Transcript 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
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.
Learning Objectives
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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.
Health Literacy
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Ability to understand:
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prescription drug bottles
educational brochures
doctor’s directions
consent forms
Ability to calculate medication
dosages
Ability to interpret test results
Identification of Patient with Low
Health Literacy
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“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.”
Identification of Patient with Low
Health Literacy
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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
Identification of Patient with Low
Health Literacy
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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
Take 2 tablets twice daily
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Low health literacy
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Marginal health literacy
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71% believed they understood the directions
35% able to demonstrate properly
84% believed they understood the directions
63% able to demonstrate properly
Adequate health literacy
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89% believed they understood the directions
80% able to demonstrate properly
Creating the Right
Environment for Health Literacy
Fostering Open and Welcoming
Attitudes
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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?”
Fostering Open and Welcoming
Attitudes
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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
Maintaining Consistency
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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
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What is this medication for?
What are the side effects?
Incorporating Basic Healthcare
Information
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Use multiple types of learning styles
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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)
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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
Incorporating Basic Healthcare
Information
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Avoid difficult medical terminology
Screening
Oral
Mental Health
Monitor
Dermatologist
Diabetes
Annually
Cardiovascular
Immunization
Diet
Depression
Referral
Contraception
Hygeine
Respiratory
problems
Eligible
Hypertension
Prevention
Community
Resources
Arthritis
Incorporating Basic Healthcare
Information
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2012 United States Pharmacopeial (USP)
Convention Standards
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Use explicit directions
Avoid from necessity of numerical skills
Examples
“Take 2 tablets twice daily”
“Take 2 tablets in the
morning and take 2 tablets
in the evening”
“Take 1 tablet every
4 to 6 hours”
“Take 1 tablet 4 to 6
times daily”
“Take 1 tablet at 8am”
“Take 1 tablet at the same
time every morning”
Incorporating Basic Healthcare
Information
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Use a Pill Chart
Name: Sarah Smith
Pharmacy phone number: 123-456-7890
Name
Used For
Instructions
Simvastatin
20mg
Cholesterol
Take 1 pill at
night
Furosemide
20mg
Fluid
Take 2 pills in
the morning
and 2 pills in
the evening
Insulin
70/30
High blood
sugars
Inject 24 units
before
breakfast and
12 units before
dinner
Date Created: 12/15/12
Morning
24 units
Afternoon
Evening
12 units
Night
Incorporating Basic Healthcare
Information
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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
Wisconsin Pharmacy Quality
Collaborative (WPQC)
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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 pharmacistprovided medication therapy
management services for participating
Wisconsin pharmacy providers.
Show and Tell
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Showing the patient what the medication
looks like
What your pharmacist did for you
today
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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 Method
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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
Common Questions to Use for
Teach Back
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“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?”
WPQC and Health Literacy
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Offers customized patient services and
private medication appointments to
ensure patients best understand their
medications
Health Literacy Criteria
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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
WPQC Interventions
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Focused adherence intervention
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Use lifestyle cues
Set medications by kitchen if taken with
food
 Set medications by bedside table if taken
at bedtime
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Use pill boxes
Use alarms
Create a schedule
WPQC Interventions
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Comprehensive medication review
and assessment
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Personalized medication appointment
Medications use, directions, and side
effects teaching
 Device technique review
 Adherence consult
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How to refer your patients for a
medication appointment
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Patients with
Medicaid, Unity,
UnitedHealth Care,
and Network
Health are eligible
Check out
pswi.org for a list
of all participating
pharmacies
Questions?
Jennifer O’Callaghan, PharmD
PGY1 Community Pharmacy Resident
University of Wisconsin Hospital and Clinics