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AHRQ issues new evidence reports on health literacy and other topics

The Agency for Healthcare Research and Quality recently published four new evidence reports. One of the reports focuses on the impact of health literacy problems on clinical outcomes.

The Nation's estimated 90 million adults with lower-than-average reading skills are less likely than other Americans to get potentially life-saving screening tests such as mammograms and Pap smears. They also are less likely to get flu and pneumonia vaccines or to take their children for well child care visits, according to the new evidence report. The report was requested by the American Medical Association.

People with a low level of literacy have difficulty reading newspapers and other simple information such as directions for taking medications or hospital discharge instructions. They also are more likely to be hospitalized, which may be because physicians are concerned about the patients' abilities to follow basic instructions and care for themselves at home when they are sick.

According to Surgeon General Richard H. Carmona, M.D., M.P.H., F.A.C.S., health literacy is the currency of success for everything that we do in primary and preventive medicine. It can save lives, save money, and improve the health and well-being of millions of Americans. In addition, low literacy plays an important role in health disparities and may contribute to lower quality of care and even medical errors, according to AHRQ director Carolyn M. Clancy, M.D.

Last year, AHRQ, the AMA, and the American Hospital Association launched a campaign to help educate clinicians and patients about the importance of effective communication. As part of the 5 Steps to Safer Health Care campaign, posters with five simple tips to encourage dialogue between patients and providers were distributed to doctors' offices and hospitals nationwide.

The AHRQ-supported evidence review also found that people with lower literacy skills are more likely to have difficulty understanding informed consent forms and comprehending their children's diagnoses and medication instructions. They also are less likely to be knowledgeable about the health effects of smoking, diabetes, asthma, AIDS, and postoperative care. In addition, the review found evidence suggesting that well-conceived interventions, such as easy-to-read guides and other comprehension aids, can at least improve the outcome of knowledge for both lower and higher literacy patients.

Dr. Clancy noted that AHRQ has developed several low-literacy publications aimed at helping people avoid medical errors, take medications safely, and obtain appropriate preventive services. Select to access more information on low-literacy publications.

In addition, the AMA and the AMA Foundation have developed a health literacy kit for physicians and other health professionals called "Health Literacy: Help Your Patients Understand," which contains a 48-page manual for health professionals, a video, patient information, and buttons for physicians and their office staff to wear that say simply: "Ask me—I can help." The AMA kit is available online at

The AHRQ report calls for more research on health literacy to examine whether poor reading ability is really the cause of adverse health outcomes or whether it is a marker for other problems, such as low socioeconomic status, impaired access to care, and low trust in medical providers. It recommends that a patient-centered research design would help identify the challenges associated with navigating the health care system.

The Department of Health and Human Services is addressing health literacy in many ways through its Healthy People 2010 initiative. For example, HHS worked with the Department of Education to develop the first-ever national assessment of health literacy, called the Health Literacy Component of the National Assessment of Adult Literacy. The first data from the new survey will be available in late 2004.

The new evidence report, Literacy and Health Outcomes, Evidence Report/Technology Assessment No. 87, was prepared by AHRQ's Evidence-based Practice Center at RTI International-University of North Carolina at Chapel Hill.

The full report (AHRQ Publication No. 04-E007-2) and a summary of the report (AHRQ Publication No. 04-E007-1) are available from the AHRQ Publications Clearinghouse.

Other evidence reports and summaries published recently by AHRQ include the following:

Total Knee Replacement. Evidence Report/Technology Assessment No. 86. Summary (AHRQ Publication No. 04-E006-1) and full report (AHRQ Publication No. 04-E006-2) are available from the AHRQ Publications Clearinghouse.

Strategies for Improving Minority Healthcare Quality. Evidence Report/Technology Assessment No. 90. Summary (AHRQ Publication No. 04-E008-1) and full report (AHRQ Publication No. 04-E008-2) are available from the AHRQ Publications Clearinghouse.

Effectiveness of Antimicrobial Adjuncts to Scaling and Root-Planing Therapy for Periodontitis. Evidence Report/Technology Assessment No. 88. Summary (AHRQ Publication No. 04-E014-1) and full report (AHRQ Publication No. 04-E014-2) are available from the AHRQ Publications Clearinghouse.

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