“Our national health literacy rate is only 12 percent. That means nine out of 10 people will walk out of a doctor’s office not understanding the health concern.”
the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes. Dr. Stevens is director of the Center for Applied Health Research at Baylor Scott and White Health, where he con- ducts research on ways to improve care and health outcomes for older adults. “There’s no bad question when a pa- tient is engaged in a discussion of his or her health. Questions suggest that a patient is ready to change to healthier behaviors,” he said. The Texas Legislature created TIH- CQE in 2011 to identify and promote evidence-based approaches to improve health care quality, accountability, edu- cation, and cost containment in Texas. Dr. Stevens says the institute took up health care literacy as an initiative be- cause it embodies all these goals. “This is a topic that gathers traction
very easily,” he said. “It’s an issue that we can actually improve.”
“the ability to obtain, process, and under- stand basic health information and ser- vices needed to make appropriate health decisions.”
Houston family physician Patrick
Carter, MD, who serves on the TIHCQE Board of Directors and on the Texas Medical Association Council on Legisla- tion, says one of the biggest problems in his daily practice is communicating with patients who don’t understand their dis- ease or its consequences on their health. “Often a patient will say, ‘I feel fine. These medications you’re giving me don’t make me feel any better,’” he said. But patients don’t always feel the ef-
fects of diabetes or high blood pressure, Dr. Carter says. They might then see an advertisement or an article that shows their prescribed medication in a negative light and choose to stop taking it. “A lot of information is available. Fig- uring out what is accurate or meaning- ful, that’s the hard part,” Dr. Carter said. “The more people know about health care, the more they will be able to be an important part of the decisionmaking.” Dr. Carter says an uninformed patient
is more likely to do things that will harm his or her health, whereas a knowledge-
46 TEXAS MEDICINE July 2014
able patient is less likely to spend health care dollars on treatments with little or no impact. According to TIHCQE’s strategic plan, “low health care literacy and ineffective health care communication contribute to poor health outcomes and generate hundreds of billions of dollars in waste- ful spending each year.”
The annual cost of low health literacy
ranges from $106 billion to $238 billion, according to a 2007 George Washington University Milken Institute School of Public Health report. “When one accounts for the future costs of low health literacy that result from current actions (or lack of action), the real, present day cost of low health literacy is closer in range to $1.6 trillion to $3.6 trillion,” the authors wrote. TIHCQE Board of Directors member Alan Stevens, PhD, says the quality of patient care also suffers, which is clear when you look at the national rate of hospital readmissions. U.S. hospitals readmit about 20 per- cent of Medicare beneficiaries within 30 days of discharge, costing the public an estimated $15 billion per year, accord- ing to a May 2013 article published in
Promoting health literacy TMA is helping doctors promote health literacy outside the office by participat- ing in the national Walk With a Doc pro- gram, which promotes patient-physician communication and healthy lifestyles. Round Rock plastic surgeon Susan
Pike, MD, chair of TMA’s Patient-Physi- cian Advocacy Committee, says as the traditional health care model changes, physicians need to think of new ways to approach patient care. Physicians can no longer meet the needs of all patients during a 15-minute office visit, she says. Dr. Pike was one of the first TMA phy- sicians to hold a Walk With a Doc event in 2012, and she continues to lead regu- lar walks in Georgetown. Dr. Pike says she typically starts each event with an informal, five- to 10-min- ute talk about a specific health topic. “Then we all go out and walk,” she said. “Basic exercise, something as sim- ple as walking, can reduce your risk of heart disease, cancer, and diabetes, and elevate mood and lower blood pressure.” The walk takes about 45 minutes, during which patients can engage the physician about specific topics or talk about general health issues. Dr. Pike says many patients are less intimidated
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