Soul Pitt’s Healthy You! Health and Wellness Resources in Pittsburgh

By Carol M. Allen,

Director of Public Affairs and Program Development,
Gateway Health Plan^®

Have you ever been to the doctor’s office or met with a pharmacist and later wondered what they were talking about? Do you have trouble reading your medicine labels? If you answered yes to these questions, you may need to improve your health literacy.

What exactly is health literacy?  Health Literacy is defined by Healthy People 2010 Project as the degree to which people have the capacity to obtain, process and understand basic health information and services needed to make appropriate decisions[1]. It is not as easy as you may think. The simple truth is Americans struggle with health literacy regardless of age, race, ethnicity, income and education-level. This leads to poorer health outcomes, less adherence to medications, overuse of the emergency department and repeat hospitalizations.

Barriers to Health Literacy:

Literacy is not just knowing how to read and write text. It’s being able to apply that information in order to make the right decisions. According to a U.S. National Assessment of Adult Literacy survey, findings showed that 33 % of adults in the United States are at a basic or below average level for written literacy. At least 34 % are at a basic or below average level for document literacy – understanding medical forms – and 55 % are at a basic or below average for numerical literacy, such as understanding percentages and statistics[2].

For some people, age is a factor in understanding health information. Older adults, those who are 65 years and over, make up more than 12 percent of the U.S. population. Many people in this age group have difficulty learning due to limited literacy, disease, chronic conditions and illness, drug interactions, social changes, stress and anxiety. Children and young adults also need to learn about health and in age-appropriate ways.

People with limited vision or hearing may have problems learning because they have one less way to receive information. When people gradually lose those skills, they may be unaware of their diminished abilities and unfamiliar with other ways of communicating.

Language also influences health literacy. About 20 percent of the U.S. population speaks a language other than English at home. Besides English, more than 325 languages are spoken. It can take anywhere from two years to a lifetime to become fluent and have the language skills needed for complex concepts such as “how” and “why.”

Culture is the context in which people understand words. Culture includes people’s values, beliefs, traditions as well as language. Even people from the same country or region may not share the same point of view.

Some people may have difficulty listening when they are scared, anxious or overwhelmed. Given the right set of circumstances, everyone can have trouble understanding health information. To make a patient feel more comfortable, a doctor will often ask a patient to get dressed and to meet in his office before discussing health information.

Take Charge of Your Health

When discussing health literacy, you will need to know how it relates to you. Know your numbers such as your cholesterol, blood sugar (glucose) levels, blood pressure and weight. Knowing what your numbers are will help better control chronic conditions such as asthma, diabetes and heart disease. Before visiting the doctor, prepare a list of questions and write down any symptoms you experience. Make sure you schedule regular visits with your healthcare provider so you can receive optimal care and before any symptoms develop.

While visiting the doctor, health facility or pharmacist do not be shy about asking questions. Take notes or ask a friend or family member to take them for you. Ask for a copy of test results so you can review them on your own time.

Improving Doctor, Patient Communication:

In order for patients to maintain their health, it is essential that doctors and patients truly understand one another. Most complaints against doctors from patients have nothing to do with their clinical competency, but rather, their communication skills. Regardless of age, race or education level, doctors should establish a baseline health literacy level with their patients early on and deliver healthcare recommendations in a suitable manner.

Most medical schools are now teaching doctor-patient communication skills. Training of future doctors involves the knowledge that today’s patients are health consumers and want to be active participants in their own health. The evolution of the Internet is also proving to be something today’s doctors are observing as more people with chronic conditions are using online resources for supplemental information.

Physicians should pick up on emotional cues because if the patient is in a state of distress, the less likely they are to remember important information. You may feel more comfortable having someone with you when you talk to the doctor. Most physicians do not mind having someone else in the room with, and encourage it for instances where caregivers and/or spouses are directly involved with patient care.

Most important of all, perhaps, is for patients to be honest and forthright. Too often, patients withhold critical information or lie because the truth is embarrassing or because they don’t want to disappoint the doctor by admitting that they did not follow the advice or the precise treatment plan.

Ask Me Three:

Building good health literacy skills starts with practice. The next time you visit your primary care physician, make a list of the things you wish to discuss and write them down so you won’t forget[3]. You can begin by asking your doctor the following three important questions:

• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?

If you can, repeat back to your doctor the answers to these three questions above so you are on your way to a better understanding of your health. It may be helpful to have your physician also ask you how you prefer to receive health information. For example, do you prefer learning new things through hearing, writing or visual aids such as photos or videos? Tell your doctor and have him explain his medical instructions in a manner that you prefer. Many primary care physicians have anatomy charts where they can show you exactly where the problem is and why he’s recommending a particular treatment.

Understanding health insurance and benefits

Healthcare is complicated and understanding the healthcare system along with its medical jargon can be confusing. Are you or someone in your family new to Medicare? If so, familiarize yourself with the various plans and benefits that may be available for you.

Medicare is a program administered by the U.S. government, providing health insurance coverage to people who are 65 and over, or who meet other specialized criteria such as chronic disease and/or disability. There are different parts to Medicare. Part A covers inpatient hospital stays. Part B covers physician and outpatient services. Medical Advantage Plans, known as Medicare Part C covers all the benefits of Original Medicare, plus added coverage such as Part D, which includes prescription drug plans.

Medicaid is also referred to as medical assistance and is health insurance that is administered and operated individually by each participating state. The costs of the program are shared by the federal and state governments. Some people are eligible for both Medicare and Medicaid. In these circumstances, and they are known as dual eligible because they meet the insurance criteria for chronic conditions, disability or live in a skilled nursing facility. Some insurance companies offer what is called a Special Needs Plan (SNP) for this population if they live in the plan’s service area and meet the eligibility requirements.

Make sure you or your designated caregiver knows how to navigate the healthcare system. They may be the ones filling out your paperwork or speaking directly with your healthcare providers or care manager. Make sure you keep your insurance card available so you can retrieve it when asked to present with your account information.

Sometimes, your physician will need to submit a referral when you need specialized services above the scope of primary care, such as a neurologist or cardiologist. In these cases, additional paperwork will need to be filled out and you may be asked to present with prior to being seen. It is also important for you to know your rights and responsibilities if a medical claim is denied and you wish to appeal. Regardless of which plan you choose, all Managed Care Organizations (MCOs) provide member services handbooks that can help you navigate the complexities of health insurance.

For more information on the latest government assistance for healthcare, visit www.medicare.gov. or, call toll-free 1-800-MEDICARE (633-4227) TTY users should call 1-877-486-2048.

[2] National Assessment of Adult Literacy. http://www.nces.ed.gov/naal/health

[3] National Patient Safety Foundation at http:///www.npsf.org/askme3/

Filed under: Gateway Health Plan