No one likes being in the hospital. For the most part our beds at home are more comfortable, eating our own food is enjoyable, and sleeping in real pajamas is always preferred. So if this is the case, why do up to 30 percent of us having such trouble staying out of the hospital and not being readmitted after we leave?
When we’re first in the hospital, we’re focused on getting better. But very quickly our focus turns to going home. Then the moment finally arrives, and the wheelchair pulls up to take us to the “promised land” — our cars. Unfortunately, this is also when most hospitals decide to give us the information we need for a successful home recovery. This means our goals are not aligned. We’re expected to take in and understand all of the information. If that’s not bad enough, we’re expected to remember it. This is where health literacy becomes one of the greatest barriers to a successful discharge pathway.
Step 1: Understanding our condition. Understanding what condition or medical problem placed us in the hospital is the first health literacy challenge. We often get a diagnosis we do not truly understand, or know how we can control it. If we don’t understand what caused our admission in the first place, how are we to keep ourselves from repeating what may have caused the hospitalization in the first place?
Step 2: Understanding follow-up. A second step is to understand what types of follow-up we need to undertake in order to continue our convalescence. Seeing one’s doctors and getting follow-up tests is often not as easy as it may seem. When my elderly aunt was recently released from the hospital, two of the doctors she was supposed to see didn’t have appointment openings for more than two months. My aunt didn’t know what she was supposed to do, so she just accepted one of those too late appointments. Studies have shown that almost 50 percent of readmissions occur within a week of discharge. If I had not intervened, she would not have gotten the timely follow ups that’s so important.
Step 3: Understanding medications. The third step is understanding our medications. Most people come out of the hospital with at least one new prescription. In the case of my aunt, she came out with four new medications. This was in addition to the three that she was already taking.
Knowing when to take the medicines and what to expect with both side effects and effectiveness is another hurdle that needs to be overcome in order to remain at home and not re-hospitalized. Even I as a physician am sometimes challenged with health literacy associated with medication management. When the medicine is prescribed to be taken three times a day, does this mean every 8 hours or does it mean breakfast lunch and dinner? If I have a health literacy challenge, what does that mean for my aunt and her seven medicines?
Step 4: Have a home buddy. The fourth step to a successful discharge from the hospital is one of the most important; having a “home buddy” to help. As I said earlier, discharge directions are most often given as we’re leaving the hospital. Having a family member or friend there when the discharge directions are given can be a huge help. It’s a second set of ears, someone that can help to create a “home plan” and someone that can help with things such as transportation to follow-up visits, getting your medications for you and support around the home. No one can do this all alone.
The Institute of Medicine states that health literacy is “A person’s ability to obtain, process and understand basic health information and services needed to make appropriate health decisions.” It is also being able to act on all of the information given around one’s health. The U.S. Department of Education has found that only 12 percent of adults are proficient in health literacy. If we believe this information to be true, it’s a wonder more of us don’t end up boomeranging back into the hospital, having to give up control, being in a less preferred environment in order to once again maximize our health.