Tackling Health Illiteracy Key in Managing Chronic Disease Patients

WASHINGTON — Physicians are experimenting with better ways to communicate with patients with low health literacy, Joanne Schwartzberg, M.D., said at a conference on health literacy sponsored by the American College of Physicians.

“It's right in the lap of every physician,” said Dr. Schwartzberg, director of aging and community health at the American Medical Association. “Physicians can't say it's someone else's problem.”

Using simple language, distributing patient education materials, speaking slowly, reading instructions aloud, using teach-back techniques, and drawing pictures are some of the ways health care providers say they are trying to do a better job of reaching out to patients with low health literacy, Dr. Schwartzberg said.

The AMA has developed a health literacy kit with a video and manual for clinicians. The group has also started a train-the-trainer program. To date, the group has trained 11 teams from state and specialty societies. In 6 months, the first 5 teams have conducted 57 trainings and reached more than 1,500 physicians, she said.

Preliminary results show that after the training, a majority of the physicians changed their communication with patients.

For example, many reported that they were more often asking patients to repeat back instructions.

Reaching out to patients with low health literacy is especially important in managing chronic disease because there is a “mismatch” between the capabilities of individuals and the demands of their diseases, said Dean Schillinger, M.D., associate professor of medicine at the University of California, San Francisco.

In examining the interactions between physicians and patients with type 2 diabetes, Dr. Schillinger found that physicians used a lot of medical jargon when providing recommendations or education to patients. Patients with low health literacy were confused by terms that physicians might expect a person with chronic diabetes to know, such as “glucometer,” or by hearing that their weight is “stable.”

But simply raising awareness may not be enough, Dr. Schillinger said. Physicians say they need more systematic support, such as appropriate educational materials.

And more research is still needed on what interventions work, especially if the medical community is going to ask insurers and other payers to offer financial incentives in this area, said David Kindig, M.D., chair of the Institute of Medicine Committee on Health Literacy.