Impact Studies in Health Literacy and Patient Activation - PART 6

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Slide 1

Any questions?   WHEN DO PEOPLE USUALLY ASK IF YOU HAVE QUESTIONS?   At the end of the presentation   At the end of the visit

Slide 2

One third of patients leave the doctor’s office without getting answers to important questions.   REMEMBER: patients with low literacy skills and patients with low activation are both less likely to ask questions.   Asking questions is an indicator of an activated patient.

Slide 3

The third impact case study I want to share is about encouraging patients to ask questions and to create a list of questions as an agenda setting tool for medical appointments.

Slide 4

The research example comes from Katz, et. al, “Patient literacy and question-asking behavior during the medical encounter.”

Slide 5

The study looked at the impact literacy has on the number and types of questions asked by patients during primary care office visits.   Patients with low literacy skills asked fewer questions. They were also more likely to ask the physician to repeat something that was just stated.   Patients with higher literacy skills asked more probing questions and in effect received more information about their medical conditions and treatments.   One of the characteristics of activated patients is asking more questions. Raising activation levels in patients, regardless of their literacy skills, could help bridge the information gap… but can asking more questions actually improve health outcomes?

Slide 6

There is actually very little published research to show that interventions that encourage patients to ask questions have a positive impact on health outcomes. However, there is evidence to support that even simple interventions increase question asking among patients who would otherwise not ask questions.   Use of question prompt sheets and agenda setting tools are often well received and considered useful by most patients; they increase patient satisfaction; and in one study, where patients were offered a list of questions prior to a medical consultation, doctors reported these patients to be taking more initiative and control, especially in subsequent visits.   While there is no direct evidence linking “question asking” to improved health outcomes, it is not a big leap to suggest that increased patient satisfaction, higher levels of trust, and increased patient involvement lead to better understanding, improved patient adherence, and a decrease in the opportunities for miscommunication and medical errors. Overall, these benefits do impact patient health and outcomes.

Slide 7

Ask Me 3 is one tool that encourages patients to ask three simple but essential questions and the end of each visit.

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The three questions are:   What is my main problem?   What do I need to do?   Why is it important for me to do this?   Which question is most important?

Slide 9

What if I ask these three questions and I still don’t understand?   To be effective, patients need to be trained to ask the questions and health care providers need to be trained how to answer them.   Some recent studies have shown that the three questions alone have little impact of changing outcomes.

Slide 10

Questions are the Answer is a tool developed by the Agency for Healthcare Research and Quality. It is a national consumer education campaign.

Slide 11

Questions Are the Answer Website

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Questions Are the Answer PSA.s.   You might have seen the singing/dancing doctors and nurses.   New PSAs added include examples of people asking lots of questions: a woman ordering dinner at a restaurant, and a man shopping for a cell phone. Each commercial ends showing them at a doctor’s appointment with the doctor asking, “Any questions?” and both say “no.”

Slide 13

Interactive “build your list of questions” tool

Slide 14

“Questions Are the Answer” is different than Ask Me 3 in that it promotes pre-visit planning and agenda setting. The focus is on preparing for the appointment and thinking about what questions to ask. (Ask Me focuses question asking at the end of the visit).

Slide 15

Questions Are the Answer also reinforces strong patient-centered, patient-activated messages.

Slide 16

AHRQ tools and resources in the public domain and can be linked from your organization’s web site. In this example, several AHRQ tools, including Questions Are the Answer, are linked to the “request an appointment” page and also on a page encouraging patients to prepare and plan ahead for upcoming visits.

Slide 17

And Questions Are the Answer was imported into their Krames library, including a link to interactive ‘build your list of questions” tool.   Since we discussed that patients with low literacy skills or low activation are less likely to use or have access to the Internet, Questions Are the Answer is available as a brochure. It can also be used as a question prompt tool or agenda setting tool that is mailed to patients with their appointment reminder, or available for them to fill out in waiting areas, or can be gone over with the patient as part of the patient rooming process.

Slide 1

Any questions?

Slide 2

Any questions? According to a 2004 Commonwealth Fund survey, one-third of sick patients in the U.S. leave the doctor’s office without getting answers to important questions. (Schoen C, Osborn R, Huynh PT, et al. Primary care and health system performance: adults’ experiences in five countries. Health Affairs Web Exclusive, October 28, 2004, W4-487-W4-503.)

Slide 3

Impact Case Study 3 Encouraging patients to ask questions and using questions as an agenda-setting tool

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Patient literacy and question-asking behavior during the medical encounter Katz MG, Jacobson TA, Veledar E, Kripalani S. Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis. J Gen Intern Med. 2007 Jun;22(6):782-6. Epub 2007 Apr 12. Impact Case Study 3 Research Example

Slide 5

The objective was to examine the effect of literacy on the number and types of questions asked by patients during primary care office visits. Low-literacy patients ask fewer questions about their medical care, and this may affect their ability to learn about their medical conditions and treatments. Also significantly more likely to ask their physician to repeat something that was just stated. Impact Case Study 3 Research Example

Slide 6

Why encourage patients to ask questions? Benefits of Asking Questions Increases understanding Increases patient involvement Improves adherence Improves satisfaction Improves patient-provider communication Demonstrates patient-centered care Builds trust in relationship Consequences of NOT Asking Questions Increases risk for errors Limits information and patient involvement Decreases adherence Decreases satisfaction Increases opportunities for miscommunication Increases confusion and intimidation Heightens unmet needs

Slide 7

Impact Case Study 3 “Ask Me 3” Clear communication is the foundation for patients to be able to understand and act on health information. Ask Me 3 is a quick, effective tool designed to improve health communication between patients and providers. Ask Me 3 promotes three simple but essential questions that patients should ask their providers in every health care interaction. http://www.npsf.org/askme3/index.php

Slide 8

Which question is the most important one to ask? http://www.npsf.org/askme3/index.php

Slide 9

Which question is the most important one to ask? http://www.npsf.org/askme3/index.php

Slide 10

Agency for Healthcare Research and Quality (AHRQ) National public service advertising (PSA) campaign designed to encourage adults to take a more proactive role in their health care. PSA for television and radio Web site Billboards Posters Patient education Impact Case Study 3 “Questions Are the Answer”

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http://www.ahrq.gov/questionsaretheanswer/index.html

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http://www.ahrq.gov/questionsaretheanswer/level2col_1.asp?nav=2colNav00&content=09_0_videos Impact Case Study 3 “Questions Are the Answer”

Slide 13

http://www.ahrq.gov/questionsaretheanswer/index.html

Slide 14

Promotes pre-visit planning and agenda setting Works for acute care and complex chronic disease management, as well as preventive care Supports consumer engagement and increases confidence to make decisions and use comparative information Offers a broader invitation for patients to take an active role in managing their heath Impact Case Study 3 “Questions Are the Answer”

Slide 15

Patient-centered Involves the patient as an important member of the heath care team and promotes two-way communication and shared decision making: “Improving health care quality is a team effort.” “The single most important way you can stay healthy is to be an active member of your own health care team.” “You can improve your care and the care of your loved ones by taking an active role in your health care.” Impact Case Study 3 “Questions Are the Answer”

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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