Health literacy promotion strategies in primary care

Sponsored by the Commonwealth Fund in NY and Kaiser Permanente, an examination of health literacy-related "promising practices" for clinicians and office staff in the primary care setting - "Health Literacy Practices in Primary Care Settings: Examples from the Field"

This report presents findings from a 2005 study in which the Association of Clinicians for the Underserved first did an online survey of health care facilities across the country and then followed it up with visits to five selected sites for staff and patient interviews. The study identified five health literacy practices that staff considered especially valuable for their group’s patients and potentially applicable to other clinics: a team effort, beginning at the front desk; use of standardized communication tools; use of plain language, face-to-face communication, pictorials, and educational materials; clinicians partner with patients to achieve goals; and organizational commitment to create an environment where health literacy is not assumed.

(via the Health Policy blog)

Related Article Searching

The case study in the January 2008 issue examines the search for information related to patient experiences and perceptions of electronic medical records. The search strings included in the case study represent the concept of the patient in the following manner:

(Patient Access to Records [mh] OR (Access to Information [mh] AND Patients [majr]) OR (Attitude to Computers [mh] AND Patients [majr]))

You'll notice that this part of the search string does not include any non-controlled vocabulary terms. As we were compiling the case study, this was an intentional decision, and of course there could be many ways to construct a comprehensive search strategy. It is quite likely that no one search strategy would accurately capture all the articles we'd consider. In this particular case, there were far too many additional articles that were added in the results when the term "patient" and its variations were brought in as a keyword search. In a few cases, there were articles that used the plural terms of a collective group of patients (i.e. patients') that were difficult to capture in the search results effectively. For example, this 2003 article by Flynn et al.discusses patient concerns to EMRs in the psychiatric setting. Due to the indexing, this particular article does not appear in our search results, but would appear if patients* [ti] were added to the portion of the search string shown above as it uses the plural for the collective group of patients in the title. However, this small change increases the search retrieval from just over 100 articles to more than 700 articles! Luckily, this Flynn article appears on the first page of Related Articles result from one of the articles included in the final packet, the Pyper C et al article from 2004. What are some ways you might address these type of nuances?

Using the Related Articles feature in this situation proved quite helpful for locating additional articles. As we were working on the case earlier this year, a post from the Shelved in the W's blog was quite timely. In this August 2007 post, the author details in depth some of the aspects of PubMed's Related Searching feature and highlights findings from a report out of the University of Maryland. It makes for an interesting read and serves as a good reminder on the benefits of using "Related Articles." Using this feature may help you locate relevant articles that may not be picked up by multiple search strings.

January 2008 issue available online

The January 2008 issue of the Journal of the Medical Library Association is now available in PubMed Central.

This issue includes the next installment in our case study series; this month's article
is titled, "Synthesis of informatics literature to support institutional policy statement development" and focuses on expert searching and literature summarization to support decisions by healthcare administrators.

An excerpt from the case:

In this hypothetical case, you are approached by one of your hospital's administrators. She is the chair of the hospital's policy development committee and asks you to locate information regarding patient perceptions of their access to their own electronic health records (EHRs) to support the development of an administrative policy statement for your institution. Committee members include clinicians and informaticians who have considerable background knowledge of the matter but also value your expertise in information filtering and synthesis. Thus, the committee requests a comprehensive analysis supporting this initiative.

Reference:
Koonce TY, Sathe NA, Giuse DA, Jirjis J. Synthesis of informatics literature to support institutional policy statement development. J Med Libr Assoc. 2008 January; 96(1): 3–11.

Additional posts related to this case to follow...

Health literacy and Magic Johnson

Magic Johnson Enterprises and Aetna have announced a new partnership focused on urban businesses:

Working together, the two companies will strive to empower businesses and ethnically diverse communities to make informed choices about their health care options by improving health care literacy, showing them the benefits of wellness, exercise and healthy eating, and other initiatives...

The principal goals of the relationship are to:

-- Create a dialogue and action in diverse urban communities to help people understand the health resources, products and services available to them, and encourage them to take a more active role in their health and wellness.

-- Give credible voice, via a recognized and respected leader, to major issues in health care such as the need to improve "health literacy." This will include community events and community-based initiatives to increase people's comfort with the language of health care, as well as encourage better understanding of treatment needs and better adherence to a physician's care plan.

-- Raise awareness of racial and ethnic inequality in health care within these communities to empower people to ask questions, seek answers and create a demand for high-quality health care that respects their cultural preferences.

(the project website, which doesn't include much more information yet)

Consumer health: searching confidence

From the Patient Centered Health Information Technology blog - “Confidence” in Health Searches a Poor Indicator of Finding Good Information talks about a new study from the Journal of Medical Internet Research noting:

1. Searching high-quality online resources improves consumers’ health knowledge; and
2. Consumers’ degree of “confidence” in their answers is not a good indicator of whether their answers are correct.

The JMIR study:
Lau AYS, Coiera E. Impact of Web Searching and Social Feedback on Consumer Decision Making: A Prospective Online Experiment. J Med Intern Res 2008;10(1):e2.

Health literacy training

From the MidContinental Region NN/LM blog:

The Health Resources and Services Administration offers a new, free, online course, "Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency”. Those taking the course can receive five credits (CEU/CE, CHES, CME, CNE). The course is valuable for librarians as they reach out to provide support and information to the public and health professionals and would provide them another option to obtain continuing education units. In addition, The Unified Health Communication course complements The Medical Library Association and National Institutes of Health/National Library of Medicine (NLM) work in literacy research, curriculum design and hospital outreach. Freely share this information with other colleagues. http://www.hrsa.gov/healthliteracy/training.htm

Vancomycin

There's a really thorough discussion of the history of vancomycin and how its use has evolved in the 50+ years it has been available in the US in this 2006 article:
Levine DP. Vancomycin: a history. Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S5-12.

The Wikipedia entry on this antibiotic also gives a little history and briefly discusses vancomycin resistance. For a better examination of vancomycin resistance, consider this CDC page on vancomycin-resistant Enterococcus and this one on vancomycin-resistant Staphylococcus.

Pharmacokinetics and pharmacodynamics

The October 2007 JMLA case talks a lot about how drugs, in this case vancomycin, work within the body, and how clinicians and researchers explore and understand these mechanisms -- pharmacokinetics and pharmacodynamics are two key concepts introduced in the case and worth further exploration.

Pharmacokinetics: This PowerPoint presentation from the University of Connecticut, A Short Course in Pharmacokinetics, gives a great overview of what pharmacokinetics is, what it means for drug delivery and metabolism in humans, and an explanation of a lot of related terminology.

This one from Kennesaw is also a good basic introduction.

Pharmacodynamics: This overview from Howard University provides a great discussion of pharmacodynamics and how this concept is used to explain and understand how drugs actually affect the human body and its systems.

PCR, set to music...

Scientists for Better PCR has put together a great music video describing the PCR technique and its history, in the style of "We Are the World," seems to be sponsored by BioRad Labs and has a little advertisement for their equipment at the end.

(via several of the ScienceBlogs)