Patients may not know where to look when researching a health issue. This may lead them to resources that are not supported by research and may become an issue for their own health. Some websites may be filled with medical jargon, which can potentially exacerbate anxiety about a particular condition or cause concern for unrelated health issues. A handout compiling a list of resources would be helpful to providers and beneficial to patients.https://scholarworks.uvm.edu/fmclerk/1416/thumbnail.jp

Ehret, Zachary Winston

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UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2018A Patient's Guide to Smart ResearchZachary Winston EhretUniversity of VermontFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationEhret, Zachary Winston, "A Patient's Guide to Smart Research" (2018). Family Medicine Clerkship Student Projects. 353.https://scholarworks.uvm.edu/fmclerk/353A Patient’s Guide to Smart Research By: Zach Ehret, MS-III Family Medicine site: UVMMC-Berlin Faculty Mentor: Kristopher Jensen, MD February - March 2018Slide 1The Problem Two decades of research show that almost 9 out of 10 adults have difficulty using, locating, and evaluating the credibility and quality of health information that is routinely available (13). According to the U.S. Department of Education, 53% of adults have intermediate health literacy, 22% have basic literacy, and 14% have below basic literacy; 89% of adults with lower health literacy were more likely to obtain information about health issues from radio and television rather than books, brochures, or the internet (11). For those using the internet, top searches consist of patient education materials that require comprehension levels higher than the reading level of the general public (8). Most popularinternet searches also direct patients to top-level domains such as “.com,” which may be less credible than “.org” or “.gov” counterparts. Distributing patient resources is provider-specific and there is no standardized method toprovide patients with easy-to-read, yet reliable resources. A health care system with a preventative focus needs to have an effective method for delivering patient education (12). Knowledge of how resources affect patient understanding may help providers better create and distribute patient education materials. Slide 2Public Health Cost  Studies have linked low health literacy to misunderstanding instructions about prescription medication, medication errors, poor comprehension of nutrition labels, and mortality (13). Due to the complexity and multifactorial nature of health literacy, there are limited studies that assess the full impact of low health literacy with costs for health care services (13). However, some studies indicate that people with limited health literacy have higher medical costs. It is estimated that low health literacy costs between 106 and 236 billion dollars annually and is associated with chronic illness, poor quality of life, and disability (9). According to the National Assessment of Adult Literacy (NAAL), 22% of adults had basic health literacy and 14% had below basic health literacy. Of Vermont residents, 7% of adults lack basic literacy skill. In Washington county, 6% of residents lack basic literacy skills (12). This numbermay be higher in the context of medical information.  Health literacy is important because it may help predict mortality and morbidity. For example, in a rural setting like Vermont, low literacy adults hospitalized with heart failure were 1.94 times more likely to be readmitted (7).Slide 3Community Perspective  “It can be dangerous for patients if they don’t know where to look. For example, they may stop their statins because they’ve read about an association with Alzheimer’s Disease somewhere.” –Dr. Kowalski “Debunking ideas patients come in with can take time out of a visit that could be used in a more effective way.” –Dr. Rodriguez  “Education level may be a barrier for patients.” –Laura from the Community Health TeamWhat I’ve learned in interviews: Patients may not know where to look when researching a health issue. This may lead them to resources that are not supported by research and may become an issue for their own health. Some websites may be filled with medical jargon, which can potentially exacerbate anxiety about a particular condition or cause concern for unrelated health issues. A handout compiling a list of resources would be helpful to providers and beneficial to patients.Slide 4Intervention and MethodologyThe Goal: To create a handout that containsreliable and user-friendly websites to distribute to patients. A “dot-phrase” containing this list was also created to include in patient’s discharge instructions.  Interviews were conducted to obtain provider insight of the problem and their perspectives on which resources would be most helpful to include.  A 10 question Likert scale survey was completed by 30 patients visiting UVMMC-Berlin. Survey contained non-identifiable questions pertaining to current resources used, knowledge gained, office experience, and utility of an educational handout.Slide 5The HandoutThe handout consists primarily of government and non-profit organization websites.Resources include information on common medical conditions, diet, exercise, travel, immunizations, wellness, sexual health, and mental health. It also includes resources one shouldgenerally avoid when researching.Slide 6Results and Responses 22 out of 30 patients (73%) indicated that they would utilize a handout often or always. 14 out of 30 patients (47%) independently researched their medical condition sometimes, often, or always. Common resources used included websites, blogs, forums, magazines, and television. Of the total patients who researched their condition or reason for visit, 32% indicated it raised concerns or they found it difficult to read.Slide 7Effectiveness and LimitationsEffectiveness Providers at UVMMC-Berlin found the handout useful, especially when included in patient discharge instructions.  Providers also said that future follow-up encounter time could be saved with patients who utilized the handout and resources pertaining to their disease.Limitations Websites included in the handout have some degree of subjectivity. I chose websites that I thought would be readable and comprehensible by someone with a basic reading level. There is currently no research done that evaluates the effectiveness of one website compared to others.  Surveys were distributed to all patients visiting UVMMC-Berlin and not necessarily those who reside only in Washington County. Survey results may reflect a larger geographical community perspective. The utility of a handout with websites is limited to those without internet access. Slide 8Future Directions Update handout and dot-phrase to reflect changing guidelines and website information. Include a tab with updated resources for patient under Health and Wellness on the uvmhealth.org homepage. Assess effectiveness of handout with patients in the future. “Much more research needs to be conducted to make a definitive statement about the costs of limited health literacy” (9).Of note, current research projects conducted by the U.S. Department of Education include: Testing Impact of Health Literacy and Integrated Family Approach Programs Improving Literacy Instruction for Adults Research on Reading Instructions for Low Literate AdultsSlide 9References 1) Akinleye, Sheriff D., Ryan Krochak, Nicholas Richardson, Garret Garofolo, Maya Deza Culbertson, and Orry Erez. “Readability of the Most Commonly Accessed Arthroscopy-Related Online Patient Education Materials.” Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 34, no. 4 (April 2018): 1272–79. https://doi.org/10.1016/j.arthro.2017.09.043.2) Bui, Thanh-Lan, Catalina Silva-Hirschberg, Josefina Torres, and April W. Armstrong. “Are Patients Comprehending? A Critical Assessment of Online Patient Educational Materials.” The Journal of Dermatological Treatment, September 22, 2017, 1–5. https://doi.org/10.1080/09546634.2017.1372558.3) Hansberry, David R., Michael D’Angelo, Michael D. White, Arpan V. Prabhu, Mougnyan Cox, Nitin Agarwal, and Sandeep Deshmukh. “Quantitative Analysis of the Level of Readability of Online Emergency Radiology-Based Patient Education Resources.” Emergency Radiology 25, no. 2 (April 2018): 147–52. https://doi.org/10.1007/s10140-017-1566-7.4) Funnell, Martha M., Michael B. Donnelly, Robert M. Anderson, Patricia D. Johnson, and Mary S. Oh. “Perceived Effectiveness, Cost, and Availability of Patient Education Methods and Materials.” The Diabetes Educator 18, no. 2 (April 1, 1992): 139–45. https://doi.org/10.1177/014572179201800207.5) Martin, Alexandra, J. Ryan Stewart, Jeremy Gaskins, and Erin Medlin. “A Systematic Assessment of Google Search Queries and Readability of Online Gynecologic Oncology Patient Education Materials.” Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, January 20, 2018. https://doi.org/10.1007/s13187-017-1319-z.6) Michael Farnsworth, MA. “Differences in Perceived Difficulty in Print and Online Patient Education Materials.” The PermanenteJournal - Kaiser Permanente. Accessed April 20, 2018. https://www.thepermanentejournal.org/issues/2014/fall/5770-edu.htmlSlide 10References 7) Moser, Debra K., Susan Robinson, Martha J. Biddle, Michele M. Pelter, Thomas S. Nesbitt, Jeffery Southard, Lawton Cooper, and Kathleen Dracup. “Health Literacy Predicts Morbidity and Mortality in Rural Patients With Heart Failure.” Journal of Cardiac Failure 21, no. 8 (August 2015): 612–18. https://doi.org/10.1016/j.cardfail.2015.04.0048) Terry C. Davis, Michael A. Crouch, Georgia Wills, Sarah Miller, and D.M. Abdehou. “PsycNET Record Display - PsycNET.” Accessed April 20, 2018. http://psycnet.apa.org/record/1992-14144-0019) Vernon, J. A., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national policy. Retrieved April 21, 2018, from http://www.gwumc.edu/sphhs/ departments/healthpolicy/chsrp/downloads/LowHealthLiteracyReport10_4_07.pdf10) Wallace, L. S., and E. S. Lennon. “American Academy of Family Physicians Patient Education Materials: Can Patients Read Them?” Family Medicine 36, no. 8 (September 2004): 571–7411) “The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy,” September 6, 2006. https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=200648312) “State and County Literacy Estimates - State Estimates.” Accessed April 20, 2018. https://nces.ed.gov/naal/estimates/StateEstimates.aspx13) “National Action Plan to Improve Health Literacy.”  https://health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdfSlide 11

A Patient\u27s Guide to Smart Research

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A Patient\u27s Guide to Smart Research

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