient Reaction
Patients’ Reactions to Screening Over 95% of patients did not have problems with
screening for health literacy in primary care.
No difference in the reported prevalence of shame (p<0.33) by literacy level (Fisher’s Exact Test)
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Outcomes – Patient Reaction Patient Recommendations Regarding
Screening (n= 135)
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Outcomes - Patient
Fff
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Outcomes – Business Case
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Outcomes – Physician Utilization
Staff training increased awareness of the importance of health literacy and clear health communication
A majority (66.7%) also felt that using the NVS to identify patients with limited health literacy improved their quality of care they were able to deliver
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Outcomes – Physician Utilization
Over 60% also felt that scores helped in customizing their communication with patients
Observed tendency to revert back to their normal – pre-intervention – care processes and behaviors