Health Communications In The Ultrasound Department Mira L. Katz, Ph.D., M.P.H. University of North Carolina at Chapel Hill
Literacy Facts About Adults Living In The United States • Average reading level: 8th to 9th grade • About 1 out of 5 adults read at or below the 5th grade level • Almost 2 out of 5 adults read below the 5th grade level: older Americans (> 65 years) and inner-city minorities Doak, Doak, & Root1996
Literacy Facts About Adults Living In The United States • 40 - 44 million Americans (21%) cannot read or write and another 50 million (25%) have only marginal reading skills (1992 National Adult Literacy Survey, U.S. Dept. of Education) • Low literacy is associated with poor health outcomes-Indirect (poverty, employment in hazardous jobs) - Direct (not properly caring for chronic medical conditions) (Ad Hoc Committee on Health Literacy, JAMA 1999) • Estimated additional annual healthcare expenditures due to low health literacy were about $73 billion in 1998 healthcare dollars(The Center for Health Care Strategies and the National Academy on Aging, 1998)
Functional Health Literacy Functional health literacy is a constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the healthcare environment. Patients with adequate health literacy can read, understand, and act on healthcare information. Ad Hoc Committee on Health LiteracyAmerican Medical Association JAMA, 1999
“Blockage in the blood vessel in your neck that takes blood to your brain” Vocabulary of medicine “Internal Carotid Artery Stenosis”
Examples • Prescription drug errors: “Take 1 teaspoon orally 3 times a day until all is taken” • Physician communication: “I think we are going to have to move him to the floor”
Information provided to the patient prior to undergoing procedure 50 39 Percen t 32 33 28 18 0 0 Katz Unpublished data
Reading Levels Of Healthcare Materials Avg. reading skill # of materials Reading grade level Doak, Doak1992
Reading Level: Grade 14+ A physician trained in the diagnostic and/or therapeutic use of X-rays and radionuclides, radiation physics, and biology; a diagnostic radiologist may also be trained in diagnostic ultrasound and magnetic resonance imaging and applicable physics.
Implications: Ultrasound Department • Patients with low health literacy may: • Arrive on the wrong day or time • Improperly prepare for the ultrasound procedure • Be anxious/fearful about the procedure • Provide an inaccurate medical history • Not understand the informed consent documents • Not follow verbal directions during the procedure or post procedure instructions • Not understand the results of the test • Not be satisfied with their care
Communications - Health Literacy Improving Productivity with Six Sigma Methodology LaConte, 2001www.gemedicalsystems.com
Image quality improves Earlier diagnosis 1991 2001
Advances in ultrasound equipment Allows us to re-visualize where disease process begins Causes us to make changes to the diagnostic criteria Makes us change how we communicate with healthcare professionals and patients (Remember: how we communicate shapes and misshapes patients’ perceptions/understanding) Are we changing the human experience of disease?
Health Literacy “The goal of health literacy is enabling patients,caregivers, healthcare consumers, and policymakers to make the best-informed decisionsthey can concerning health-related issues and to act appropriately upon these decisions.” S.J. Giorgianni Patient-centered model: Recognizes and respects the patient’s knowledge, culture, beliefs, needs, and experiences.
Future Challenges See beyond the boundaries of the “ultrasound community” • Healthcare Professionals • Ultrasound Division