Improve Patient Outcomes by Supporting Their Health Literacy

By Hymin Zucker, Executive Vice President of Clinical Services

If you’re a healthcare provider, then you’ve worked with patients who just can’t seem to follow their course of treatment—month after month, year after year. Their health declines. They might even stop showing up for appointments. It’s frustrating because you care.

What we often don’t realize is that patients come to us with different levels of health literacy. Unfortunately, despite its impact on patient outcomes, health literacy is hardly touched upon in medical school. Here are a few things all providers should know about the subject, including ways to help improve patients’ health literacy.

What is health literacy and why does it matter?

The CDC defines personal health literacy as “the degree to which individuals have the ability to find, understand and use information and services to inform health-related decisions or actions for themselves and others.” A report by the Milken Institute tells us that 12% of adults in the U.S. have adequate health literacy to navigate the healthcare system and promote their own well-being, showing us how widespread the problem is.

Adults with lower health literacy may have trouble understanding their treatment or reading their medication labels. They’re less likely to be in touch with their doctor, fill out medical forms properly, show up for their appointments, take their medications or make necessary lifestyle changes.

All of that can make it harder for them to stick with their treatment plan. There is some good news though: There’s a lot you can do as a provider to help improve their health literacy issues.

How to help patients improve their health literacy

If you want to increase patient health literacy, you need to understand who your patients are, talk to them at their level and prove they can trust you. Here’s how you do it.

Get to know your patients

As a provider, it’s easy to focus on the disease and forget that the disease is part of the person. Patients are people first. When you treat the person, including not just the disease, but also the things that get in the way of caring for themselves, you can help them be more consistent with treatment.

I cared for a man in his 80s with diabetes who wasn’t taking his insulin regularly. Discussing what kept him from taking it revealed a painful story. He looked back on owning a candy store as a younger man as the best time in his life. That time was cut short in his 40s when his son was killed in an accident and his marriage ended. He grew depressed, stopped caring about his own health and developed diabetes.

Treating him as a person first meant recognizing what he had gone through and supporting him in recovering from his losses. He still couldn’t manage to administer his own insulin, but he started coming into the office daily to get his shot. This kept him out of the hospital, and when he eventually passed away, it was from old age, not from complications from diabetes.

Getting to know your patients this well could take several visits. You might work with a psychologist to help with evaluations and flesh out the historical context of your patients and their conditions. If you put extra effort into understanding your patients, that’s going to make a huge difference for them and for you.

Assess your patients’ health literacy

As you get to know your patients, ask yourself where they fall on the health literacy spectrum.

High health literacy

Patients do their own research and adhere to treatment. They may have family in healthcare and a good support system. This might be the person with diabetes who understands the impact of consuming sugar, the importance of taking their medicine and they’re able to take it themselves.

Medium health literacy

Patients may adhere to some aspects of treatment, but not all. They might be more motivated by a sense of obligation to others, like their doctor, than for themselves. Intellectually, they understand their treatment, but they lose motivation after they get home.

An example of this was a patient who kept getting hospitalized with severe heartburn. After she passed away, her son discovered she had 50 bottles of Zantac at home. They were available to her for free and she had dutifully filled the prescription every time, but she didn’t take it as prescribed. That’s when you know there was another issue that needed to be resolved.

Low health literacy

Patients could have a low education level or might be dealing with substance abuse or depression. The former candy store owner struggling with taking his insulin due to depression is a good example of this.

Ask the right questions

To understand a patient’s situation, we need to have compassion and be realistic. Keep in mind that we all do things we know we shouldn’t sometimes and that there’s a reason why people might be struggling with treatment. Here are some questions to help you start to understand things from the patient’s perspective.

– Are they illiterate? Difficulty reading or a language barrier could be at play.

– Do they not care? When people are deeply depressed, everyday tasks can seem insurmountable.

– Are they confused? It can be hard for patients to keep everything straight after an E.R. or hospital visit.

– Do they need more help? Are they physically or cognitively impaired?

Find meaningful connections between patients’ lives and their treatment

Help people understand their treatment in a way that makes sense and is personally motivating. You can make explanations clearer by using simple language they can understand and taking more time to explain things fully.

People using bronchodilators daily might question whether they need them since they don’t have a cold, bronchitis or pneumonia right now. You may have to explain that they can’t know when they’re going to get sick and using their bronchodilator now reduces the risk of ending up on a ventilator down the road. Or for the person with diabetes who complains about getting up often in the night to go to the bathroom, explain that managing their blood sugar can reduce that problem so they can get a better night’s sleep.

Prioritize and simplify treatments

People can get overwhelmed and confused by everything they need to do. Rather than try to do everything at once, help them prioritize their most essential treatments. If someone has depression, start by just asking them to take their antidepressants. Then add on other treatments after a month or two of compliance.

Focus on positive reinforcement

Many people will start to avoid you if they get scolded or lectured every time they visit. Instead, focus on acknowledging and complimenting them. Let them know you noticed that they shaved or that their outfit looks nice. Celebrate their successes. When they know you pay attention and care, they may feel that their visit is more rewarding and that treatment is worthwhile.

Re-establish PCP trust and primacy

Healthcare these days can feel impersonal to some people. That’s why patients need a caring and compassionate health advocate more than ever. Their PCP is in the best position to offer whole-person care. Patients need you to re-establish trust and the primacy of your care. Here are some ways to do that.

Be there when it matters

Put yourself in front of patients at the right time, for the right reason. Find out when they’re in the hospital and help coordinate their care in their moment of need. Follow up immediately after discharges. Let them know you’re there and that they matter so they see you as their first choice for care.

Follow up regularly

See patients every 90 days. That helps maintain your presence in their care and reduces the chance that they’ll stop medications or other treatment. Check in with them by phone between visits.

Delegate where it makes sense

Have your medical assistants, case and disease manager and outreach staff offer support to patients by phone between quarterly visits. Have them say things like, “The next time you come in, be sure to tell the doctor what you just told me.” These check-ins can reinforce adherence and the primacy of the PCP. And since they’ll be done mostly by your staff, you can accomplish more without burning out.

How ilumed can help PCPs improve health literacy

Ilumed can help improve your patients’ health literacy. We’re like an extension of your clinical staff team that helps offer compassionate service to your patients. Our outreach team can help patients schedule and get to appointments. The case and disease management team gives patients weekly support calls to help them stick with their treatment plans. Social workers help patients find local community resources to meet all kinds of needs. We also help you figure out who your most at-risk patients are and stay in touch with them.

All of this helps you be more effective and efficient. It improves patient outcomes with less burnout. Reach out to ilumed to learn more about how we can help.