April 22, 2014

Maria Barhams

Communications Strategies that Foster Patient Accountability

Health literacy, defined as the “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”,* is a growing concern within the U.S. as more Americans are diagnosed with multiple chronic diseases…chronic diseases that often require complicated self-care. When you factor in socioeconomic, language and familial concerns, you have a recipe for a rising segment of the population who are willing but unable to comprehend the information given to them by their healthcare providers.
The American Medication Association Foundation sponsored a National Assessment on Adult Literacy (NAAL) that reported only 12% of American adults demonstrated proficient health literacy and over one-third of Americans have difficulty following directions on a prescription drug label or childhood immunization schedules.** The consequence of miscommunications, on behalf of the provider or patient, can result in medical errors, reduced health outcomes and increased healthcare disparities.
To overcome these challenges try implementing the “ASK” sandwich.
Ask the Patient Questions
Many of us were told “when in doubt ask” or “no question is a stupid question.”  Draw information from your patient and help them understand that you can only support them to the point that they provide you insights into their experience.
Identify Health Risks & Conditions
Describe the healthcare challenges that require management and explain the consequence of inaction, such as risk factors for more serious chronic disease. Make the connection between the actions they can take and how their actions can protect them from more severe consequences that impact their quality of life. It’s important for patients to establish positive anchors that motivate them to achieve their personal health goals.
Ask Additional Questions to Understand the Behavioral & Socioeconomic Factors Contributing to their Health Status
Better understanding the patient’s ability to manage his or her care between office visits can be used to help tailor a self-care action plan. Here are a few common issues to consider reviewing with patients:

  • Financial Limitations – Ask the care team to locate prescription coupons or co-pay savings cards to limit the patient’s out of pocket expenses
  • Parental/Childcare Challenges – Offer virtual follow-up visits and consultation via phone or email. With emerging technologies, virtual meeting solutions may prove helpful to support real-time, bidirectional communication between office visits
  • Low Literacy – Refer patients to personal health records that visualize and help explain common elements of disease management plans. At minimum, these tools can help to encourage a more in depth dialogue and shed light into how much the patient understands about their health

One of the greatest assets you can deliver to your patients is empathy. Create a shame-free practice environment so that your patients understand on a deep level that nothing is too simple or embarrassing to share with you and your care team.
This blog is the first of a three-part blog series titled: “Empowered – Rethinking the Point of Encounter”
*  Lynn Nielsen-Bohlman (2004), Health Literacy: A Prescription to End Confusion, Washington DC: The National Academies Press
** Sheida White (2008), Assessing the Nation’s Health Literacy: Key Concepts and Findings of the National Assessment of Adult Literacy, Chicago: American Medical Association Foundation

About Maria Barhams

Ms. Barhams joined DrFirst in 2014 as the director of population health after beginning her career at the National Institutes of Health (NIH) as a fellow in 2007. In her public service capacity, she leveraged her background in biology and public health/health services administration in various analyst, administrative, intramural, and extramural functions across the NIH. Most notably, Ms. Barhams supported the revision of clinical guidelines and risk stratification of a rare disease affecting patients with compromised immune systems. These guidelines were later adopted and published by the American Academy of Neurology. Ms. Barhams is passionate about public health and the rapid diffusion of evidence from research into real-world clinical settings to improve patient outcomes and reduce disparities. In her capacity at DrFirst, she supports the realization of this vision via DrFirst's technology solution, Patient Advisor.