From The Editor: The following is from ISMP MEDICATION SAFETY ALERT, published
by the Institute for Safe Medication Practices. While they are concerned with
all medications, misdosage of diabetes medications can have especially severe
consequences.
Many people have trouble functioning well as patients, even health professionals.
Whether limited by knowledge, socioeconomic factors, emotional or clinical
state, or cultural background, their level of health literacy - the ability
to read, understand, and act on healthcare information, is often dangerously
low. A popular television show, ER, portrayed this problem recently, in an
episode where a Spanish-speaking woman misunderstood the directions for taking
a potent medicine. The prescription clearly stated she was to take the medication
“once a day.” But, in Spanish, “once” means eleven. In
the show, the patient died from taking such an excessive dose (and there have
been real-life examples of the same misunderstanding, use of “once”
on labels for Spanish-speaking individuals.)
Other examples of patients who've had difficulty reading and understanding medication directions are plentiful: The elderly patient who couldn't tell if he'd picked up his bottle of Coumadin or Celebrex; the young mothers who, after reading the acetaminophen label, could not accurately state their child's dose; teenagers who've misunderstood directions for contraceptive jelly and have eaten it on toast every morning to prevent pregnancy.... But lest you believe that poor health literacy is an isolated problem with the elderly, disabled, uneducated, or certain socioeconomic classes, here are some startling facts from the American Medical Association's Health Literacy Introductory Kit:
More than 40% of all patients with chronic illnesses are functionally illiterate.
Almost a quarter of all Americans read at or below a fifth grade level. Medical information leaflets are typically written at a tenth grade level.
An estimated three of four patients throw out the medication leaflet stapled to the prescription bag without reading it.
Only half of all patients take their medications as directed..
Low health literacy skills have increased our annual healthcare expenses by an estimated $73 billion.
Furthermore, people who have difficulty reading or understanding health information are often ashamed, and can try to hide the problem. In addition, low literacy isn't obvious. Researchers have reported poor reading skills in some of the most poised and articulate patients.
Patient education requires a new approach —
assume everyone has a literacy problem. After all, people at all literacy
levels prefer simple straightforward instructions and written materials. Here
are some things to keep in mind:
Offer small amounts of information at a time. First, tell patients what they
truly need to know, so they can follow the directions. Emphasize the desired
behavior, not the medical facts. Leave background information for later encounters.
Provide written materials at a fifth grade level or lower. Use clear captions, ample white space, and pictures, diagrams, or videotapes to help explain necessary concepts. Most people, even those who read well, depend on visual cues to reinforce their learning and spark memory.
Involve your patients. Use focus groups of patients to help write personally relevant and culturally sensitive education materials. After they understand the information, ask these patients how you might best explain it to others. Use a different focus group of patients to review the final materials and highlight any word or concept they do not fully understand.
Verify that your patient understands. Avoid asking yes/know questions — instead ask patients to show and tell you how they would take their medicine at home. That way you will spot problems.
Keep your eye on evolving technologies. For example, talking prescription labels (Talking RX from Millennium Compliance and ScripTalk from EnVision), recording devices for prescription instruction (ASKO Corporation's Aloud) and electronic pill organizers/reminders (E-Pill) are now being tested or are already on the market.
Editor's Note: See VOICE OF THE DIABETIC, Vol
16, No. 3, Summer 2001, for an article titled: “Talking
Medicine Identifiers.”