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Retooling the Pharmacist to Improve Health Literacy

Retooling the Pharmacist to Improve Health Literacy. Jennifer O ’ Callaghan, PharmD PGY1 Community Pharmacy Resident University of Wisconsin Hospital and Clinics. Disclosure Statement.

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Retooling the Pharmacist to Improve Health Literacy

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  1. Retooling the Pharmacist to Improve Health Literacy Jennifer O’Callaghan, PharmD PGY1 Community Pharmacy Resident University of Wisconsin Hospital and Clinics

  2. 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.

  3. 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.

  4. 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

  5. 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.”

  6. 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

  7. 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

  8. 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

  9. Creating the Right Environment for Health Literacy

  10. 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?”

  11. 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

  12. 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?

  13. 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

  14. Incorporating Basic Healthcare Information • Avoid difficult medical terminology

  15. Incorporating Basic Healthcare Information • 2012 United States Pharmacopeial (USP) Convention Standards • Use explicit directions • Avoid from necessity of numerical skills • Examples • “Take 2 tablets in the morning and take 2 tablets in the evening” “Take 2 tablets twice daily” “Take 1 tablet every 4 to 6 hours” “Take 1 tablet 4 to 6 times daily” “Take 1 tablet at the same time every morning” “Take 1 tablet at 8am”

  16. Incorporating Basic Healthcare Information • Use a Pill Chart Afternoon Morning Evening Night

  17. 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

  18. 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.

  19. Show and Tell • Showing the patient what the medication looks like

  20. 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

  21. 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

  22. 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?”

  23. WPQC and Health Literacy • Offers customized patient services and private medication appointments to ensure patients best understand their medications

  24. 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

  25. 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

  26. WPQC Interventions • Comprehensive medication review and assessment • Personalized medication appointment • Medications use, directions, and side effects teaching • Device technique review • Adherence consult

  27. 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

  28. Questions? Jennifer O’Callaghan, PharmD PGY1 Community Pharmacy Resident University of Wisconsin Hospital and Clinics

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