ASHP InterSections Fall 2009 - 9

“If patients can put it in their own words, there’s a greater chance they’ll be able to do what I’m asking them to do.” problems related to patients’ misunderstanding of common dosage instructions and learned the keys to drug-label design that ensure patient understanding. Assessing for Literacy Pharmacists utilize a variety of tools to assess and respond to low health literacy. For example, a patient who says he can’t see the medication directions because he left his reading glasses at home may be hiding the fact that he can’t read. In this instance, a test such as the Rapid Estimate of Adult Literacy in Medicine (REALM) may be helpful. Pharmacists are also turning to the Ask Me 3 program, which empowers patients to ask and understand the following questions: 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this? Ryan recommends that patients complete the REALM test during their initial visit. This assessment ensures that patients don’t feel they are being profiled for their reading abilities while giving health care providers insights into the health literacy challenges that may be present. REALM test results help determine next steps, including using the teach-back method, arranging for relatives to help read instructions once the patient goes home, or informing physicians of the challenges that may be present through medical chart notes. “I have encountered a significant number of patients who can’t read. It really is a big challenge,” Ryan said. “I’m always trying to figure out how to be effective and efficient. If I’m handing out pamphlets, I don’t want to just check a box to say I gave a person a piece of paper. I want it to work for them.” But no matter how simple written instructions are, there is nothing better or more effective than face-toface counseling with pharmacists, said Michael J. Miller, DrPH, who has researched health literacy as an associate professor at the University of Oklahoma College of Pharmacy in Tulsa. Gina Ryan, Pharm.D., BCPS, CDE, left, clinical pharmacist at Grady Health System Diabetes Clinic, counsels a patient, right, at the clinic, as pharmacy student Rhondolyn Jones takes notes. and other dietary supplements they take daily, was created utilizing health literacy guidelines. “‘My Medicine List’ is a really great tool to help facilitate that all-important conversation between pharmacists and their patients,” said ASHP president Lynnae Mahaney, M.B.A., FASHP. “We know from national efforts like Healthy People 20102 that health literacy is a large and growing area of concern, and pharmacists can play a critical role in ensuring patients understand what medications they are taking and how to take them correctly.” ASHP’s House of Delegates approved a policy in 2002 encouraging health literacy efforts among pharmacists. And it conducts educational programming to help members improve their medication counseling skills related to literacy. At the 2008 Summer Meeting, for example, ASHP offered a session called “Prescription for Confusion: Health Literacy and the R x Label.” Attendees identified Steven Chen, Pharm.D., FASHP, a clinical pharmacist at the JWCH Medical Clinic, Los Angeles, checks the blood pressure of a patient. “We have a tendency to communicate in the written word. We want to use that as a substitute for personal communication. But there’s no substitute for one-on-one questions,” Dr. Miller said. ASHP members also use the unique medium of “fotonovelas” to educate patients on health issues such as diabetes. Similar to graphic www.healthypeople.gov The American Society of Health-System Pharmacists

ASHP InterSections Fall 2009

Table of Contents for the Digital Edition of ASHP InterSections Fall 2009