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Health Impact of Low Literacy & Partnering to Address Solutions

Health Impact of Low Literacy & Partnering to Address Solutions . Paul D. Smith, MD, Associate Professor UW Department of Family Medicine Paul.Smith@fammed.wisc.edu. Topics today. Social determinants of health Impact of literacy on health and health care Collaboration in Wisconsin

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Health Impact of Low Literacy & Partnering to Address Solutions

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  1. Health Impact of Low Literacy & Partnering to Address Solutions Paul D. Smith, MD, Associate Professor UW Department of Family Medicine Paul.Smith@fammed.wisc.edu

  2. Topics today • Social determinants of health • Impact of literacy on health and health care • Collaboration in Wisconsin • Policy issues to consider

  3. Social Determinants of Health • Social determinants of health • Impact of literacy on health and health care • Collaboration in Wisconsin • Policy issues to consider

  4. In Their Own Words • Insert video clip here

  5. How Age Effects NALS Data • Adults age 60 and over • Living in households or prisons • 68-80% are in Level 1 and 2 • More in Level 1 and 2 with advancing age • 89-99% Level 1 and 2 age 80 and over

  6. Literacy Levels Change with Age BUT, they do not recognize their problem Age 60 and older • 91% Read well or very well • 88% Write well or very well • 83% Do arithmetic well or very well

  7. NAAL Health Literacy Assessment • Basic and Below Basic by education level • In High School, GED or HS grad 34-37% • Less than/some High School 76%

  8. NAAL Health Literacy Assessment • Basic and Below Basic by Self-reported health status • Excellent 25% • Very Good 28% • Good 43% • Fair 63% • Poor 69%

  9. The Impact of Low Literacy on Health • Poorer health knowledge • Poorer health status • Higher mortality • More hospitalizations • Higher health care costs

  10. Poorer Health Knowledge • Understanding prescription labels • 395 patients • 19% low literacy (6th grade or less) • 29% marginal literacy (7-8th grade) • 52% adequate literacy (9th grade and over) • 5 prescription bottles Literacy and Misunderstanding Prescription Labels. Davis et al. Ann Intern Med 2006;145:887-894

  11. Poorer Health Knowledge • At least one incorrect • 63% low literacy • 51% marginal literacy • 38% adequate literacy Literacy and Misunderstanding Prescription Labels. Davis et al. Ann Intern Med 2006;145:887-894

  12. Poorer Health Knowledge “Take two tablets twice daily” Stated correctly Demonstrated correctly 71% low literacy 35% 84% marginal literacy 63% 89% adequate literacy 80% “Show me how many pills you would take in one day.” Counted out 4 tablets-correct

  13. Poorer Health Status • 2923 new Medicare enrollees • Inadequate literacy had increased frequency of: • Diabetes • Hypertension • Heart failure • Arthritis

  14. Poorer Health Status • Medical Outcomes Study (SF-36) • Inadequate literacy had • Decreased: • Physical function • Mental health • Increased • Limitations in activity due to physical health • Pain that interferes with normal work activities

  15. Poorer Health Status Diabetics with retinopathy 36% 19%

  16. Increased Mortality • Age 70-79 • Reading level 8th grade or less • Five Year Prospective Study Sudore R, et al. Limited Literacy and Mortality in the Elderly. J Gen Intern Med 2006; 21:806-812.

  17. Increased Mortality Risk of Death Hazard ratio: 1.75

  18. More Hospitalizations 2 year hospitalization rate for patients visiting ED 31% 14%

  19. Increased Health Care Costs • Data • 2003 Medical Expenditure Panel Survey • 2003 National Assessment of Adult Literacy Low Health Literacy: Implications for National Health Policy. Vernon, J, Trujillo, A, Rosenbaum, S, DeBuono, B. Oct. 2007

  20. Increased Health Care Costs • Annual cost today: • Future costs based on today’s actions (or lack of action): Low Health Literacy: Implications for National Health Policy. Vernon, J, Trujillo, A, Rosenbaum, S, DeBuono, B. Oct. 2007 $106-238 Billion $1.6-3.6 Trillion

  21. Low Literacy is Overlooked • Patients do not volunteer their literacy problem • Many are ashamed • Some do not recognize their inadequate literacy • Lack of trust

  22. The Big Secret • % of low literate adults that have not told their:

  23. More likely to have Low Literacy • Older • Less education • Non-white

  24. More likely to have Low Literacy • Immigrants • Immigrate after age 12 >50% • NALS Level 1

  25. More likely to have Low Literacy • Low-income • Medical Assistance • Incarceration

  26. You Can’t Tell by Looking • Many Level 1 people don’t fit the stereotypes • 75 % born in USA • 50% are white • 40% hold full or part time jobs

  27. Other Issues Effecting Literacy • Visual Impairments • 60 and older 17% • 80 and older 36%

  28. Other Issues Effecting Literacy • Cognitive impairment • Learning disability • 65 and older • 6% severe dementia • 10-15 % mild-moderate • Increases with advancing age

  29. Screening for Low Literacy • Upside-down test • Rapid Estimate of Adult Literacy in Medicine • REALM • Test of Functional Health Literacy in Adults • TOFHLA • Newest Vital Sign • NVS

  30. Common Clues of Low Literacy • Patients say things like: • “I lost my glasses” • “I don’t need to read this through now, I’ll read it when I get home” • “I’d like to discuss this with my family” • “I have a headache now and can’t focus

  31. Common Clues of Low Literacy • Medication review • Looking vs reading • Unable to name med • Do not know why taking med • Do not know medication timing

  32. Common Clues of Low Literacy • Non-compliance • Medications • Testing • Consultations

  33. How do we fix this problem? • Universal Design • If it works for people with low literacy or low English skills, it will work for everyone.

  34. Barriers to Effective Communication • Environmental factors • Noise • Lack of privacy • Distractions • Time constraints

  35. Barriers to Effective Communication • Health care provider factors • Jargon • Lack of rapport • Ambiguous wording • Incomplete message • Too much information

  36. Barriers to Effective Communication • Patient factors • Language • Cultural issues • Lack of trust • Hearing impairment • Visual impairment

  37. Summary Low literacy is a common problem Low literacy affects health

  38. Summary Low literacy is hard to identify Most of our documents are written at a reading level that is too high.

  39. Policy Issues to Consider • Healthcare Social Marketing • ABE ELL, family, workforce and corrections programs.

  40. What can YOU do? • Raise awareness • American Medical Association Foundation • Low Health Literacy: You Can't Tell By Looking • Health Literacy: Help Your Patients Understand • Institute of Medicine • Prescription to End Confusion

  41. What can YOU do? • Be a patient. • Review processes • Review documents

  42. What can YOU do? • Universal Design • Health Literacy Definition • The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed tomake appropriate decisions regarding their health.

  43. Understandable Consent Forms • A consent process that checks understanding • Documents written at 5th grade reading level • Procedures • Research • Billing/insurance

  44. Informed Consent • Who are We Really Protecting? • Institutions • Researchers • Sponsors • Patients?

  45. Other Consenting Methods • Script with verbal consent • Computer consent • Video/DVD

  46. What can YOU do? Partner with your local Literacy Council Connie Solsrud Executive Director Marathon County Literacy Council 300 N. 1st Street, Wausau 715-261-7292

  47. What can YOU do? Partner with your local Literacy Council Jennifer Lund Director The Neighbors’ Place 745 Scott Street, Wausau 715-845-1966

  48. Wisconsin Literacy • Coordinating organization for community-based adult literacy organizations. • 52 Organizations scattered around the state. • Four Regional Literacy Consultants.

  49. Wisconsin Literacy • www.wisconsinliteracy.org • Michele Erikson, director • 608-257-1655 • michele@wisconsinliteracy.org

  50. Health Literacy Regional Meetings • Steering Committee volunteers needed • Sponsors needed

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