October 26, 2015 — Blog Post
Health Literacy as Engine Oil for Care Transitions
Transitions usually mean change. For example, in speech and literature, transitions are words that help connect one idea to the next (e.g.: alternatively, thus, on the other hand, consequently). In business, transitions are the change of a company’s ownership to others, such as the owner’s children after his retirement or death. Likewise, in healthcare, transitions are the movement of patients between practitioners and settings as their conditions and needs change.
Care transitions imply more than just transferring the patient from one setting to the other or from one practitioner to the other. According to the Transitions of Care Task Force Report, three things are transferred:
Responsibility and authority are automatically transferred. But we cannot assume information is transferred. Transferring information requires an effort, a process, and a set of skills to make sure that all the information needed to treat the patient is in the hands of those responsible for and with authority over his health.
For example, in the transition between home and the Emergency Department, staff in the ED becomes automatically responsible when the patient walks through the door. They won´t automatically assume they have the information they need. They’ll try to get it directly from the patient or a family member by asking what the problem is, if the patient is allergic to any medications, what the patient´s social security number is, etc.
Similarly, when discharged from the ED, responsibility and authority will be transferred from the hospital to the patient and caregivers; but transferring information will take additional effort. Usually, the hospital will use a discharge summary showing the reasons for hospitalization, significant findings, procedures and treatment provided, the patient’s discharge condition, and patient and family instructions. However, because this is often the only way of communicating a patient’s care plan to the post-hospital care team, the omission or misrepresentation of even small details would lead to significant risks for the patient.
Take the many cases of kids who end up in emergency rooms after unintentional medicine overdoses caused by their parents, or the high rates of readmissions caused by patients who misunderstand their medication regimens. As these cases show, the only outcome that can be expected out of giving someone complete responsibility and authority but incomplete, wrong, or non-understandable information is disaster; just as making an engine work with insufficient, wrong, or no oil.
During a transition, information about, responsibility for, and authority over a person’s health and healthcare are shared among several people. We could capture this processes in the Latin word communicare (to share) which is the origin of our word communication in English.
However, a condition for communication is literacy, in this case, health literacy. And since patients, caregivers, physicians, and others will be making those decisions, it’s important to increase the health literacy of each one of them. This capacity depends on factors such as communication skills, knowledge of health topics, complexity of the system, and characteristics of the situation that pertain to all of those involved in the care.
To avoid the mistakes caused by the wrong or inaccurate information during transitions, we need to find ways to improve communication by:
- Improving the communication skills of patients, practitioners, and caregivers; not only the ability to express symptoms, instructions, or conditions, but also to listen and ask questions.
- Increasing the knowledge of health topics of patients, practitioners, and caregivers; not just biomedical information, but also the psychosocial aspects of illness.
- Reducing the complexity of the system so that patients can access the information and services they need, that practitioners can be more integrated and collaborate among different practices and specialties, and that care givers can understand their role and feel confident about supporting patients.
- Providing the technology that increases the efficiency in critical situations and helps coordinate and share information between patients, practitioners, care givers, payers, and others involved.
Even though health literacy is important during all the healthcare episode, it is during care transitions that it becomes critical, since by definition, transitions imply communication.