The speaker and mentors have no actual or potential conflict of interest in relation to this presentation.

Implementing an inpatient
health literacy workflow
Catherine Eichler, PharmD
PGY-1 Pharmacy Resident
Parkview Health | Fort Wayne, Indiana
Catherine.Eichler@parkview.com

Mentors: Cole Luty, PharmD, BCPS; Abby Todt, PharmD, BCPS

Parkview Health | Fort Wayne, Indiana
BACKGROUND
 Health Literacy Definition

Centers for Disease Control and Prevention. Health Literacy. Accessed August 9, 2022.
https://www.cdc.gov/healthliteracy/learn/index.html. 3
 Prevalence
• Healthy People 2010: “proficient” health literacy needed
for daily healthcare navigation
• National Assessment of Adult Literacy 2003: proficient
health literacy in 12% of 19,000 subjects

Office of Disease Prevention and Health Promotion. National Action Plan to Improve Health Literacy. May 2010.
https://health.gov/sites/default/files/2019-09/Health_Literacy_Action_Plan.pdf 4
 Healthy People 2030

Office of Disease Prevention and Health Promotion. Health Literacy in Healthy People 2030. Accessed August 9, 2022.
https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030. 5
Office of Disease Prevention and Health Promotion. National Action Plan to Improve Health Literacy. May 2010.
https://health.gov/sites/default/files/2019-09/Health_Literacy_Action_Plan.pdf 6
PRIMARY LITERATURE
 Fabbri M, et al.
Health literacy and outcomes among
patients with heart failure
Systematic review and meta-analysis

• Inclusion of two types of studies:

• Observational studies
• Interventional studies
• Outcomes: mortality, hospitalizations,
emergency department (ED) visits

Fabbri M, et al. JACC Heart Fail. 2020;8(6):451-460. 8

 Di Palo KE, et al.
Implementation of a patient navigator
program to reduce 30-day heart
failure readmission rate
Process Analysis
Intervention
•Pharmacist and nurse team
• Guideline-directed medical therapy
recommendations
• Comprehensive heart failure (CHF)
education
• Medication education upon
discharge by pharmacist

Di Palo KE, et al. Prog Cardiovasc Dis. 2017;60(2):259-266. 9

Knowledge Check #1
What percentage of subjects in the 2003 National
Assessment of Adult Literacy had proficient health
literacy?
A.54%
B.25%
C.12%
D.66%

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Knowledge Check #1

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PARKVIEW’S PHARMACIST-LED
HEALTH LITERACY WORKFLOW
Parkview Hospital Randallia
• 1 of 12 Parkview Health
Hospitals
• Community hospital
• 244 beds
• Underserved population
• Graduate Medical
Education team rounds
Purpose

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METHODS
 Health Literacy Assessment
Rapid Estimate of Adult Literacy in Medicine – Short Form (REALM-SF)

Agency for Healthcare Research and Quality. Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-
SF). Personal Health Literacy Measurement Tools. Published Nov 2019. Updated Dec 2022. Accessed March 23,
2023. https://www.ahrq.gov/health-literacy/research/tools/index.html#rapid.
Medication Education Tools
 Study Design and Population
• Implementation of the pharmacist-led health literacy process
• Retrospective chart review of baseline characteristics and health
outcomes 90 days before and after intervention

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Endpoints

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Data Points

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Knowledge Check #2
Which of the following patient care outcomes related to
health literacy is used to measure the impact of the
pharmacist(s) on patients’ health literacy?
A.Hospitalizations
B.Utilization of preventative health measures
C.Chronic disease state management
D.Medication adherence

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Knowledge Check #2

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RESULTS
Patients

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Baseline Characteristics
Characteristic N = 10
Age, years, avg. 69.9 ± 9.57
Male, N(%) 4 (40)
Ethnicity – White, N(%) 7 (70)
REALM- SF Score, avg. 5
Score of 0, N(%) 1 (10)
Score of 1 to 3, N(%) 0 (0)
Score of 4 to 6, N(%) 9 (90)
Discharge medications, avg. 16.4
Seen by diabetes educator, N(%) 3 (30)
Co-morbidities
CHF, N(%) 3 (30)
T2DM, N(%) 5 (50)
COPD, N(%) 8 (80)

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 Intervention Data
Characteristic N = 10
Medications Educated on, avg. 2.7
Assessment and Education Time, avg. (min) 11.5

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Primary Outcome
90-day pre-admission 90-day post-discharge
date (N=10) date (N=10)
Composite of
hospitalizations 1.1 1
and ED visits, avg.
ED visits, avg. 0.5 0.2
Hospitalizations,
0.6 0.8
avg.

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 Subgroup Analysis
Outcomes 90-day pre-admission vs 90-day post-admission
Composite of
hospitalizations and ED visits, avg Hospitalizations, avg
ED visits, avg
Pre Post Pre Post Pre Post
COPD (n = 6) 0.66 0.66 0.17 0.17 0.5 0.5
CHF (n = 2) 1.5 3 0.5 0.5 1 2.5
PNA (n = 2) 2 0 1.5 0 0.5 0
T2DM (n = 0) 0 0 0 0 0 0

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DISCUSSION
Results

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Limitations

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Future Steps

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References
1. Centers for Disease Control and Prevention. Health Literacy. Accessed August 9, 2022.
https://www.cdc.gov/healthliteracy/learn/index.html.
2. Office of Disease Prevention and Health Promotion. National Action Plan to Improve Health Literacy.
May 2010. https://health.gov/sites/default/files/2019-09/Health_Literacy_Action_Plan.pdf
3. Office of Disease Prevention and Health Promotion. Health Literacy in Healthy People 2030. Accessed
August 9, 2022. https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030.
4. Fabbri M, Murad MH, Wennberg AM, et al. Health literacy and outcomes among patients with
heart failure: a systematic review and meta-analysis. JACC Heart Fail. 2020;8(6):451-460. doi:
10.1016/j.jchf.2019.11.007
5. Di Palo KE, Patel K, Assafin M, Piña IL. Implementation of a patient navigator program to reduce 30-day
heart failure readmission rate. Prog Cardiovasc Dis. 2017;60(2):259-266. doi:
10.1016/j.pcad.2017.07.004.
6. Agency for Healthcare Research and Quality. Rapid Estimate of Adult Literacy in Medicine—Short Form
(REALM-SF). Personal Health Literacy Measurement Tools. Published Nov 2019. Updated Dec 2022.
Accessed March 23, 2023. https://www.ahrq.gov/health-literacy/research/tools/index.html#rapid.

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