Prescription 4 Health
Prescription 4 Health
Introduction
There is a wide range of research findings that link poverty, and an inability to read to poor health literacy and medication management outcomes, particularly among the adolescent population.In order to influence and improve the health outcomes of adolescents it is important that health care providers are equipped with an awareness of health literacy, and are given toolsnecessary to provide patients with an improved ability to read, understand, and act on, the basic health care information required to make appropriate decisions regarding their well being. The challenge with low literate or non-literate patients is: how do we influence healthcare providers to be aware of and sensitive to, the health literacy viability of their patients? At the same time, how do we influence low literate or non-literate patients to understand their medication regimen in ways that will encourage and sustain healthy and safe use of medications? The “Prescription4Health” Project is a communication and educational process that employs a pictogram designed for use between the health care provider, the patient, and the pharmacist ensuring a greater medication understanding and producing a healthy medication regimen outcome.
Background
Consider some of these facts regarding literacy and poverty in the City of Buffalo:
• One in five residents of Erie County is functionally illiterate.• One in three residents of the City of Buffalo is functionally illiterate
• Between 41% and 44% of adults with the lowest literacy skills live in poverty. (Based on federal poverty guidelines.)
• In the Buffalo Public School System, 50% of children entering pre-Kindergarten are not “ready for school” (Brigance /DIBELS assessments – BPS). Children are entering school with limited oral vocabularies, have an inability to identify letters of alphabet, shapes, colors, and often do not know own given name.
• 60% of 4th graders not proficient in reading, as measured by NYS’s English Language
Arts (NYS-ELA4 2006-07) standardized assessment; 67% of 8th graders not proficient in reading, as measured by NYS’s English LanguageArts (NYS-ELA8 2006-07) standardized assessment; 39% of children entering 9th grade in Buffalo Public Schools do not graduate fromhigh school. (NYS Education Department)
• In the City of Buffalo 33% of all households are living on incomes under $15,000 per year; additionally,18% of households are living on incomes between $15,000 and $24,999, 34% of families with children under 18 are living below 100% of the poverty level and 45% of children under 5 are living in households below 100% of the poverty level. In the zip code 14207 where the project will be prototyped, 25% of the population falls below federal poverty guideline standards.
• Based on the number of children born to mothers with less than a high school diploma, approximately 1,000 babies born each year are at future risk of low literacy.
•In a 2007 study by the Harvard school on Public Health, Buffalo was ranked near the top of metropolitan areas in the U.S. with the worst indicators of neighborhood environment for children.
Project Rationale
A literature review of the relationship between poverty, literacy level, and health was conducted. The review indicated that the Prescription 4 Health Project had significance and justification for the chosen population.
The Center for Disease Control’s Health Promotion Goals for Adolescents (age 12-19) includes- Achieve Healthy Independence. One aim of the project is to increase the number of adolescents who are prepared to be healthy, safe, independent, and productive members of society.
In 2004, The Institute of Medicine produced a study that cited 36% of U.S adults are considered “health Illiterate” e.g. do not have a capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.
In a landmark 2004 study, Nabors found that self medication with over the counter (OTC) drugs begins during early adolescence and increases with age, using OTC’s provides individuals with confidence about regulating their own health, and adolescents and young adults often do not self-medicate correctly or effectively.
After a dissection of the literature and with empirical evidence determined in focus group discussions with providers, it was concluded that by influencing provider assessment of health literacy as the “6th vital sign”, adolescents could be provided simple health management tools around the independent and safe use of medications. In addition, providers could be made aware of the health literacy needs of their patients in order to communicate with them in a way that would help to make sure that there was an understanding of the “how, why, when and who” questions about the medication and regarding its safe and effective use.
Description of the Project
A protocol and process has been designed where Health Care Professionals at the Northwest Buffalo Community Health Care Center will be reminded to discuss with their patients four main questions on how to utilize medicines by providing these health care practitioners with a set of tools. The four questions to be reinforced throughout the process from the Healthcare practitioner, to the patient and finally to the pharmacist are: Why am I taking the medication?, When and How do I know it’s working?, When and How do I take it?, and Who do I call if I have a question?. These tools include reminder posters in the examination room (Tool #1), a patient take-away pictorial sheet (pictogram) on how to use their medicines (Tool #2) and attached to each prescription is a “remainder note” (Tool #3) reemphasizing to the community pharmacist’s the importance of discussing this patient’s prescription and over-the-counter medicines using these 4 questions.
The community pharmacists and pharmacy’s that serve these patients will also be provided with the same poster and take-away pictorial sheet (Tool #2) in order to work with the patients.
The entire process will be monitored and measured to determine if there is follow-up from the healthcare practitioner all the way through to the pharmacist. The project is aimed at modifying the practice and behavior of the healthcare professionals in order to influence better medication outcomes for the patient.
The Prescription 4 Health program is being developed in conjunction with the Community Health Foundation of Western and Central New York (CHFWCNY) Health Leadership Fellows Program. A component of this fellowship program is the development of a sustainable project by teams of fellows to assist our community in the mission areas of the CHFWCNY which specifically target children of poverty and the frail elderly. This project is supported by funds provided from the CHFWCNY.
Project Fellows: Gayle Brazeau, Joseph Cozzo, JoAnne Haefner, Tanya Perrin-Johnson, Jane Ogilvie, Christina Sage, Advisor: John Frederick
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