Did the Patient Really Understand What I Said?

Often patients think they understand how to take their medication, but the fact is about 50% of patients fail to take medications correctly. This is why Aligning Forces for Quality – South Central PA’s Health Literacy Learning Collaborative is focusing on the technique, Teach Back with five local practices.

Teach Back provides an opportunity for patients to repeat back to the doctor what they’ve heard in their own words. It’s also an opportunity to get patients engaged, which is a very important step to raising the quality of care.

Dr. Gordon Zubrod, a physician for Thomas Hart Family Practice and advisor of the family practice’s residency program, joined the collaborative in November 2010, and began implementing Teach Back. “We started small. A resident of mine, and I were the first two in the practice to use Teach Back. We wanted to see the outcomes before spreading it throughout the practice. The coaches from the collaborative recommended that we measure one thing first, and not to start too broad. Therefore, we concentrated on patients who were receiving new medications and/or changed their medications because this is a high risk area for misunderstanding. By asking the patients to repeat to us what was said, we learned patients were taking too many pills, taking medications at the wrong time, and much more. We reported back to the collaborative’s team of coaches, and then decided to get the rest of the practice involved,” he said.

Initially, there were concerns among the doctors, as some thought the patients may think the technique is awkward, but the practice hasn’t seen this type of reaction. Dr. Zubrod feels it’s quite the opposite, and it reinforces to the patient that he or she understands. It builds their confidence.

“It’s a great tool because it promotes conversation between the patient and the doctor. It opens up the dialogue and may help both the patient and doctor discover issues or concerns that may have not come up otherwise,” stated Sam Obeck, an AF4Q – South Central PA coach for the Health Literacy Learning Collaborative.

“It’s important for practices to remember that change doesn’t happen overnight. It takes reinforcement, and the Health Literacy Learning Collaborative provides that reinforcement. Because we meet with all the practices involved to discuss what’s working and to measure our findings, it helps keep it top of mind. It’s a process to make this part of normal behavior,” said Dr. Zubrod.

Some physicians may fear that this technique is time intensive and adds minutes to each visit. But according to Dr. Zubrod and others involved in the collaborative, this has not been the case.

In the end, it’s saving the patient from making errors. The patient leaves feeling confident, and it reassures the doctor and the patient that he or she is leaving with an understanding.

“It produces better outcomes; we’re preventing harm, and getting better control of the patient’s health as a team,” Dr. Zubrod concluded.

Finally, it’s important to remember that Teach Back is designed to confirm the understanding of the condition or medication, but it’s up to the patient to take action.

To learn more about Teach Back or to become part of the Health Literacy Learning Collaborative, contact Robin Rohrbaugh of Healthy York County Coalition at rrohrbaugh@wellspan.org or (717) 851-2333, or Kathy Gaskin of Healthy Adams County at (717) 337-4137.

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