Health literacy: How do your patients rate?


Health literacy is the ability of a patient to read, understand, and use health care information to make decisions and follow instructions for treatment. Many physicians overestimate these abilities in their patients, which can lead to poor communication, poor outcomes, and even allegations of malpractice.

Key Points

In a landmark 2003 study, the U.S. Department Of Education issued a National Assessment of Adult Literacy. That study concluded that 88% of adults in the United States did not possess basic health literacy ( According to the Partnership for Clear Health Communication (PCHC) at the National Patient Safety Foundation, low health literacy is a huge cost burden to the American health care system. This problem may impact up to 90 million people in the United States, and is more prevalent in immigrant and minority groups.

Wealth of education materials available

Many Americans get their health education from the Internet or independent reading, but several companies specialize in creating patient education content for Web sites, hospitals, physicians, and even direct marketing to consumers. These vendors provide content in a number of formats. The content is designed to address the health literacy issues in America and is generally written at a 5th to 7th grade level. Content vendors have capitalized on research that shows patients do not understand health care instructions given to them verbally, generally cannot read at a high school level, have poor retention of simple facts, and are likely to be more compliant with instructions and take medications if they are provided basic, simple facts.

Perhaps best known among urologists is Krames' patient education brochures and pamphlets ( Urologists may purchase printed materials, but the most common solution is a Web-based "on-demand" product covering common urologic conditions and procedures and prescription drugs, customizable and published in multiple languages. Practices may publish a link to the Krames content on their Web site. The content also can be licensed and downloaded to a local server or even integrated with your electronic medical record and configured to link documents based upon ICD-9 or CPT codes used in patient workflow.

Other vendors include Thomson Reuters, with its Micromedex patient education offerings (, and ExitCare (, which caters to the emergency room and urgent care market. Mdconversation ( is another inexpensive subscription-based online service with extensive offerings in urology. More than 80 audio-visual presentations are available on a wide range of urologic topics, including specific conditions, diagnostic tests, medical and surgical treatments, and decision support. These modules have been written independently by urologists, are peer-reviewed, and attempt to represent best practice. Mdconversation modules are prescribed by the physician, and all activity by the patient in the system is tracked back to the prescribing physician in a detailed manner.

New app displays anatomic images

In addition to these Web-based resources, a free application is now available for Apple's iPhone and iPad products called drawMD ( http://http:/ The app contains accurate, colored, anatomic drawings of the male and female genitourinary system and allows the urologist to make notes, place arrows, and insert stamps of instruments, stents, and catheters onto the drawings and even add text to enhance communication to the patient. The drawings can then be moved to your EMR or saved and printed for the chart or for the patient to keep.

One of the priorities of the Centers for Medicare & Medicaid Services is to engage patients and their families in their health care. The American Recovery and Reinvestment Act of 2009 included a provision called the Health Information Technology for Economic and Clinical Health (HITECH) Act, which included incentives for the "meaningful use" of health information technology. One of the objectives is "to use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate." Eligible providers who document that more than 10% of all unique patients are provided patient-specific education resources will meet one of the menu set objectives to qualify for meaningful use.

Bottom line: Urologists probably overestimate the health literacy of their patients. Considerable research indicates that this can directly affect patient compliance with treatment and outcomes of care. Numerous inexpensive tools exist to assist us in the important job of educating our patients. A disciplined approach to providing patients with literacy-appropriate materials may improve patient outcomes, satisfaction, and even the bottom line.

Dr. Baum is a urologist in private practice in New Orleans. He is the author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically.

Dr. Dowling is medical director of Urology Associates of North Texas, a 49-physician, community- based, single-specialty group in the Dallas-Fort Worth metroplex.

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