Health Literacy Problem “Poses a Challenge for the Success of the Affordable Care Act”

According to the National Journal, the Congressional advisory committee on Medicare (MedPAC), is concerned that poor health literacy discourages patient involvement in treatment decisions and substantially increases the cost of Medicare.

The article also reminds us why health literacy should be of particular concern to President Obama in the coming months:

The health literacy problem also poses a challenge for the success of the Affordable Care Act. Once the exchanges open on Oct. 1, the millions of new patients added to the system in the coming years are expected to have high rates of health illiteracy, as many of them may not have had health insurance before.

As noted in the article, improving health literacy “is a stated priority for HHS Secretary Kathleen Sebelius.”

Catching up on Summer Reading: New Book on Health Literacy from National Academies Press

Health Literacy: Improving Health, Health Systems, and Health Policy Around the World: Workshop SummaryThis is (relatively) old news, but in case you missed it, the National Academies Press recently released an interesting new book on health literacy interventions around the world, Health Literacy: Improving Health, Health Systems, and Health Policy Around the World. The book is basically a summary of the discussions and findings that came out of a workshop held here in Washington earlier this year on international health literacy efforts.

You can read it online or download a PDF of the book for free. You can also order a hard copy directly from National Academies or through Amazon.

Michael Lytton, Blog Editor for the American Journal of Preventative Medicine, discusses this publication in a recent blog post the first installment in a short series he is planning to write on the subject of health literacy.

Study: Diabetes Patients Who Don’t Understand Basic Health Information Significantly Less Likely To Adhere To Prescribed Treatment

Something new today to add to the list of health problems associated with low literacy: in a recent study conducted by the Kaiser Permanente Division of Research and the University of Washington School of Medicine, a big majority (72%) of the 1,366 study participants turned out to have limited health literacy and significantly poorer adherence to newly prescribed antidepressants compared to other patients.

According to Kaiser Permanente, depression occurs twice as frequently among adults with diabetes compared to adults without diabetes.

Although poor adherence to antidepressant medications has been a known issue with some diabetes patients, what’s new here is the evidence that diabetes patients with limited health literacy were much less likely to refill their antidepressant medications in a timely fashion than patients without such limitations.

Dr. Amy Bauer of the University of Washington School of Medicine, notes that “patients with limited health literacy may require more intensive counseling and clearer explanations about use of antidepressant medications and closer follow-up.” Considering the high number of participants in this study who were found to have low health literacy, I suspect that most doctors should, in fact, be prepared to deal with this issue.

But as a matter of public policy, we could also address this by working on improving the literacy skills of adults in this country to begin with, which would lessen the need for such interventions. Does anyone think it’s likely our health care system can really support the cost of more intensive counseling and closer followup what is likely millions of patients with low literacy/health literacy?

This study isn’t the first report to draw a connection between literacy/health literacy and public health (see link above). Shouldn’t improving adult literacy in the U.S. be a major component of our overall strategy to improve public health and lower health care costs in this country?

Question of the Day: Low Literacy and Medicine Bottles

During the last week of May, WBEZ’s radio series Front & Center began airing a series about low literacy in the Great Lakes region. In an article on their Web site that accompanies the series, they run through a bulleted list of facts on the impact of low literacy. One of those bullets was: “Medication errors due to misread or misunderstood prescription labels cause up to 7,000 deaths each year.”

The inability to follow prescription instructions is a frequently used example to illustrate the challenges of low literacy. I’ve used it myself in material I’ve prepared for D.C. LEARNs and ProLiteracy. And it makes at least some logical sense. If prescription information is written at a level that is too difficult for people with low literacy to read, it’s not a stretch to assume that those people are more likely to make a mistake (and there is anecdotal evidence supporting this). But I wonder whether there is any hard data that actually shows how many people are directly harmed by people with low literacy misreading prescription labels.

The source for Front & Center‘s factoid above was derived from a 2005 American Medical Association publication that accompanied a White House Conference on Aging mini-conference on on health literacy and health disparities. Here is what that publication actually said:

All medications have the potential of causing harm as well as benefit, the incidence of adverse medication events increases with the number of medications. Medication errors are the most common medical mistakes – some as a result of misread or misunderstood prescription labels – causing up to 7,000 deaths each year and costing the health care system nearly $73 billion annually. Improving communications on medications can improve care, reduce errors, and save lives. (my emphasis)

The key word above is “some.” In other words, medication errors cause up to 7,ooo deaths annually, and the authors of this report think that some of those 7,000 are due to misread or misunderstood prescription labels. But even among that subset of the 7,000, it’s not stated how many misread or misunderstood prescription labels can be attributed to low literacy. Just because a label is misread or misunderstood, that doesn’t mean that low literacy was the cause. I have relatively high literacy and I misread things all the time.

I have passing familiarity with the literature on health literacy. I know there are studies on the relationship between low literacy and poor health, educational attainment and mortality rates, on the difficulties that people with low literacy have in understanding health information, or navigating the health care system, etc. What I’m specifically interested in is whether there is better data on the number of medication errors—and more importantly, the harm caused by those errors—that can clearly be attributed to low literacy adults misreading labels. Can anyone point me to a good source?