Research continues to show that patients do not remember - or understand - everything they are told when they are discharged from medical facilities.  An earlier Ix Blog post on health literacy and patient recall discussed findings such as 14% of patients being unaware of the fact that their physician had prescribed a new medication for them.

A more recent article in the Annals of Emergency Medicine found a strong tendency for patients to overestimate their understanding of emergency department (ED) care and discharge instructions.  Patients had more difficulty understanding post-ED discharge care instructions than information about the diagnosis and cause of their illness, ED care, or return instructions.

This research finding suggests that asking patients whether or not they understand medical instructions is not an adequate way to measure comprehension.  Although handwritten or printed discharge instructions are considered a best practice, this should not be the only method of communicating discharge instructions to patients.  Asking patients to explain information or instructions in their own words may be a better strategy for assessing patient understanding and providing clues about where to focus further discussion and explanation.

A recent University of California study reports a striking increase in fatal medication errors (FMEs) over the last 22 years.  The study examined accidental deaths occurring at home, but also included deaths occurring away from home.  The deaths were further categorized into those involving alcohol and/or street drugs and those not involving alcohol and/or street drugs.

The most striking increase in FMEs was with those that occurred at home, especially those involving alcohol and/or street drugs (a 3,196% increase).  FMEs at home, not involving alcohol and/or street drugs increased by 564%.   FMEs that occurred away from home involving alcohol and/or street drugs increased by 555%.  Finally, FMEs away from home, but not involving alcohol and/or street drugs increased by 5%.

Shifts in health care have resulted in reduced professional oversight and increased patient responsibility for monitoring medication use.  Information therapy prescriptions can play a critical role in complementing medication prescriptions.  If consumers are expected to manage increasingly complex - and potentially dangerous - drug regimes, they need access to tailored information to help them do so safely.

Last week, I had a brilliant idea: have my son blog about his first official experience with information therapy.  He had just received his first after-visit summary.  He’s bright and creative, so I was sure he would come up with something good.  As it turns out, he didn’t have much to say about it.  I proceeded to show him his newly and barely populated PHR (personal health record).  He was still unimpressed.  Now might be a good time to mention I bribed him with Internet access.  “After you write about information therapy, you can play on the Internet.”  He was in a hurry to get this over with so he could do (apparently more interesting) things on the Internet than look at a lousy PHR.

This is where I jump in and tell him that when I was his age, I had to wait for 2 to 3 hours in the waiting room to see my doctor (you know, the “When I was a kid, I had to walk uphill in the snow to school…both ways!” story).  I only went to the doctor when I was sick.  The doctor would promptly produce a small white piece of paper (an Rx), and that was the end of my visit.  I hated going to the doctor and had never heard of prevention and would never expect the doctor to explain what he/she thought was wrong with me.  I would have never thought he/she would discuss my treatment options with me or ask me, “Would I like to try medication for it?” or “Would I like to try some preventive approaches to avoid this happening again in the future?”.

Fast forward 25 years and I have a kid who does not appreciate how far the health care system has come.  I really can’t blame him, though.  Information Therapy is kind of like, “Duh!”  It’s a no-brainer.  It’s an “invention” that is so overdue that when it finally appears you ask yourself, “How have I lived without this for all these years?”.

“Mom, I wrote the blog.  Can I go play on the Internet now?”

This year, for the second time in my life, I had the opportunity to choose between several health insurance providers.  I opted for a provider that has a good reputation for embracing the latest information technology and also being patient-centered.  I chose my doctor online, scheduled an appointment online, and received communication - prior to my initial appointment - online.

Several days before my appointment, as instructed, I went to my assigned one-stop shopping center (a.k.a. medical center) to have my blood drawn.  Later that day, I received my cholesterol levels online (cool!).  The day before the appointment, I received the results of the remaining blood tests.  I don’t know much about white cells and red cells and what is supposed to be high or low, but my results were reported alongside desirable ranges.  At my appointment, my doctor walked me through the blood test results, reviewed my medical history, and asked about my medical concerns. 

The grand finale of my visit was receiving my first “after-visit summary.”  In addition to my vital signs (I could have lived without the inclusion of my alleged weight!), the summary included follow-up instructions for various issues we discussed.  For example, since I am a new patient, the summary tells me where to go in the one-stop shopping center to request the transfer of my previous medical records.

I feel like a kid again, like a child who has just learned a new and exciting skill.  I feel a sense of ownership over this experience because I was able to do things like choose a health plan and view my test results online…all without the “supervision” of an adult!  Obviously, I was happy to have an in-person interaction with a real doctor to explain my test results and address my medical concerns.  I feel like a big kid, though, because I feel I am being treated like a capable and welcome participant in my own health care.  Maybe it’s not really me “growing up,” but the health care system.  Either way, it’s a good thing.

African American men have the highest incidence and death rates for prostate cancer than any other racial/ethnic group in the US.  How can information therapy (Ix) promote increased health equity in prostate cancer outcomes?  One of the functions of Ix is to deliver relevant health information to consumers where they are – in this case, the barber shop.

Research suggests that community-based education efforts by barbers could increase prostate cancer screenings among African American men.  Barbers were trained on an educational intervention based on the principles of Paulo Freire’s critical pedagogy.  In this ongoing pilot study, barbers ask male clients over the age of 40 if they have been screened for prostate cancer.  Clients who have not been screened are educated about prostate cancer and informed that they are a candidate for screening.

The training resulted in a statistically significant increase in barbers’ knowledge of prostate cancer.  Screening rates are not yet available, but preliminary results from qualitative interviews indicate increased knowledge about prostate cancer in clients.

If you are interested in promoting health equity, join us at the 7^th Annual Ix Conference in Washington, DC on June 11 and 12.  The Ix and Health Disparities track on June 12 will address promising new interventions that have been developed to narrow health disparities.