CMSA Today - Issue 7, 2016 - 6

President's Letter Case Management and Health Literacy BY MARY MCLAUGHLIN-DAVIS, DNP, RN, MSN, ACNS-BC, CCM T he case manager establishes a relationship with his or her patient as the first step in assisting that patient to experience optimal health. It is in the initial patient assessment that the case manager determines if the patient is able to speak English, and if not, accommodations are made to communicate through an acceptable interpreter. Language is one potential barrier in the relationship between the case manager and the patient. However, there is another, less obvious roadblock to communication and relationship in serving diverse patient communities. Case managers must be cognizant of how our patients' health literacy impacts their decision-making capability and health-related outcomes. The awareness of the importance of a patient's health literacy directs the case manager's plan for patient education and care management. The Institute of Medicine (IOM), The Agency for Healthcare Research and Quality (AHRQ) and the American Medical Association (AMA) 6 CMSA TODAY Issue 7 * 2016 * DIGITAL have all issued reports on health literacy. All reported that as many as one-half of all adults lack the literary skills needed to function and navigate in the healthcare system. Patients with limited health literacy come from all segments of society, and most are white, native-born Americans (Weiss, et al., 2005). Health literacy is also the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. It involves the ability to use and interpret text, documents, and numbers effectively - skills that might seem to be distinct but are highly correlated with one another (Weiss, et al., 2005). Health literacy is also the ability to perform basic reading and math skills required to function in the healthcare environment. Limited literacy increases the gap between the health provider and the patient, and makes mutual understanding more challenging. In the U.S., one-third of English-speaking patients had low health literacy. There is an association between limited health literacy and worse health outcomes (Chew, Bradley, & Boyko, 2004; Sarkar, Schillinger, Aronson, 2015). All healthcare encounters are cross-cultural through language, religion, and gender. The healthcare community has a culture of its own, and this is apparent as soon as you enter the physician's office or the hospital. We do not intentionally miscommunicate, but we do not always look for the signs of fear and deference to our roles as care providers. While limited health literacy is found most often in individuals with low global literacy, the IOM revealed that nearly half of all adults in the U.S. have basic or below basic English-language literacy skills. Patients may have adequate health literacy but limited understanding of basic math; in combination, this can still affect health. Equally important are critical-thinking skills that allow patients to make thoughtful decisions about when and how to take their medications and make appropriate health choices (Misra-Herbert, Isaacson, 2012; Sarkar, Schillinger, Aronson, 2015). Low numeracy literacy impacts outcomes of chronic disease conditions such as glycemic control for patients with diabetes and unnecessary hospital admissions for patients with asthma (MisraHerbert, Isaacson, 2012; Sarkar, Schillinger, Aronson, 2015). Only 12 percent of U.S. adults have the health literacy skills needed to manage the demands of our complex healthcare system, and even these individuals' ability to absorb and use health information can be compromised by stress or illness (Sarkar, Schillinger, Aronson, 2015). Health literacy may impact health via three pathways: access and utilization of care, patient provider relationship and self-care. Health literacy is linked to both an individual's and a community's socio-economic context. It is the mediator of the social determinants of health and a necessary element for achieving health

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2016