Tag Archive | health literacy

Launching a Center for Consumer Health Informatics Research

We are very excited that the Nova Southeastern University College of Pharmacy has officially launched our Center for Consumer Health Informatics Research (CCHIR)! Like all undertakings of this magnitude, it has been in the works for some time and has benefited from tremendous support from many corners – in particular the Chair of the Department of Pharmacy Practice and the Dean of the College of Pharmacy. Below is a presentation outlining some basics about the Center. I look forward to working with its faculty and collaborators and steering the CCHIR toward many great developments in the future.

@kevinclauson

 

UPDATE: The dedicated site is up at www.CCHIR.com

Texting for Diabetes @ Medicine 2.0’11 Stanford

For Medicine 2.0 (#med2) at Stanford this month, I am excited to be delivering a Research in Progress presentation of our study,  “Impact of Texting and Predictive Potential of Health Literacy on Medication Adherence in Type 2 Diabetes Mellitus”. The study, supported by the McKesson Foundation Mobilizing for Health grant program, aims to help a diverse and largely uninsured and underinsured population in South Florida improve adherence to the medications they take for type 2 diabetes mellitus. Our study intervention is designed as a simple series of text messages through treatment targeting one of the primary hurdles to optimal medication adherence – reminders. I will also be sharing our plan for integrating health literacy assessments and disease state knowledge into the clinic EHR as a means to provide more patient-centric counseling and support. Our hope is that we produce an effective intervention to improve health which is also low-cost and thus ultimately scalable. There are a lot of scary numbers being bandied about for diabetes such as its $174 billion annual cost and forecasts that as many as 1 in 3 Americans could develop diabetes by 2050; it would be massive if this contribution could assist in stemming the tide.

Beyond being surrounded by a great study team, I have also been fortunate that providers at our primary care clinic partners have become very enthused about the study. We actually amended our original protocol to account for the fact that physicians at other clinics within the Memorial Healthcare System approached us and volunteered to help recruit participants.

Over the years, Mednet and its offspring, the Medicine 2.0 Congress have been among the most ambitious, surprising, and practically beneficial conferences I’ve attended.  Every year I see new attendees from seemingly disparate areas and sectors that come and then find commonalities that produce stimulating discussions, research collaborations, business ventures, and even friendships. This year will continue that tradition with the pre-conference lineup at the Stanford Summit on September 16, 2011 and the two-day Medicine 2.0 conference proper that follows on September 17th and 18th.  I will be there to share our research to date and eager to participate in the other sessions. I hope to see you there too!

@kevinclauson

Community pharmacists’ use of language access services

One of my pet interests is health literacy and its far-reaching impact on quality and access to healthcare.  The issues surrounding it can almost be insidious in nature.  Despite this, health literacy is typically only given superficial coverage in traditional training programs. 

Here in South Florida we have an especially diverse patient population with a higher than average percentage of those with limited English proficiency (LEP).  It’s pretty intuitive, but LEP patients are (unfortunately) more likely to encounter barriers to health care and are associated with poorer outcomes than non-LEP patients. 

In part to address this, there was actually an Executive Order mandating “meaningful access” be given to LEP persons for Federally-funded activities (what, you didn’t think ‘meaningful use/access’ was limited to EHRs and the like?).  Consequently, hospitals, clinics, etc. began incorporating translators and other language access services (LAS) as SOP (at least on paper) due to their receipt of Federal funding/payments.  However, a funny thing happened on the way to implementation in community pharmacies – much as those pharmacies and the healthcare professionals that staff them are treated differently than similar entities/professionals in our system of health care…this mandate has been treated more as a voluntary compliance issue.  What, if any, impact has this had on reimbursement or outcomes?  The jury is still out.  However, as a first step to methodically examine this issue, we conducted a national survey of availability and use of LAS in community pharmacies; the initial results of which have recently been published in the Journal of the American Pharmacists Association (JAPhA).

Pharmacist responses to the survey ranged from descriptions of widely advertised and seamlessly integrated interpretation (verbal) and translation (written) LAS services to the (rarely observed) attitude of ‘if they’re in our country they should speak English’.  Overall, we identified issues regarding awareness (e.g., about half of pharmacies with LAS capacities did not report making them known to patients), use of LAS (e.g., about 40% said they “never” used interpretation/translation tools), and workflow/time (e.g., a quarter of respondents said they simply lacked time to use LAS).  Alternately, there were encouraging signs as pharmacies that did apprise patients of LAS availability used a variety of methods including in-store direct notification, signage, flyers, and targeted mailings.  Additionally, more LAS products are becoming available such as Elsevier’s MEDcounselor Languages module, which advertises SIG translation and patient education materials in 14 languages.  Another gem that area pharmacists have started using (albeit moreso in AmCare clinic settings) is the free MediBabble iPhone app.  My understanding is that a future update will (ahem) include pharmacists in the introductions section. 

Unfortunately, our article “Community pharmacists’ use of language-access services in the United States” is behind a subscription wall, but I would be happy to answer any questions that I can.

@kevinclauson

Disclosure: A couple years ago we received a grant from one of the quadrillion companies Elsevier operates for an unrelated research study.  Inclusion of their product in this post is mostly due to timing (I just received an email about it), and should probably not be construed as a conflict of interest except for the most Mel Gibsonian of conspiracy theorists.  Separately, this JAPhA LAS study was funded by a NSU President’s Grant.  Going forward we are planning to study the LAS disconnect further, as well as possible solutions that may include tools such as automated LAS kiosks in pharmacies and online functionality as well as LAS availability notification via social media; funding source(s) TBD.

 

Source: Feichtl MM, Clauson KA, Alkhateeb FM, Jamass DS, Polen HH. Community pharmacists’ use of language-access services in the United States. J Am Pharm Assoc. 2011;51(3):368-72.

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