Impact Studies in Health Literacy and Patient Activation - PART 4

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Slide 1

So lets put this all into perspective by highlighting some examples from the field. For each example I have included a research study and then describe initiatives designed to translate those research findings into practice.   The first impact case study focuses on health literacy and patient activation strategies to improve adherence to medication and treatment plans.

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The first research example is Williams et.al, “Inadequate literacy is a barrier to asthma knowledge and self-care,” a study from 1998, between the two national literacy surveys.

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This study included about 500 patients with a confirmed diagnosis of asthma. The REALM was used to measure health literacy, a 20 question oral test and inhaler technique demonstration was used to measure asthma knowledge. Less than 30% of the participants read at above the 8th grade level, 40% read at the 6th grade level or below.   Key findings:   Patient reading level was the strongest predictor of asthma knowledge   Reading level was the strongest predictor of MDI technique   Inadequate literacy was common and strongly correlated with poorer knowledge of asthma and improper MDI use   How can we improve adherence with patients with low literacy? Can increasing patient activation compensate for lower literacy and improve asthma knowledge and medication adherence?

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A pilot study is currently looking to answer these and other questions. It is a pharmacist-led, telephonic intervention with patients enrolled in a federally qualified health center. Demographic information for this mostly rural population includes low income and low education levels, so we anticipate higher levels of low health literacy and low activation and have built in strategies within the intervention to address these issues.

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We defined non-adherence using this criteria.

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Our initial pull of data from a sample of the population showed a high incidence on non-adherence.

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We used the TOFHLA to assess health literacy at baseline. We are also using the Patient Activation Measure at baseline and post intervention; the Medication Adherence Measure; monitoring prescription refill data; conducting the Asthma Control Test at baseline, at each intervention with a pharmacist (three telephone calls over 6 months) and again at the end of the study; as well as collecting additional data through participant surveys and review of the medical record.

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The goals of the study are to:   Increase asthma patients’ adherence to prescribed regimens Identify barriers, including health literacy and patient activation Tailor education and coaching within Medication Management Therapy And test a standardized counseling framework   My role included quality assurance of phone calls   The study concludes this fall, manuscript will be published.

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There are some initial findings:   Participants have different definitions of good asthma control For some, having to use a rescue inhaler 3 times a week is “good control” – even though scores on the Asthma Control Test do not coincide.   There is a lack of understanding about the different types of inhalers, control vs. rescue inhaler, and the purpose of each. In fact, a common request of participants is to only have one inhaler.   Part of the standardized framework includes an evaluation of inhaler technique over the phone. Not surprisingly, inhaler knowledge and technique varies considerably.   Many patients express that they would more education and support, but are unaware of available resources.

Slide 1

Impact Case Study 1 Improving adherence to medication regimen and treatment plans

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Impact Case Study 1 Research Example Inadequate literacy is a barrier to asthma knowledge and self-care Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998 Oct;114(4):1008-15.

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Impact Case Study 1 Research Example

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Impact Case Study 1 Improving Adherence Role of Pharmacist Evaluation in Activation of Adult Asthma Patients Pharmacist-initiated telephonic intervention Adult asthma patients enrolled in Federally Qualified Health Center

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Impact Case Study 1 Improving Adherence Non-adherent therapy is defined as: Lacking controller medications Lacking rescue medications < 80% refills with controller medications >100% refills with rescue medications Combination of any of above

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Impact Case Study 1 Improving Adherence Population sample data pull Of the 93 FQHC patients with confirmed asthma diagnosis: 84 out of 93 patients meet non-adherent medication use Of the 94 FQHC patients enrolled in case management with confirmed asthma diagnosis: 93 out of 94 patients meet non-adherent medication use

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Impact Case Study 1 Improving Adherence Test of Functional Health Literacy in Adults at baseline Patient Activation Measure at baseline and post-intervention Medication Adherence Measure (Morinsky, et. al) Prescription refill data Asthma Control Test (ACT) Additional patient survey data

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Impact Case Study 1 Improving Adherence Project goals: Increase asthma patients’ adherence to prescribed regimens Identify barriers, including health literacy and patient activation Tailor education and coaching within Medication Management Therapy Standardized counseling framework

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Impact Case Study 1 Patient Response Initial findings: Different definitions of asthma control Lack of understanding regarding medication purpose and effectiveness Only want one inhaler Inhaler technique and knowledge varies Would like more education and support but unfamiliar with available resources

Summary: This presentation is an expanded version of a webinar sponsored by Krames Patient Education. Low health literacy is a barrier to care, and populations with chronic diseases are at higher risk. Research suggests activation may help compensate for lower literacy skill. This series explores effective methods to increase patient activation and to address the needs of patients with low health literacy.

Tags: doug seubert health literacy communication communications activation patient engagement empower

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