Imagine you have suffered a heart attack. After 3 days in the hospital, you are being discharged home. Your nurse is going over the discharge documents, including your medication list and prescriptions. Imagine she tells you, “Your doctor is starting you on 2 new blood thinners for your myocardial infarction. She wants you to stop taking your doxazosin. Here’s a script for atorvastatin 20mg; take this instead of the simvastatin. She wants you to double up your metoprolol to 100mg twice daily and take amlodipine 5mg, which may need to be titrated to get your BP to goal.” She also says, “you can get a stool softener OTC if you need it. You need to schedule a follow-up appointment with your PCP to talk about whether or not to start on insulin, since your A1c was borderline elevated. You should also set up an appointment with Dr. Frank from Cardiology in a few weeks, who will refer you to the cardiac rehab center.” Imagine the nurse spends a couple of minutes going over this with you, and then asks, “Any questions?” You stare at her for a moment and shake your head, “No.” She smiles, hands you the paperwork, and wishes you all the best in your continued recovery at home.
Every day, thousands of patients receive new health information. Sometimes it is easy to understand. But more often than not, the information is complex, unclear, or delivered quickly. How well would you be able to follow the instructions above? Now consider… How well would you be able to follow them if you were sick? If your sleep had been interrupted for the last 3 nights by vital sign checks, blood draws, and ambient hospital noise? If your family were not present? If you weren’t well-versed in health care terminology? What if English were not your first language?
According to a study by the U.S. Department of Education, nearly 40% of adult Americans have difficulty understanding, processing, and acting on health information. They are said to have low health literacy. Research shows that patients with low health literacy have less knowledge of their medical conditions, more difficulty following medication instructions, poorer disease control, and higher mortality.
What can we do? First, we must use plain language when communicating with patients and their families. Second, we should encourage questions, not by asking, “Any questions?” but by asking, in a more open-ended manner, “What questions do you have?” Third, rather than assume that patients understand the information provided, we should remember that 40% of adult Americans have low health literacy and struggle to understand seemingly straightforward health information, such as prescription labels. We should confirm patient understanding by asking them to teach-back the key information. Lastly, many patients and their families will find it helpful to receive educational materials. These could be brochures or printouts about the patient’s health condition. The materials could also be medication related. The Agency for Healthcare Research and Quality (AHRQ) has tools available for educating patients about medication management, while being attentive to their level of health literacy. My colleagues and I have also developed an illustrated daily medication schedule for use by consumers, caregivers, or health care personnel.
By being aware of the challenges that patients face in understanding new health information, and by adapting our communication style and providing educational aids, we can improve the care of patients who may have low health literacy.
Sunil Kripalani, Chief
Section of Hospital Medicine
Vanderbilt University:
