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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Health Literacy
Benjamin J. Powers, Jane V. Trinh, Hayden B. Bosworth

Sections:  Clinical Scenario, Methods, Results, Scenario Resolution, Bottom Line, References

Topics Discussed: health literacy

Excerpt: "A 67-year-old patient presents to your clinic for the first time 4 days following hospital discharge for a new diagnosis of atrial fibrillation. His heart rate is adequately controlled, and he was prescribed warfarin (5 mg daily) at discharge, with a plan for anticoagulation management. His international normalized ratio today is 1.4 (goal, 2-3), and you plan to enroll him in your nurse-run anticoagulation clinic but wonder about his ability to read and follow written instructions for managing his anticoagulation therapy.Health literacy is "the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions."1 The 2003 National Adult Assessment of Literacy estimated that 14% of adults had below basic literacy and an additional 22% had only basic literacy—resulting in more than 90 million US adults who may lack the literacy skills to effectively function in the current health care environment.2 Written instructions are a key component in health communication, and patients with limited literacy frequently do not understand prescription medication labels3 or complex instructions like anticoagulation dosing.4 This limitation is most common in older patients, those with lower education levels, immigrants, and racial/ethnic minorities.5-8 Prior research has supported the association between literacy and disease knowledge, utilization of preventive services, hospitalization, overall health status, control of chronic disease, and mortality.9-14..."
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