Health Literacy ResourcesIn the Indian Health System

June 17, 2013CDR Christopher Lamer, PharmD, MHS, BCPS, CDE

Office of Information Technology/Health Education

• Provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives.

• Serves members of 566 federally recognized Tribes.

Agenda

• Health Literacy Assessment Tools

• Health Factors

• Patient Education

• Patient Goals

• Handouts

9

91

Adequate  Health  LiteracyLow  Health  Literacy

88

12

Adequate  Health  LiteracyLow  Health  Literacy

REALM Results(word recognition)

Newest Vital Sign Results(numeracy/food labels)

The patient does not demonstrate the ability to obtain, process, and understand basic health information.

Assessment is made by a low score on a health literacy screening tool or observation.

Tools for Assessing Low Health Literacy

Interpreter needed

FineMotorSkills Deficit

Dementia

Values or Beliefs

Stressors

Low Health Literacy

Cognitive Impairment

No Barriers

Visually Impaired

Blind

Hard of Hearing

Deaf

Does Not Read English

Speaks English as a second language

Health Factors: Barriers to Learning

Patient Education

Topic Sub-topic Code+ =

Heart FailureHypertensionICD9 (250.03)

ExerciseNutritionMedicationsPreventionHome ManagementSelf-ManagementLiterature

SubtopicsActivities of Daily LivingAnatomy & Physiology Behavioral and Emotional HealthComplicationsCultural/Spiritual Aspects of HealthDisease ProcessEquipmentExerciseFollow-upHelp LineHome Management Health Promotion Disease PreventionHygieneInfection ControlLiteratureLifestyle AdaptationsMedicationsMedical Nutrition TherapyNutritionPain ManagementPreconception CarePreventionProceduresSafetySecond/Third Hand SmokeSelf Management PlanStress ManagementTestsTobaccoTreatmentWound Care

MEDICATIONS

STANDARDS:1. Describe the name, strength, purpose, dosing directions, and storage of the medication.2. Discuss the benefits and common or important side effects of the medication and follow up as appropriate.3. Discuss any significant drug/drug, drug/food, and alcohol interactions, as appropriate.4. Discuss the importance of full participation with the medication plan and that this is the patient’s responsibility. Discuss any barriers to full participation.5. Discuss the importance of keeping a list of all current prescriptions and over-the- counter medicines, vitamins, herbs, traditional remedies, and supplements. Encourage the patient to bring this list and pill bottles to appointments for medication reconciliation.

Patient Education Data Captured

• Education Topic

• Level of Understanding

• Readiness to learn

• Free text comment field

• Time

Patient Education and Measures

• Use of the codes

• Use in quality measures• Tobacco cessation

• Comprehensive CVD (GPRAMA measure)

• Health Education reports

• Diabetes measures

2010

2011

2012

0 2000000 4000000 6000000 8000000

7,541,324

6,198,609

5,822,930

57.8%

55.9%

Patient Education Plans

ExerciseNutritionMedicationsPreventionHome ManagementSelf-ManagementLiterature...

Create SNOMED subset

ProblemSub-topic OptionalPointer

Proposed Documentation Process

Integrated Problem List

Diagnosis (SNOMED) Narrative Status Date added [] Add EducationDiagnosis (SNOMED) Narrative Status Date added [] Add EducationWellness [] Add Education

General Eduction Codes[] Exercise [] Complications[] Nutrition [] Medications[] Lifestyle Adaptation [] Nutrition [] Special InitiativesAssociate with condition: [__________________]

Special Initiative Eduction Codes

DiabetesBaby FriendlyPrenatalAdministrationAdmission to Hospital

[] hypoglycemia[] insulin[] exercise

Patient Goals

• Captures patient selected goals

• Compatible with personal action plan or motivational interviewing

• Enables followup and captures notes related to the goal over time

Goal

Step

Follow Up

Patient Handouts

http://www.ihs.gov/healthcommunications

Logic

Patient Wellness Handout (PWH)

My Wellness Handout Report Date: Aug 13, 2010 ------------------------------------------------------------------------------********** CONFIDENTIAL PATIENT INFORMATION [CCL] Aug 13, 2010 **********DOE,JANIE HRN: 3 CHEROKEE INDIAN HOSPITAL1 MAIN STREET CHEROKEE, NC 28734CHEROKEE, NORTH CAROLINA 28719 SMITH, DOCTOR555-555-5555 828-497-9163

Thank you for choosing CHEROKEE INDIAN HOSPITAL.This handout is a new way for you and your doctor to look at your health.______________________________________________________________________HEIGHT/WEIGHT/BMI - Weight and Body Mass Index are good measures of your health. Determining a healthy weight and Body Mass Index also depends onhow tall you are. You are 5 feet and 10 inches tall.Your last weight was 220 pounds on Aug 03, 2010.You should have your weight rechecked at your next visit.______________________________________________________________________MEDICATIONS - This is a list of medications and other items you aretaking including non-prescription medications, herbal, dietary, andtraditional supplements. Please let us know if this list is not complete. If you have other medications at home or are not sure ifyou should be taking them, call your health care provider to be safe.

1. ALBUTEROL MDI (HFA) 6.7GM Rx#: 1234567 Refills left: 5 Directions: INHALE 2 PUFFS BY MOUTH EVERY 4 HOURS IF NEEDED FOR BREATHING; **SHAKE WELL BEFORE USING**

2. FLUTICASONE PROP 11O MCG (12GM) Rx#: 1234568 Refills left: 11 Directions: INHALE 1 PUFF 110MCG/INHL BY MOUTH TWICE A DAY

3. FOSINOPRIL= 40 MG TAB Rx#: 1234569 Refills left: 10 Directions: TAKE ONE (1) TABLET BY MOUTH DAILY FOR KIDNEY PROTECTION ! AND BLOOD PRESSURE

4. GLIPIZIDE 10MG TAB Rx#: 1234570 Refills left: 8 Directions: TAKE ONE (1) TABLET BY MOUTH TWICE A DAY

5. METFORMIN= 500MG *PLAIN* TABS Rx#: 1234571 Refills left: 10 Directions: TAKE THREE TABLETS BY MOUTH EVERY MORNING AND TAKE ! TWO TABLETS EVERY EVENING TAKE WITH FOOD FOR DIABETES TREATMENT ______________________________________________________________________BLOOD PRESSURE - Blood Pressure is a good measure of health.

Controlling your cholesterol can keep your heart and blood vessels healthy.

Your total cholesterol result was 150 mg/dL on Aug 10, 2010.Your last LDL (bad cholesterol) result was 70 on Aug 10, 2010.Your last HDL (good cholesterol) result was 40 on Aug 10, 2010.Your last triglyceride result was 120 on Aug 10, 2010.

LDL (bad cholesterol) should be under 100 mg/dL. Your LDL cholesterolis good! You should have your cholesterol checked every year.______________________________________________________________________

DIABETES CARE

HEMOGLOBIN A1cHemoglobin A1c is a test that measures your blood sugar control over a3-month period. You should have this test done every 3-6 months.Your last A1c test on file was 8.0 done on Aug 10, 2010.Ask your health care provider how you can keep lowering your A1c.

DIABETES KIDNEY ASSESSMENTDiabetes can cause kidney damage. There are tests that can see how well yourkidneys are working. Getting these tests at least once a year can help your health care provider protect your kidneys and lower your risk of getting kidney damage and dialysis.

Your kidneys were tested on Aug 10, 2010. You will need to have your kidneys tested again on Aug 10, 2011.

DIABETES EYE EXAMDiabetes can affect your eyes and vision. Early detection of eye problems can help you to get the treatment you need to lower your chances of having problems such as blurred vision or blindness.

Your last diabetes eye exam was done on Aug 10, 2010. You will need tohave another eye exam by Aug 10, 2011.

DIABETES FOOT EXAMDiabetes can make your feet hurt or feel numb. Having a diabetes footexam every year can help to lower the chance of losing feeling in your feet,getting an infection, or having an amputation.

Your last diabetes foot exam was done on Aug 10, 2010. You will need tohave another foot exam by Aug 10, 2011.______________________________________________________________________MAMMOGRAM

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