A January 2012 online publication in Health Affairs speaks to a fundamental issue in healthcare, which costs billions, causes great harm, and creates barriers to healthy communities: the lack of health literacy.
The major components of health literacy are print literacy (writing and reading), oral (listening and speaking) and numeracy (using and understanding numbers, such as risk of a complication or medication doses).
Most patients do poorly on all! Only 12 percent of U.S. adults understand and use health information effectively and 8.7 percent of Americans are not even proficient in English (pdf).
About a year ago, I developed a significant medical problem (more on that later, perhaps). Being on (and not beside) the examination table brings a very different perspective. So, I listened, questioned, read the provided literature, read consents (horribly written) and re-read……then I went to the web!
Wow, how confusing! Knowing medical terminology helped, and knowing where to find reliable references was a start, but sorting opinion and science was somewhat harder. There was not a single source of information that I could use to make an informed decision.
So, how can we expect patients and families to follow a complicated (or even simple) therapeutic plan? New communication strategies improve adherence to medications dosing (38 percent versus 9.3 percent) and fewer dosing errors (5.4 percent versus 47.8 percent). Yes, nearly half of patients or families demonstrated dosing errors, which results in billions of dollars annually in unexpected healthcare costs and emergency room visits!!
How does a healthcare provider readjust a dosage (or add a new medication) to control, say, hypertension, if the patient really was taking the medication as prescribed only half the time???
And whose job is it to provide this education? Healthcare educators! Whether a physician, nurse, unique educator or supporter, we have to get the right plan in play. And from my viewpoint, the physician is not likely to be that individual. We can help, provide counseling and reinforce the plan, but most of us don’t have the patience or luxury of time to listen, really answer all the questions and truly understand what the patient understands.
The current financial reimbursement structures almost look as if we might be getting paid to simply get things done rather than getting them done correctly (although I am proud to say Scott & White follows the latter), but as healthcare continues to transform, an enhanced understanding of the therapeutic plan—on the part of the patient along with the provider– will save billions and provide better health for our communities.