Abstracts

Rationale: Low health literacy (LHL) is a crippling problem for the US healthcare system. The Institute of Medicine states that 50% of American adults have difficulty understanding and using health information. Health economists estimate that problems associated with low literacy cost health systems $73 billion annually. LHL is linked with poor health outcomes, including low health access, longer hospital stays, and high mortality. These patients are less likely to follow instructions, keep appointments, engage in self-care and take medications. These issues, especially taking medicines correctly, can be catastrophic in diseases like epilepsy which require tight management for adequate control. Hence, epilepsy clinicians must be aware of LHL and use appropriate communication strategies. The goals of this project are to learn the scope of LHL, recognize heath system barriers faced by low literacy patients and improve strategies of communication. First, we assessed the knowledge base of those actively involved in the care of epilepsy patients on health literacy and known communication strategies. Second, we educated providers about two specific communication strategies aimed at improving patient-physician communication: AskMe3 and Teach Back Method. Methods: We queried 4 groups of caregivers in an academic neurology practice: support staff, medical students, neurology residents and faculty. Participants were queried on epilepsy, health literacy and to identify key points of the AskMe3 campaign and the Teach Back Method. Maximum LHL score on the test was 16. Epilepsy, AskMe3 and Teach Back Methods were scored separately. At the completion of the survey, caregivers were educated about the above-mentioned methods. Results: 33 responses were obtained. Due to small sample size, we were not able to determine statistical significance of our results. However, the trend demonstrates a striking difference in knowledge of issues surrounding health literacy among medical students (68% correct; n=10), residents (45% correct; n=10) and faculty (61% correct; n=5). The office staff score (47% correct, n=8) is comparable to that of residents'. Epilepsy knowledge in the 4 groups was compatible with training level. Regarding AskMe3 and Teach Back Method, only 6% (2 providers) and 15% (5 providers) were aware of these strategies, respectively. Conclusions: Stellar medical students scores reflect recent medical school curriculum changes to include doctoring in pre-clinical training. Faculty have limited training on specific issues of LHL; however, clinical experience and institutional mandated CME to lower liability risk which includes LHL may account for these results. At our institution, 85% of the neurology residents graduate from foreign medical schools; LHL may not have been taught. Training programs must include LHL in neurology residency curriculum as residents are entrusted with the care of patients with epilepsy, who are at higher risk for LHL. Communication strategies such as AskMe3 and Teach Back should be used to foster a shame-free communication environment for people with low health literacy.