Retooling the Pharmacist to Improve Health LiteracyJennifer OCallaghan, PharmDPGY1 Community Pharmacy ResidentUniversity of Wisconsin Hospital and Clinics
Disclosure StatementI 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.
Learning ObjectivesIdentify 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.
Health LiteracyAbility to understand:prescription drug bottleseducational brochuresdoctors directionsconsent formsAbility to calculate medication dosagesAbility to interpret test results
Identification of Patient with Low Health LiteracyEven 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.
Identification of Patient with Low Health LiteracyAsk for medications by color or shapeUnable to explain purpose or dosing of medicationNon-compliance with medicationsLack of follow through on labsIncomplete registration forms
Identification of Patient with Low Health LiteracyMay need more time to make health care decisions
Patients may hide their lack of understanding or may not even realize they have trouble understanding
Take 2 tablets twice dailyLow health literacy71% believed they understood the directions35% able to demonstrate properlyMarginal health literacy84% believed they understood the directions63% able to demonstrate properlyAdequate health literacy89% believed they understood the directions80% able to demonstrate properly
Creating the Right Environment for Health Literacy
Fostering Open and Welcoming AttitudesSmile and acknowledge the patientAlways introduce yourselfSpeak in a slow, relaxed pace in a conversational toneListen and be empatheticEncourage patients to ask questionsAsk Am I clear?
Fostering Open and Welcoming AttitudesUse interpreter services if availableUse signs with pictures to tell patients where to go and what they needProvide a waiting areaDecorate the pharmacy
Maintaining ConsistencyUse larger printsUse 12-point Times or 11-point ArialInclude brand and generic namesInclude medication purposeUse the same generic if possiblePost questions to ask pharmacistWhat is this medication for?What are the side effects?
Incorporating Basic Healthcare InformationUse multiple types of learning stylesPeople 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 gradePatient education materials in chain pharmacies2% of materials at 7-8th grade69% of materials at 9-12th grade29% of materials at 12th grade or higher
Incorporating Basic Healthcare InformationAvoid difficult medical terminology
ScreeningOralMental HealthMonitorDermatologistDiabetesAnnuallyCardiovascularImmunizationDietDepressionReferralContraceptionHygeineRespiratory problemsEligibleHypertensionPreventionCommunity ResourcesArthritis
Incorporating Basic Healthcare Information2012 United States Pharmacopeial (USP) Convention StandardsUse explicit directionsAvoid from necessity of numerical skills
ExamplesTake 2 tablets twice daily Take 2 tablets in the morning and take 2 tablets in the eveningTake 1 tablet every 4 to 6 hoursTake 1 tablet 4 to 6 times dailyTake 1 tablet at 8amTake 1 tablet at the same time every morning
Incorporating Basic Healthcare InformationUse a Pill ChartMorning
Name: Sarah Smith Date Created: 12/15/12Pharmacy phone number: 123-456-7890 NameUsed ForInstructionsSimvastatin20mgCholesterol Take 1 pill at night Furosemide20mgFluidTake 2 pills in the morning and 2 pills in the eveningInsulin70/30 High blood sugarsInject 24 units before breakfast and 12 units before dinner24 units12 units
Incorporating Basic Healthcare InformationFocus on how to incorporate medications and health changes into the patients 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
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.
Show and TellShowing the patient what the medication looks like
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
Teach-back MethodTeach-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
Common Questions to Use for Teach BackI 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 lets 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?
WPQC and Health LiteracyOffers customized patient services and private medication appointments to ensure patients best understand their medications
Health Literacy CriteriaRequires 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
WPQC InterventionsFocused adherence interventionUse lifestyle cuesSet medications by kitchen if taken with foodSet medications by bedside table if taken at bedtimeUse pill boxesUse alarmsCreate a schedule
WPQC InterventionsComprehensive medication review and assessmentPersonalized medication appointmentMedications use, directions, and side effects teachingDevice technique reviewAdherence consult
How to refer your patients for a medication appointmentPatients with Medicaid, Unity, UnitedHealth Care, and Network Health are eligible
Check out pswi.org for a list of all participating pharmacies
Questions?Jennifer OCallaghan, PharmDPGY1 Community Pharmacy ResidentUniversity of Wisconsin Hospital and Clinics