Virginia Mason Medical Center, Seattle, WA The “Silent” Disparity - Health Literacy: Enhancing Provider Awareness

• Published in: The Ochsner journal 2016-03, Vol.16 (S), p.47
• Main Authors: Liberman, J S, Shenoy, A K, Sullenberger, L, Abshire, G, Owens, B
• Format: Article
• Language: English
• Subjects: Health care; Health education; Health literacy; Patients
• ISSN: 1524-5012

Background: Health literacy is an essential concept in patient-centered medical care. It represents the combination of literacy skills and the ability to understand, process, and engage in healthcare to further one's own health and provide a sense of patient autonomy. Deficiency in this skill is a common problem, and the Institute of Medicine estimates that half the adult population in the United States, approximately 90 million people, have difficulty understanding and acting upon health information. The impact of poor health literacy is striking. Lower health literacy levels are associated with a nearly 2-fold increase in mortality. Patients with limited health literacy often have difficulty with treatment adherence and are likely to misinterpret instructions such as medication labels. This, in turn, leads to progression of disease, subsequent hospitalizations, poor health outcomes, and increased costs. We investigated the incidence of limited health literacy in a subset of the Virginia Mason Medical Center patient population in one of our primary care clinics. Methods: Members of the healthcare team (attending physicians, residents, and nurse practitioners) were assessed for their ability to accurately identify patients with deficiencies in health literacy. We selected the Rapid Assessment of Adult Literacy in Medicine (REALM-R) as our literacy assessment tool. Designated medical team members administered REALM-R surveys to patients. They were scored and kept anonymous and confidential. Providers were then asked 2 questions: (1) have you met this patient before? and (2) does this patient have a problem with health literacy? Answers provided by healthcare providers were then compared to the objective data provided by the REALM-R survey to assess provider identification of health literacy deficiencies. A multidisciplinary team was assembled to develop an educational intervention/curriculum using the ADDIE (analysis, design, development, implementation, evaluation) model and based on previously published literacy interventions. Videos highlighting individual stories from patients who experienced an inability to understand their own healthcare were created and made available through a website devoted to addressing the topic of health literacy. Results: Preliminary data collection with the REALM-R tool was done in a general internal medicine outpatient clinic. Participating providers included physicians and nurses in an integrated care management team. Follo