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This Web page is designed to help everyone get the best care.  
 
Patients and their family members are an important part of the healthcare team. The more that a patient or family member actively participates, the better the results and the more satisfied they are with their care. As patients and family members become more educated and active and more savvy healthcare consumers, healthcare providers should be equally prepared to respond to the patient’s needs.
We would like to think that every doctor, nurse, pharmacist, hospital, and other provider gives high-quality care, but we know this is not always the case.

Health care quality varies widely and for many reasons. Quality varies depending on where you live. Quality can vary from one state to another and it can vary from one doctor's office to another.

We hope this Web site will help providers improve the quality of the health care provided to patients everywhere.

Health Literacy
Health literacy is the ability to read, understand and effectively use basic medical instructions and information. Low health literacy can affect anyone of any age, ethnicity, background or education level.

People with low health literacy:

  • Are often less likely to comply with prescribed treatment and self-care regimens
  • Fail to seek preventive care and are at higher (more than double) risk for hospitalization.
  • Remain in the hospital nearly two days longer than adults with higher health literacy
  • Often require additional care that results in annual health care costs that are four times higher than for those with higher literacy skills

Why is health literacy important to me?
Chances are high that some of your patients are among the 90 million people in the United States whose health may be at risk because of difficulty in understanding and acting on health information. In fact, you may not even know that these patients are in your practice because:

  • They are often embarrassed or ashamed to admit they have difficulty understanding health information and instructions.
  • They are using well-practiced coping mechanisms that effectively mask their problem.

Resources:

Communications 101

  • Encourage patient and/or family to write down questions they have for you ahead of time.
  • Sit down. Physicians who sit down during their visits are rated by patients as having spent more time than physicians who are standing up spending the same amount of time.
  • Allow the patient to tell the story without interruption. The average amount of time that a physician allows a patient to speak before interrupting is only 20 seconds.
  • Inquire before departing, if there is anything else that the patient would like to address. Studies show that patients save the most troubling questions for the end of the encounter. Involve the patient in the decisions that are made. Make sure you provide complete explanations and a variety of options for treatment.
  • Provide answers in understandable, non-technical language.
  • Make eye contact. Listen effectively. Show empathy.
  • Ensure the availability and efficacy of translation services and other aids to overcome language and hearing barriers.
  • Ask if there is anything more that the patient would like to discuss during the visit.
  • Don’t sugar-coat the unpleasant side effects of certain drugs or treatments. Patients want the truth and it will cut down on complaints regarding clinical care if the expectation is realistic.
  • Coordinate information with other physicians, nurses, etc. Patients’ confidence in the quality of the information they are receiving diminishes if consulting physicians or nurses contradict the information given.
  • Appearance of lack of familiarity with the case results in negative patient perceptions.
  • Give patients the option of having another person present when receiving information about treatment and diagnosis.
  • Physicians and all staff should knock on the door and wait to be invited in, greet the patient while making eye contact, and introduce themselves and any accompanying staff.
  • Be honest and conservative with a patient when you estimate wait times for certain procedures or visits. Never underestimate, always keep the patient informed of delays if what you estimated turns out to be incorrect.
  • Understand and respect patients’ preferences and cultural backgrounds.
  • Show concern for the patient's comfort.
  • Make yourself available to the patient and family. Make certain they know how to contact you with any questions, even if you are consulting.
  • Inquire about the patient’s understanding of the disease and its treatment.

Evidence Based Medicine
Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

The  United States Preventive Services Taskforce, an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services, have provided the following recommendations. A searchable database for clinicians is also available at http: epss.ahrq.gov/PDA/index.jsp

Grade A Recommendations from the United States Preventive Services Taskforce:

Newborns

  • Gonorrhea: Preventive Medication -- Newborns
    • Specific Recommendations:  The USPSTF strongly recommends prophylactic ocular topical medication for all newborns against gonococcal ophthalmia neonatorum.

Adolescents and Adults

  • HIV: Screening -- Adults and Adolescents, with Risk Factors
    • Specific Recommendations:  The USPSTF strongly recommends that clinicians screen for human immunodeficiency virus (HIV) all adolescents and adults at increased risk for HIV infection.
    • Frequency of Service:  No frequency of service information currently available.
    • Risk Factor Information: Men having sex with men (MSM), Unprotected sex with multiple partners, Injection drug user, Sex worker; History of sex partners who are HIV+, bisexual, or injection drug users; History of STDs, Transfusion between 1978-85, Patient requests an HIV test.

Adults 18 years and older

  • High Blood Pressure: Screening -- Adults 18 Years and Older
    • Specific Recommendations:  The USPSTF strongly recommends that clinicians screen adults aged 18 and older for high blood pressure.
    • Frequency of Service:  No Frequency of Service information currently available.
  • Tobacco Use Cessation: Screening -- All Adults; Counseling -- Those Who Use
    • Specific Recommendations: The USPSTF strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products.
    • Frequency of Service: Brief smoking cessation interventions, including screening, brief behavioral counseling (less than 3 minutes), and pharmacotherapy delivered in primary care settings, are effective in increasing the proportion of smokers who successfully quit smoking.
  • Aspirin to Prevent CVD: Preventive Medication -- Adults, Increased Risk
    • Specific Recommendations: The USPSTF strongly recommends that clinicians discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease (CHD). Discussions with patients should address both the potential benefits and harms of aspirin therapy.
    • Frequency of Service: Although the optimal timing and frequency of discussions related to aspirin therapy are unknown, reasonable options include every 5 years in middle-aged and older people or when other cardiovascular risk factors are detected.
    • Risk Factor Information: Age, sex, diabetes, elevated total cholesterol levels, low levels of high-density lipoprotein (HDL) cholesterol, elevated blood pressure, family history of cardiovascular disease (in younger adults) and smoking.

Sexually Active Women

  • Cervical Cancer: Screening -- Female, Sexually Active
    • Specific Recommendations: The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix.
    • Frequency of Service: Indirect evidence suggests most of the benefit can be obtained by beginning screening within 3 years of onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 years.
  • Chlamydia: Screening -- Female, 25 Years or Younger and Older Women at Increased Risk
    • Specific Recommendations: The USPSTF strongly recommends that clinicians routinely screen all sexually active women aged 25 years and younger, and other asymptomatic women at increased risk for infection, for chlamydial infection.
    • Frequency of Service: The optimal interval for screening is uncertain.
    • Risk Factor Information: All sexually active women 25 years old or younger are at increased risk. Other patient characteristics associated with a higher prevalence of infection include being unmarried, African-American race, having a prior history of sexually transmitted disease (STD), having new or multiple sexual partners, and using barrier contraceptives inconsistently.

Pregnant Women

  • Rh(D) Blood Typing: Screening -- Pregnant Women, First Pregnancy Related Visit
    • Specific Recommendations: The USPSTF strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care.
    • Frequency of Service: First prenatal visit.
  • Asymptomatic Bacteriuria: Screening -- Pregnant Women
    • Specific Recommendations: The USPSTF strongly recommends that all pregnant women be screened for asymptomatic bacteriuria using urine culture at 12-16 weeks' gestation.
    • Frequency of Service: All pregnant women should be screened for asymptomatic bacteriuria using urine culture at 12-16 weeks gestation. The optimal frequency of subsequent urine screening during pregnancy is uncertain.
  • Hepatitis B: Screening -- Pregnant Women
    • Specific Recommendations: The USPSTF strongly recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit.
    • Frequency of Service: Screen at their first prenatal visit.
  • HIV: Screening -- Pregnant Women
    • Specific Recommendations: The USPSTF recommends that clinicians screen all pregnant women for HIV.
    • Frequency of Service:  No frequency of service information currently available.
  • Syphilis: Screening -- Pregnant Women
    • Specific Recommendations: The USPSTF strongly recommends that clinicians screen all pregnant women for syphilis infection.
    • Frequency of Service: All pregnant women should be tested at their first prenatal visit. For women in high-risk groups, repeat serologic testing may be necessary in the third trimester and at delivery.
  • Tobacco Use Cessation: Screening -- All Pregnant Women; Counseling -- Those Who Use
    • Specific Recommendations: The USPSTF strongly recommends that clinicians screen all pregnant women for tobacco use and provide augmented pregnancy-tailored counseling to those who smoke.
    • Frequency of Service: Extended or augmented smoking cessation counseling (5-15 minutes) using messages and self-help materials tailored for pregnant smokers, compared with brief generic counseling interventions alone, substantially increases abstinence rates during pregnancy.

Men 35 years and older

  • Lipid Disorders: Screening -- Men 35 Years and Older
    • Specific Recommendations: The USPSTF strongly recommends that clinicians routinely screen men aged 35 years and older and women aged 45 years and older for lipid disorders and treat abnormal lipids in people who are at increased risk of coronary heart disease. The USPSTF recommends that screening for lipid disorders include measurement of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C).
    • Frequency of Service: No frequency of service information currently available.
    • Risk Factor Information: Overall risk assessment should include the presence and severity of the following risk factors: age, male gender, diabetes, elevated blood pressure, family history (in younger adults), smoking.

Women 45 years and older

  • Lipid Disorders: Screening -- Women 45 Years and Older
    • Specific Recommendations: The USPSTF strongly recommends that clinicians routinely screen men aged 35 years and older and women aged 45 years and older for lipid disorders and treat abnormal lipids in people who are at increased risk of coronary heart disease. The USPSTF recommends that screening for lipid disorders include measurement of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C).
    • Frequency of Service: No frequency of service information currently available. 
    • Risk Factor Information: Overall risk assessment should include the presence and severity of the following risk factors: age, diabetes, elevated blood pressure, family history (in younger adults), smoking.

Adults 50 years and older

  • Colorectal Cancer: Screening -- Male and Female 50 Years and Older
    • Specific Recommendations: The USPSTF strongly recommends that clinicians screen men and women 50 years of age or older for colorectal cancer.
    • Frequency of Service: The optimal interval for screening depends on the test.

General Population, Increased Risk

  • Syphilis: Screening -- General Population, Increased Risk
    • Specific Recommendations: The USPSTF strongly recommends that clinicians screen persons at increased risk for syphilis infection.
    • Frequency of Service: No frequency of service information currently available.
    • Risk Factor Information: Populations at increased risk for syphilis infection (as determined by incident rates) include men who have sex with men and engage in high-risk sexual behavior, commercial sex workers, persons who exchange sex for drugs, and those in adult correctional facilities. Clinicians should consider the characteristics of the communities they serve in determining appropriate screening strategies. Prevalence of syphilis infection varies widely among communities and patient populations. For example, the prevalence of syphilis infection differs by region (the prevalence of infection is higher in the southern U.S. and in some metropolitan areas than it is in the U.S. as a whole) and by ethnicity (the prevalence of syphilis infection is higher in Hispanic and African American populations than it is in the white population). 

Source:  United States Preventive Services Taskforce