UNC physician says patient, doctor education improves health outcomes

May 07, 2003

(Embargoed) CHAPEL HILL -- Improving how doctors discuss health issues with patients and boosting patients' understanding of what ails them could do at least as much to combat illnesses across the nation as new wonder drugs and innovative medical procedures.

That's the view a young University of North Carolina at Chapel Hill physician expressed Wednesday (May 7) at an American Medical Association media briefing on health literacy in Washington, D.C..

Dr. Darren A. DeWalt, a Robert Wood Johnson Clinical Scholar and instructor in medicine and pediatrics at the UNC School of Medicine, based his conclusions on findings from new UNC research and an extensive review of work by other investigators over the past 20 years. "Low health literacy prevents many people from receiving the full benefit of the biomedical advances of the 20th century," DeWalt said. "Improving patient-physician communication is an important strategy to lessen the burden of low health literacy.

"We desperately need more research to understand how to improve health outcomes for people with low health literacy," he said. "Funding for such research has traditionally been poor, but the potential health payoffs are enormous."

Traditionally, doctors are not just healers, DeWalt said.

"The definition of doctor from the Oxford English dictionary is that of teacher, an instructor; one who gives instruction in some branch of knowledge or inculcates opinions or principles," he said. "Understanding health information does not come easily for even the most well-educated and literate individuals. Many people in our society struggle with written and spoken information."

Physicians often forget that most people seldom enter clinical settings and the medical world.

"Doctors need to translate medical information to patients' life experiences, and patients can help us perform this translation effectively," he said.

Studies have shown that patients, on average, recall about half of what health-care providers tell them, and those with low health literacy recall less than others, DeWalt said. Factors including severe illness, too many recommendations at once and patient anxiety also inhibit patient recall.

Having another family member present often aids communication, as does a closely scheduled follow-up visit. Doctors and other health providers should use plain language with patients, stress only the most important recommendations and repeat them several times, he said.

"The 'teach-back' method also improves information recall," DeWalt said. "Patients retain more medical information when their physician asks them to restate the main concepts at the end of the encounter."

A recent study by Dr. Dean Schillinger of the University of California at San Francisco and colleagues demonstrated that patients whose doctors used the teach-back method controlled their diabetes better. But that study revealed that the method was used in only 20 percent of patient-physician encounters.

Clinical research suggests that "activating" both doctors and patients in the communication process is strongly beneficial, DeWalt said.

That means making patients more involved and less passive during physician visits. Increasing patients' participation can improve both adherence to therapy and health outcomes for such conditions as high blood pressure and diabetes.

"The effect of patient activation can be powerful," he said. "The improvement in patients with diabetes, for example, was as powerful as adding a new medicine."

UNC researchers recently performed a randomized, controlled trial with patients with diabetes to compare a team disease management approach with a one-time educational session with a clinical pharmacist.

"We found that the disease management group had better control of their diabetes," DeWalt said. "What was even more interesting was that the patients who improved the most in the intervention group were those with low literacy skills. Comprehensive approaches, such as patient-centered disease management may substantially improve health for patients with low literacy skills."
Note: The AMA briefing begins at 9 a.m. Wednesday (May 7) at the National Press Club at 529 14th St. N.W. in Washington, D.C. DeWalt can be reached at (919) 966-3712 or (919) 216- 6161. On May 7, he can be reached through the AMA at (312) 464-2410.

By David Williamson
UNC News Services

University of North Carolina at Chapel Hill

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