Patients' incomplete understanding of the healthcare information provided to them poses a significant danger and creates a need for payer-provided health literacy education programs.
A past co-worker of mine was diagnosed with high cholesterol. His physician placed him on a statin and it was explained that the medicine would help to achieve his cholesterol goal. He stayed on the medicine until he achieved his goal and then went off. When he was brought to the hospital after suffering a heart attack, it was brought to the staff’s attention that this particular healthcare executive stopped his medication when he “got to goal” because this is what he thought his doctor had instructed him to do.
Can you imagine going to see a physician who speaks French while you speak English? Such an experience would most likely be frustrating, maybe even frightening. The reality is that a majority of healthcare consumers go to their providers and understand very little of what is being said. The Department of Education’s National Assessment of Adult Literacy found that 88% of the US adult population do not have health literacy skills that allow them to both understand and act on the information that their physicians and other healthcare providers give them. To them, the providers are speaking a different language.
The issues surrounding health literacy are not new. If you were to go to Wikipedia you would fi nd citations as early as the late 1980s. Some feel that the health literacy problem is as dangerous as many of the serious health conditions that you read and hear about every day and keeps a large majority of people from taking part in their own healthcare in an effective manner.
The definition of health literacy is understanding what information is being shared and then being able to take action. Interestingly enough, it is not necessarily associated with level of education. The story that I related above involved someone with a post-graduate degree who worked within the healthcare industry. When it comes to health literacy associated with the management of medication, this problem can cause potentially serious issues when the understanding of how to take a medication appropriately, factoring in dosing issues, timing, or contraindications to things such as food or other medications, is clouded. Health literacy is considered by many to be one of the top 5 reasons for medication nonadherence.
In 1998, the American Medical Association acknowledged the problem and began putting together resources for its membership to address the issue and change its communication style with patients. In 2008 the Institute of Medicine initiated a requirement for the standardization of medication labels with the hope that this would improve some of the confusion that patients have over their medications. I believe that this may help some, but it does not really address the broader issue. Health literacy was even discussed in the Affordable Care Act of 2010. So with all of the attention given to it over the last almost 20 years, why I am discussing it here in this journal and what can payers do to help address the issue?
In my previous editorial column in the March/April issue of The American Journal of Pharmacy Benefits, I spoke about what is and what is not discussed when a new medication is prescribed. As I stated, most payers of prescription benefi ts focus their attention on the utilization of medications and very few spend time thinking about the communication process that takes place surrounding the prescribing and use of these medications. In fact, very few spend much time considering this issue and the potential implications that poor or ineffective communication may cause. I spoke a bit about how information is and is not being shared with the patient at that crucial moment when a new medication is being introduced. I want to take this a step further now and focus on how these important issues could be communicated.
I suggest that healthcare payers include resources to help the healthcare consumer understand their medications in a way that works for them. These programs are as important as any of the utilization management programs. In fact, I believe that a health literacy program is a utilization management program. If someone is taking a medication incorrectly, money is being spent inappropriately—just as if someone is taking a medication that they do not really need.
I became focused on this issue several years ago and the issue of health literacy has become a passion for me. I have been very lucky to work with one of the health literacy gurus, Helen Osborne, who taught me that health literacy tactics are not hard to learn if you are just aware about how you share information. It is time for us all to become conscious of health literacy as one of the prescriptions to address many of the problems surrounding health and the cost of healthcare.
What do you think?