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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