Mental Notes

May 26, 2006

About half of the US population doesn't understand their doctors' instructions, according to health literacy advocates within the AMA and the American Academy of Neurology (AAN). Is it any wonder why clinicians are frustrated with patients' lack of compliance with therapy and lack of follow-through filling prescriptions and presenting for diagnostic tests-not to mention litigation issues that may arise, in part, from physician-patient miscommunication?

Get on Board AAN Health Literacy Initiative By: Dee Rapposelli About half of the US population doesn't understand their doctors' instructions, according to health literacy advocates within the AMA and the American Academy of Neurology (AAN). Is it any wonder why clinicians are frustrated with patients' lack of compliance with therapy and lack of follow-through filling prescriptions and presenting for diagnostic tests-not to mention litigation issues that may arise, in part, from physician-patient miscommunication?To tackle the problem, the AAN has followed in the footsteps of the AMA and taken a health literacy initiative. It distributed an at-a-glance set of health literacy tips at the recent annual meeting of the AAN, which convened in early April at the San Diego Convention Center.The AAN tip sheet outlined behaviors to look for in patients that indicate limited literacy. Behaviors include:- Tendency not to complete or to inaccurately fill out registration forms.- Tendency to miss appointments.- Nonadherence to therapeutic regimens.- Not following through on referrals or prescribed diagnostic testing.- Claiming that a therapeutic regimen is being followed, although laboratory and clinical findings tell a different story.- Claiming that written information will be read "later" (eg, when the patient locates his or her eyeglasses or when she's in the company of family members).- Being unable to name the medication prescribed or explain what it is meant to treat or how and when to take it.6 STEPS TO IMPROVE COMMUNICATIONTo ensure better adherence to management protocols and promote better physician-patient communication, the AAN recommends the following steps, adapted from guidelines developed by the AMA and the AMA Foundation:1. Speak slowly to patients.2. Use simple, nonmedical language.3. Use visual illustrations to convey information.4. Limit the amount of information given at one time and repeat the information given.5. Confirm that patients understand what you have said by asking them to restate it.6. Make patients feel comfortable about asking questions.RECALL AND RESTATEUpon departing from a visit to a physician, a patient should be able to recapitulate information about her health condition to the physician. She should be able to:- Name where she should go to obtain a prescription.- Name where and when to go for tests, referrals, and follow-up appointments.- Describe when and how to take the prescribed medication.- Explain the expected therapeutic effect of the medication and how to gauge whether the medication is "working."- Name who to call to have additional questions and concerns addressed.The extra time taken by a physician to ensure that a patient understands information and instructions helps enhance treatment outcome and also protects both physician and patient from the consequences of miscommunication.Additional information like this, including educational resources for clinicians and patients, can be obtained through the American Medical Association Foundation Web page at http://www.ama-assn.org/ama/pub/category/8115.html. To learn more about the AAN's health literacy initiative, contact Steven R. Rush, MA, LP, at srush@aan.com.Specialized Care May Help Stroke Patients Live Longer By: Colleen B. Litof Stroke remains a significant cause of morbidity and mortality in the United States. The US Brain Attack Coalition recommends treatment at comprehensive stroke centers as a way to improve outcomes for survivors. But how available is such care, and what kind of care delivers the most benefit?To find out, a team from Michigan State University led by Gretchen Birbeck, MD, MPH, assistant professor in the departments of neurology and epidemiology, reviewed data from acute, nonfederal hospitals in California to compare the outcomes achieved by multidisciplinary stroke services, stroke wards, protocols, and specialists between 1998 and 1999. Of the 381 hospitals surveyed, 257 responded, providing data for a total of 61,541 patients who had experienced acute ischemic or hemorrhagic strokes.- 7.4% had a dedicated, multispecialty stroke service.- 12% had a stroke ward.- 62.3% used protocols.- 16% provided care by neurologists who specialized in stroke.Patients treated at facilities that had a dedicated stroke service had significantly lower odds for death at 30 days after stroke. This observation held true throughout the year following hospital admission. The same could not be said for death rates at facilities featuring stroke wards, protocols, or specialists as the cornerstones of stroke care. For example, the percentage of patients who died at 30 days was 15.3% for hospitals with a stroke service but was 17.2%, 17.4%, and 17.1% for hospitals with a stroke ward, protocols, or a specialist, respectively."If all Californians who suffered a stroke during our study period had been treated at hospitals having the same mortality odds as those with a dedicated stroke service, we could have expected to see 1071 fewer deaths over the period from 1998 to 1999," Birbeck commented. The clinical implications are clear. "Our findings support the need to make stroke service care more accessible to persons in the community. It is not far-reaching to suggest that the existence of a dedicated multidisciplinary stroke service be regarded as a reflection of a hospital's ability to provide quality acute health care."The citation for this research is Birbeck GL, Zingmond DS, Cui X, Vickrey BG. Multispecialty stroke services in California hospitals are associated with reduced mortality. Neurology. 2006;Mar 15 [Epub ahead of print].