Communicating Clearly About Medicines Proceedings of a Workshop (2017) / Chapter Skim
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4 Translating Research into Practice: Case Studies
4 Translating Research into Practice: Case Studies
Pages 35-66
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From page 35... ...
Brian Jack, professor and chair of the Department of Family Medicine at the Boston University School of Medicine, reviewed Project RED, an effort to reduce rehospitalization using a redesigned discharge process, and Charles Lee, president and founder of Polyglot Systems, spoke about approaches for providing medication information to non-English speakers. Following the four presentations, Donna Horn, director of patient safety– community pharmacy at the Institute for Safe Medication Practices, and H
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From page 36... ...
Together, they issue 1.8 million 1 This section is based on the presentation by Steve Sparks, health literacy director for Wisconsin Health Literacy, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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From page 37... ...
As part of the phase 2 pilots, which began on January 1, 2016, Wisconsin Health Literacy established a project advisory committee that included pharmacy partners, health literacy experts such as Michael Wolf, and representatives from USP, the Pharmacy Society of Wisconsin, and Epic, the electronic health record (EHR) vendor that happens to be located in Madison, Wisconsin.
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From page 38... ...
, that pilot pharmacies will use starting in December 2016. On April 3, 2017, Sparks and his team members will hold a day-long medication label summit featuring testimonials from the participating pharmacy members, as well as presentations by health literacy experts such as Wolf and Ruth Parker.
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From page 39... ...
pharmacies felt we were working with them to come up with the new labels and the processes, not just giving them a set of standards they had to adopt," said Sparks. "I do not think that would have worked, and as a result, the process is going much smoother and faster." In the same vein, involving major stakeholders, including pharmacy boards and major pharmacy chains, makes for a smoother adoption process.
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From page 40... ...
"We believe that the journey to better medication labels has begun and that the project could have implications well beyond the borders of Wisconsin." INCLUDING INDIVIDUALS WITH LOW HEALTH LITERACY IN THE DEVELOPMENT AND TESTING OF PATIENT LABELING2 Laurie Myers, who has led Merck's health literacy work for the past 6 years, discussed how she and her colleagues included individuals with low health literacy in their work in developing and testing health-literate patient labeling for new molecules. Summarizing the key message of her presentation, Myers said, "It is important to include respondents with low health literacy.
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From page 41... ...
The recruitment process also includes a one-question health literacy screen in which potential respondents are asked how confident they are at filling out medical forms by themselves. This is done to make sure that there is adequate representation of participants with low health literacy.
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From page 42... ...
The company also starts the recruitment process earlier than it used to because it takes more time to identify individuals with low health literacy. Myers presented the overall results of multiple rounds of qualitative research testing patient labeling.
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. She gave FDA kudos for supporting Merck's efforts to apply health literacy principles to the development of its patient labeling.
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"It is possible, though, to develop information about new products that is simple and clear and easily understood by people of all health literacy levels." PROJECT RED: ENGAGING PATIENTS IN MEDICATION MANAGEMENT AT HOSPITAL DISCHARGE4 Brian Jack began his presentation by listing the 11 mutually reinforcing components (see Box 4-1) of the Reengineered Discharge Program (Project RED)
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From page 45... ...
A clinical pharmacist calls patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. The results of the trial showed that fewer patients who received the Project RED intervention had to return to the hospital for any reason compared with patients who received the then-standard discharge process.
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From page 46... ...
FIGURE 4-5 Medication instructions in an after-hospital care plan. SOURCE: As presented by Brian Jack, November 17, 2016.
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From page 47... ...
An accompanying calendar, color coded to correspond to the appointment list, provides another way to make sure the patient and caregivers know about what is in store for the patient over the next 30 days. Discussing the results of the clinical trial in more detail, Jack explained that the Project RED intervention was effective at reducing rehospitalization rates in patients of all health literacy levels.
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From page 48... ...
survey administered by Press Ganey showed the intervention produced statistically significant improvements in patient understanding of their discharge instructions compared to patients in the same hospital unit and throughout the hospital over the same time period. "You can raise HCAHPS scores based on the quality of the education related to discharge using the Project RED after-hospital care plan tool," said Jack.
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From page 49... ...
The Project RED postdischarge mediation process map (see Figure 4-8) provides a means of identifying where to measure failure models and analyze the effects of this process.
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Summarizing the results of Project RED, Jack said it improves transitions of care from hospital to home, with the after-hospital care plan serving as the "active ingredient." Project RED benefits those with low health literacy and recognizes that depressive symptoms and other comorbidities impact the ability to understand discharge instructions. Outcomes important to patients and caregivers include communication that is purposeful, supportive, and collaborative, and as a final note, he added that the syndemics of health literacy is an area in which the health literacy field needs to do more work.
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From page 51... ...
Lee started Polyglot Systems in 2001 and with a Small Business Innovation Research grant from the National Institute on Minority Health and Health Disparities, began to address this issue by developing medication instructions for 120 medications in 6 languages. The focus of this work is to develop a simpler, practical medication monograph, individual instructions for use, a regimen summary based on a visual daily calendar, and 3- to 5-minute video demonstrations on how to use more complex medications.
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From page 53... ...
FIGURE 4-9 A sample Polyglot Systems Meducation drug information sheet. SOURCE: As presented by Charles Lee, November 17, 2016.
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From page 54... ...
Today, Polyglot Systems produces these instructional materials in more than 20 languages, including both left-to-right and right-to-left languages. Lee showed a video demonstration, accessible on a smart phone, of how FIGURE 4-10 Medication discharge instructions to improve medication adherence.
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From page 55... ...
The art includes deciding on the key points that materials must cover as well as what information to omit. Determining reading level is also an art in that materials at the lowest grade reading level are not always better, Lee explained, because they can lose important nuances.
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SOURCE: As presented by Charles Lee, November 17, 2016.
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From page 57... ...
Nonetheless, many vendors sell software that only uses capital letters and getting them to change that would require them 7 This section is based on the comments of Donna Horn, director of patient safety community pharmacy at the Institute for Safe Medication Practices, and H Shonna Yin, associate professor of pediatrics and population health in the Departments of Pediatrics and Population Health at the New York University School of Medicine and Bellevue Hospital Center, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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From page 58... ...
"When the patient actually has a question, the information is not there." The lesson she learned from the presentations, she said, is that it is important to understand that people have questions as they go through the journey of taking their medications. Horn said she and her colleagues at the Institute for Safe Medication Practices developed a medication leaflet containing the 10 factors that
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From page 59... ...
Shonna Yin, a pediatrician who works on designing and evaluating health literacy–informed intervention tools to improve communication between health care providers and families, including communication about medication instructions, began her comments by noting that she is working on a project funded by the National Institutes of Health to redesign medication labels for pediatric liquid medicines. She remarked that each of the presentations in this session provided solutions to important pieces of the medication safety problem, but she worries that few institutions and organizations are implementing these effective programs.
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From page 60... ...
She acknowledged that many institutions are now adopting Project RED, but she wishes adoption was happening more widely. She wondered about whether Project RED could be integrated with EHR systems and expanded beyond the discharge process to include regular outpatient encounters or encounters in emergency department settings, as these are also settings where people are being sent home with prescribed medications.
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From page 61... ...
He noted that the postdischarge phone call, which Project RED introduced, is not a social call, but involves the pharmacist asking the patient or caregiver to bring their medications to the phone and reviewing how and when to take them. This step, he said, is critical for identifying potential medication issues of the sort that will lead to expensive rehospitalization.
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From page 62... ...
" Nonetheless, this is a back-burner issue for most pharmacists and it will remain so, he predicted, until some organization such as the National Association of State Boards of Pharmacy takes on an advocacy role on this issue. Jack commented that when he first presented Project RED to the senior management group of his hospital, the chief financial officer wanted to know why decreasing emergency department visits and rehospitalizations was something good given the negative impact that would have on the hospital's operating profits.
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From page 63... ...
As a result, what happens today is that nurses typically have to duplicate discharge information in the Project RED forms, an inefficient process. Michael Wolf commented that he has been hearing this same conversation for a decade and believes that policies and a reluctance to move forward are the major barriers to adoption of the many proven approaches to producing health-literate medication information.
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From page 64... ...
To her, those data point to the implications of health literacy beyond medication issues. She then asked Jack how clinical staff find the time to do the comprehensive work it takes to increase patient understanding.
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From page 65... ...
The Office of the National Coordinator for Health Information Technology, he explained, is working with EHR vendors on a universal or centralized up-to-date medication list. One challenge this effort is facing is the need to incorporate a feature that would allow patients and the home care nurse to provide input to the medication list.
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