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Access to care depends on health literacy

Laurie Martin of RAND Corp.

Carolyn Poirot
Special to the Business Press

Some 350,000 people in Tarrant County have no health insurance.
But lack of insurance may not be the biggest obstacle to their getting good health care, according to speakers at the first-ever Health Literacy Symposium in Arlington on June 6.
The biggest problem is that only 12 percent of U.S. adults have the ability to obtain, process, understand and use the health information and services they need to gain access to care and make the best health care decisions for themselves and their families, symposium speakers agreed.
The bottom line is that most health information is beyond most patients’ ability to comprehend – not only what their doctors tell them, but also what they find online about their new-found diseases, what is included in the patient advisory leaflets that come with prescription drugs, what is printed on over-the-counter drug labels and/or what the discharge nurse tells them after a hospital visit or out-patient treatment.
And it’s not only a problem for poor, elderly or undereducated patients who are new to this country and afraid to ask questions, according to speakers at the symposium, “Health Literacy in Tarrant County Adults: A Systems 
Approach.”
“A wealth of studies demonstrates that most health materials are beyond the comprehension skills of the average person. … You can be well educated and still not have health literacy,” Laurie Martin, a policy researcher with the RAND Corp., told about 200 physicians, nurses, social workers and other health care practitioners at the 
symposium.
“All individuals” may be affected by the mismatch between literacy skills and materials available to help them understand what they need to do to stay healthy, said Martin, the keynote speaker for the full-day symposium. But some people are disproportionately affected, including the elderly, racial and ethnic minorities, immigrants and those with limited education.
The purpose of the symposium, which was sponsored jointly by the Area Agency on Aging and the University of North Texas Health Science Center, was to help highlight health literacy as an unmet need in Tarrant County.
The goal of the symposium and follow-up education is “to enable health care providers to contribute to quality care by identifying and implementing strategies to address health literacy and potential community partners and strategies for collaboration,” according to flyers promoting the event funded by a United Way grant.
Health does not occur in isolation. Individuals are affected by their own basic literacy and their community’s level of health literacy, several speakers pointed out.
The higher your community’s level of health literacy, the more likely you are to benefit from the knowledge and abilities of family members, friends and neighbors. When your community has a low level of health literacy, it can be counterproductive to discuss health with those around you, Martin said.
Doctors say, “It’s not a problem in my clinic, but I know it is in some places.” That’s not true, Martin said. Health literacy is a problem everywhere. It is just a bigger problem in some communities than in others.
Literacy is a critical pathway that affects health care quality. It results in too many diabetics having poor glycemic control and too many asthma patients ending up in emergency rooms. It is a big part of the reason so many patients with congestive heart failure are readmitted to hospitals within a couple of weeks of discharge.
“They have a limited understanding of their disease, risks and treatment protocols, they are less likely to engage in screening and preventive services, and they are less likely to follow up on abnormal test results,” Martin said.
Individuals who have low health literacy may also have difficulty understanding the proper use of medications and how they work, have a lower adherence to medical regimes (self-management) and have higher health care costs, in part because they are more likely to use emergency departments for non-emergency care.
They may fail to follow discharge instructions simply because they don’t understand those instructions, Martin said.
To help predict where health literacy is lowest, the RAND Corp. has developed a prediction model using age, gender, race, education, income, marital status and other data and is applying it to census data to map hot spots and identify communities with low health literacy rates.
Hotspots in Tarrant County where more than 50 percent of the population has basic or lower health literacy include large parts of northwest and southeast Fort Worth and central 
Arlington.
Mapping enables communities to identify areas and topics that should be priorities for intervention, helps bring partners to the table for more collaboration and helps those partners select appropriate interventions and approaches that are targeted effectively, Martin said.
“Focusing on community rather than individuals provides more opportunities for action … and gives you a higher return on your investment,” she noted.
 

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