Posts Tagged health literacy

Discharge Drug Errors — 50% mistakes

manymedsMedication mistakes are common.  A recent study by Amanda Mixon following discharge from the hospital pegs the error rate at an astounding 50%.  The study focused on whether instructions given to patients at the time of discharge from the hospital matched what the patient later took at home.

The study is  biased by assuming all the errors are caused by patients — not the providers.  The authors point to patient problems of low health literacy and a poor facility with numbers.  Illegible instructions, poor communication skills, excessive complexity of medical regimens,  conflicting instructions, and giving verbal instructions to the wrong person are all provider or institutional issues.

Even a simple phone  call after discharge might have cleared up patient confusion — perhaps the study would have been better with a phone call and no phone call comparison.

The article conclusion is to apply more effort to find those high risk patients.  Another conclusion would be to find those high risk hospitals having difficulty telling patients what drugs to take.  The study was done at a VA facility affiliated with Vanderbilt — a good place to start the search.

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Shared Decision Making — shared with whom?

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What is Shared Decision Making (SDM)?  It is a process for patients to make good decisions about tests, medications, surgeries and just about anything health care providers might suggest.  What it is, and what it is not — some examples:

A patient has frequent headaches and has a visit with a provider.

Scenario 1:  The provider says “a CT scan of the brain is needed, so get that done and come back for a follow-up visit.”  (Old school, doctor knows best)

Scenario 2:  The patient wonders if a CT scan of the brain would be a good idea to make sure there is no brain tumor.  The provider says “sure, the nurse will schedule it tomorrow.”  (Consumerism, do what the patient wants)

Scenario 3:  The provider says “there are a number of options including a trial of migraine medications or getting a CT of the brain.”  Then the provider gives the patient a handout that lists independent sources for additional information.  And, says “I will call you on Monday, after you have had a chance to review the information so we can decide what to do”  (Shared Decision Making)

Group Health Cooperative in Washington State has made a big push to support SDM.  The Group has made information available on the Internet to assist the patient for many common situations.  91% of patients who used the system found it “very important” or “extremely important”.  Click to see an Example of shared decision-making by Group Health Cooperative.

Pros and Cons:

  • The process takes longer than just doing what the provider says
  • Usually the SDM comes to a decision the patient will support, so they will follow instructions and treatments more than an average patient.
  • As long as the information reviewed by the patient is based on evidence based guidelines (well researched advice) then good decisions are possible.  And, usually the decisions are less invasive and less costly.

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Inadequate Face Time – 5 minutes is not enough

Nearly 7 in 10 Americans want their doctor to spend more time with them and talk about more than just the problem at hand.  No doubt 5 minutes is not enough time for a health care visit.  Remember, just like the taxi driver, the meter is running.  Both providers and patients need to be better prepared for a visit.

  • On the provider side all data should be reviewed before the visit – not during the visit.  And, the least expensive provider should be engaged, based the nature of the visit.  Simple problems (e.g. well baby checks, blood pressure checks, and acne) should be addressed by physician assistants or nurses. Health care literacy needs to be assessed — some groups need a lot of attention by a nurse, some groups should be getting information from the Internet — giving the patient an Internet link for education saves time.  If the provider’s skill is well matched to the problem more time is available for the visit itself.  The provider should always ask “any other questions?”
  • On the patient side any patient should come to a provider visit with a written list of just 3 issues they want  to be addressed then check them off as a response is obtained.  For example:  1) my cough 2)my knee pain and 3) any less costly alternatives to my current medications.  A person should think about the issues and look in a book or on the Internet before the visit to be able to ask reasonable questions.  A visit to a surgeon is a little different.  It is always focused a single problem and the surgery to fix the problem.  The three issues usually are 1) the chance surgery will fix the problem 2) the reasonable alternatives and 3) what will the surgeon do to prevent complications (a good answer is to follow hospital protocols and use a surgical safety checklist).
  • Visits need to be on time and on task.
  • Patients are more satisfied with a provider visit if there is “discussion of broader health issues” as the poll indicates.  This finding corresponds to other work indicating America has a large problem with health literacy.  People need reliable health information and they certainly don’t get it on TV (“miracle ___ cure”, ”ask your doctor if you need ___”)

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