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The Impact of Poor Health Literacy in Patients with COPD

The Impact of Poor Health Literacy in Patients with COPD

Health literacy has been defined as the ability to obtain, process, and understand the basic health information that is needed to make appropriate healthcare decisions. Studies have shown that many adults in the United States have limited health literacy. This can lead to underuse of preventative services, worse self-management skills, and poor outcomes among patients with chronic diseases. “The role of health literacy in COPD and its effect on health status and outcomes have received relatively little attention in clinical studies,” says Theodore A. Omachi, MD, MBA. “Understanding the role of health literacy in COPD outcomes is critical to informing communication strategies in clinical settings and developing appropriate self-management support approaches.” Poor Health Literacy and COPD Outcomes In the Journal of General Internal Medicine, Dr. Omachi and colleagues had a study published that explored the links between poor health literacy and COPD-related health and outcomes in 277 patients with the disease. The analysis measured health literacy with a validated three-item questionnaire that can be incorporated readily into routine clinical practice: “How often do you have someone like a family member, friend, hospital or clinic worker, or caregiver help you read hospital materials?” “How often do you have problems learning about your medical condition because of difficulty understanding written information?” “How confident are you filling out medical forms by yourself?” Scores on the questionnaire were then tabulated to measure health literacy on a point scale ranging from 3 to 15. “It’s becoming increasingly clear that improving self-management is key to preventing poor outcomes in chronic diseases.” According to the study, lower health literacy scores were associated with worse outcomes, including...

Dumbing it Down: Where to Draw the Line?

Dumbing down medical information for patients can come in different forms. Some docs only provide the basics as to not overwhelm patients. Others may use a patronizing “you’ll be okay” tone that may be misleading. And recently a physician diagnosed a patient with “ghetto booty” instead of lumbar lordosis in an attempt to use slang to better explain a condition. So when is dumbing down technical verbiage to patients too dumb, dangerous – or offensive? The growing focus on health literacy is necessary, especially for those with a low literacy rate or for whom English is not their primary language.  The average American adult reads at a 7th to 8th grade level, so the American Medical Association, the NIH, and the U.S. Department of Health and Human Services encourage patient education materials to be written at a 4th to 6th grade reading level. But at what point does providing only basic information hinder patients from being advocates in their own care? Many healthcare professionals struggle with where to draw the line when it comes to effectively and clearly communicating information to their patients. Not every patient wants—or is capable—of handling the same amount of information. Healthcare professionals have to read the patient and situation to determine how much information to relay. Too much information may overwhelm patients or disclosing too many details of side effects may scare patients away from necessary treatment. At the same time, physicians are learning the hard way that automatically defaulting to the lowest common denominator may not always be the right answer or what’s in the patient’s best interests. Physician’s Weekly wants to know…Where...

Communicating More Effectively at ED Discharge

Emergency physicians face unique challenges in providing high-quality care due to distractions and time limitations that are common throughout ED settings. In most cases, emergency physicians have little or no previous knowledge of the patients they see. According to Margaret E. Samuels-Kalow, MD, MPhil, effective communication is paramount when patients are discharged from the ED, but this element is often overlooked. “Discharge communication is often an afterthought in the ED,” she says. “We’re limited to brief exchanges of forms and prescriptions, leaving patients with uncertainty about their care plan and increasing their risks for more health issues down the line.” Further complicating matters is that many patients and families who arrive at EDs have limited health literacy, do not speak English, or have had difficult experiences with the healthcare system. “These types of patients are at risk for being discharged from the ED without comprehending instructions from emergency personnel,” says Dr. Samuels-Kalow. Seizing Communication Opportunities Effective discharge communication provides an opportunity for emergency personnel to summarize patient visits and teach them how to safely care for themselves at home, Dr. Samuels-Kalow says. “It also gives ED physicians a chance to address any remaining questions or concerns. We can help connect patients to providers who can best manage their needs after discharge. Focused interactions with nurses and physicians are opportunities for education during the entire ED stay.” In the August 2012 Annals of Emergency Medicine, Dr. Samuels-Kalow and colleagues published a review that discussed the roles of content, delivery, comprehension, and implementation in identifying patient understanding of ED discharge instructions (Table 1). “It’s imperative that instructions are complete and understandable...

Predicting Preadmission Medication Understanding

In the hospital setting, it is vitally important that patients understand their medication regimen. Patients are often the primary source of information when physicians take a medication history for medication reconciliation. If patients don’t understand their preadmission medication regimen, their risk for errors in inpatient and post-discharge medication orders increases. “Lower health literacy, impaired cognition, and a higher number of medications can affect the accuracy of patient-reported medication regimens.” Few studies have examined how well patients understand their preadmission medication regimen and the factors that affect understanding. Low health literacy, advanced age, and impaired cognitive function all have the potential to adversely affect understanding of medication instructions. To address gaps in research, my colleagues and I conducted a study that was published in the November 2011 Journal of Hospital Medicine in which we examined how certain patient factors affected understanding of preadmission medication regimens. Predictors of Medication Understanding In our analysis, 790 patients from Vanderbilt University Hospital and Brigham & Women’s Hospital were eligible for the investigation. We found that 21% of participants had marginal or inadequate health literacy. Also, the median number of medications that they were taking was eight. The following were each independently associated with less understanding of the purpose, dose, and/or frequency of their preadmission medication regimen: Lower health literacy. Lower cognitive function. Higher number of medications. Furthermore, we found that for each increase by one medication, there was a significant decrease in medication understanding. Patients on six medications were about half as likely to understand their medication regimen as patients on only one medication. For patients on 11 medications, the odds of medication understanding...
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