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Can Patients Really Understand Their Own Health Care - and where do they get their information?
Written by Lynn Vogel - ACEon Sun, Mar 9, 2014
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The previous blog posting focused on data documenting levels of participation (or Activation) among adult members of the U.S. population, noting differences among age groups and those with chronic illnesses. The HSC study referenced in the previous posting is a good source for understanding how patients’ participation in their own health care varies by age and chronicity of illness, but it does not provide insight into the capabilities of patients to participate in their care. For insight into this question we turn to a study released in 2008 by the Agency for Healthcare Research and Quality (AHRQ) based on data collected several years earlier and reported in their 2007 National Healthcare Disparities Report.[1] In this study, the AHRQ noted that in the general population,
14 percent had below basic skills, meaning they could accomplish only simple tasks such understanding a set of short instructions or identifying what is permissible to drink before a medical test.
22 percent had basic skills, such as being able to read a pamphlet understand two reasons why a disease test might be appropriate despite a lack of symptoms.
53 percent had intermediate skills, such as being able to read instructions on a prescription label determine the right time to take medication.
12 percent of adults have proficient skills to manage their own health care; this includes weighing the risks and benefits of different treatment knowing how to calculate health insurance costs being able to fill out complex medical forms.
At the time of this study, 36% of the population had basic or below basic skills at the low end of the scale, while only 12% actually had the capability to manage their own health care. While access to the Internet may have increased the level of “health care literacy” among the U.S. adult population somewhat since this data was collected and analyzed. However, where patients get health care information has not changed significantly over the past several years, even with many more sources and, through the Internet, more access. Another recent study by the Center for Studying Health System change documented where patients seek health care information:
In 2010, 50 percent of American adults sought information about a personal health concern, down from 56 percent in 2007, according to a new national study from the Center for Studying Health System Change (HSC). The likelihood of people seeking information from the Internet and from friends and relatives changed little between 2007 and 2010, but their use of hardcopy books, magazines and newspapers dropped by nearly half to 18 percent. While the reduced tendency to seek health information applied to consumers across nearly all demographic categories, it was most pronounced for older Americans, people with chronic conditions and people with lower-education levels. Across all individual characteristics, education level remained the factor most strongly associated with consumers’ inclination to seek health information.[2]
The summary chart for this report is provided below:
As if to add to the challenges of involving patients in their own care, even the popular press cites statistics about patients’ lack of follow-through and continuing compliance with clinicians’ recommendations. One recent article made the following observations:
One in five patients fails to fill new prescriptions, and half of those being treated for chronic conditions stop their medications after six month, according to the National Institutes of Health. These lapses result in additional treatments and hospital stays that cost as much as $289B a year, according to NEHI, a Cambridge (Mass.) health policy group. On top of the expense, missed doses cost an estimated 125,000 U.S. lives a year.[3]
By any account, the facts about patients’ participation in their own care are discouraging. While there may be a myriad of reasons (often highly individualized) for why there is such a significant lack of participation, even among persons with chronic conditions, and even with the assumption that higher levels of participation lead to better, more effective and efficient outcomes, the fact remains that this situation adds to the complexity of providing care. And while patient portals, telemedicine and home-based medical devices all seek to minimize this complexity by providing opportunities for participation and seeking to make participation easier and more convenient, it remains a significant challenge.
[1] Only About 1 in 10 Adult Americans Have all the Skills Needed to Manage Their Health. AHRQ News and Numbers, May 14, 2008. Agency for Healthcare Research and Quality, Rockville, MD.
[2] Tu, Ha T., Surprising Decline in Consumers Seeking Health Information, Center for the Study of Health Systems Change, Tracking Report No. 26, November 2011.
[3] Monitoring Pills to Reduce Bills, Bloomberg Businessweek, April 1 – April 7, 2013, p. 51.
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