Tuesday, February 21, 2012

Who is responsible for improving health literacy?

Who is at risk?
Populations most likely to experience low health literacy are older adults, racial and ethnic minorities, people with less than a high school degree or GED certificate, people with low income levels, non-native speakers of English, and people with compromised health status.7 Education, language, culture, access to resources, and age are all factors that affect a person's health literacy skills.

Who is responsible for improving health literacy?

The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems. We must work together to ensure that health information and services can be understood and used by all Americans. We must engage in skill building with healthcare consumers and health professionals. Adult educators can be productive partners in reaching adults with limited literacy skills.

Why is health literacy important?


Why is health literacy important?

Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy.  In other words, nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease.  Fourteen percent of adults (30 million people) have Below Basic health literacy.  These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy.6
Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher healthcare costs.

What is cultural and linguistic competency?


What is cultural and linguistic competency?

Culture affects how people communicate, understand, and respond to health information. Cultural and linguistic competency of health professionals can contribute to health literacy. Cultural competence is the ability of health organizations and practitioners to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of diverse populations, and to apply that knowledge to produce a positive health outcome.4 Competency includes communicating in a manner that is linguistically and culturally appropriate.5
Healthcare professionals have their own culture and language. Many adopt the “culture of medicine” and the language of their specialty as a result of their training and work environment. This can affect how health professionals communicate with the public.
For many individuals with limited English proficiency (LEP), the inability to communicate in English is the primary barrier to accessing health information and services. Health information for people with LEP needs to be communicated plainly in their primary language, using words and examples that make the information understandable.

What is plain language?

What is plain language?

Plain language is a strategy for making written and oral information easier to understand. It is one important tool for improving health literacy.

Plain language is communication that users can understand the first time they read or hear it. With reasonable time and effort, a plain language document is one in which people can find what they need, understand what they find, and act appropriately on that understanding.3

Key elements of plain language include:

Organizing information so that the most important points come first

Breaking complex information into understandable chunks

Using simple language and defining technical terms

Using the active voice

Language that is plain to one set of readers may not be plain to others.3 It is critical to know your audience and have them test your materials before, during, and after they are developed.

Speaking plainly is just as important as writing plainly. Many plain language techniques apply to verbal messages, such as avoiding jargon and explaining technical or medical terms.

http://www.health.gov/communication/literacy/quickguide/factsbasic.htm

What is literacy?

What is literacy?

Literacy can be defined as a person's ability to read, write, speak, and compute and solve problems at levels necessary to:

  • Function on the job and in society
  • Achieve one's goals
  • Develop one's knowledge and potential2
The term “illiteracy” means being unable to read or write. A person who has limited or low literacy skills is not illiterate.

What is health literacy?


What is health literacy?

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.1
Health literacy is dependent on individual and systemic factors:
  • Communication skills of lay persons and professionals
  • Lay and professional knowledge of health topics
  • Culture
  • Demands of the healthcare and public health systems
  • Demands of the situation/context
Health literacy affects people's ability to:
  • Navigate the healthcare system, including filling out complex forms and locating providers and services
  • Share personal information, such as health history, with providers
  • Engage in self-care and chronic-disease management
  • Understand mathematical concepts such as probability and risk
Health literacy includes numeracy skills. For example, calculating cholesterol and blood sugar levels, measuring medications, and understanding nutrition labels all require math skills. Choosing between health plans or comparing prescription drug coverage requires calculating premiums, copays, and deductibles.
In addition to basic literacy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes.
Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.

Monday, February 20, 2012

California Pain Patients Bill of Rights


California Pain Patients Bill of Rights
California Senate Bill No 402
Passed the Senate September 5, 1997
Passed the Assembly September 2, 1997

An act to add Part 4.5 (commencing with Section 124960) to Division 106 of the Health and Safety Code, relating to health.
LEGISLATIVE COUNSEL’S DIGEST
SB 402, Greene. Health: opiate drugs.
Existing law, the Intractable Pain Treatment Act, authorizes a physician and surgeon to prescribe or administer controlled substances to a person in the course of treating that person for a diagnosed condition called intractable pain, and prohibits the Medical Board of California from disciplining a physician and surgeon for this action.
This bill establishes the Pain Patient’s Bill of Rights and states the legislative findings and declarations regarding the value of opiate drugs to persons suffering from severe chronic intractable pain. It, among other things, authorizes a physician to refuse to prescribe opiate medication for a patient who requests the treatment for severe chronic intractable pain, the physician to inform the patient that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates, and authorizes a physician who prescribes opiates to prescribe a dosage deemed medically necessary.
The people of the State of California do enact as follows:
SECTION 1. Part 4.5 (commencing with Section 124960) is added to Division 106 of the Health and Safety Code, to read:
PART 4.5. PAIN PATIENT’S BILL OF RIGHTS
124960. The Legislature finds and declares all of the following:
(a) The state has a right and duty to control the illegal use of opiate drugs
(b) Inadequate treatment of acute and chronic pain originating from cancer or non-cancerous conditions is a significant health problem.
(c) For some patients, pain management is the single most important treatment a physician can provide.
(d) A patient suffering from severe chronic intractable pain should have access to proper treatment of his or her pain.
(e) Due to the complexity of their problems, many patients suffering from severe chronic intractable pain may require referral to a physician with expertise in the treatment of severe chronic intractable pain. In some cases, severe chronic intractable pain is best treated by a team of clinicians in order to address the associated physical, psychological, social, and vocational issues.
(f) In the hands of knowledgeable, ethical, and experienced pain management practitioners, opiates administered for severe acute and severe chronic intractable pain can be safe.
(g) Opiates can be an accepted treatment for patients in severe chronic intractable pain who have not obtained relief from any other means of treatment.
(h) A patient suffering from severe chronic intractable pain has the option to request or reject the use of any or all modalities to relieve his or her severe chronic intractable pain.
(i) A physician treating a patient who suffers from severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve severe chronic intractable pain as long as the prescribing is in conformance with the provisions of the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.
(j.) A patient who suffers from severe chronic intractable pain has the option to choose opiate medication for the treatment of the severe chronic intractable pain as long as the prescribing is in conformance with the provisions of the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.
(k) The patient’s physician may refuse to prescribe opiate medication for a patient who requests the treatment for severe chronic intractable pain. However, that physician shall inform the patient that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates.
124961. Nothing in this section shall be construed to alter any of the provisions set forth in the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code. This section shall be known as the Pain Patient’s Bill of Rights.
(a) A patient suffering from severe chronic intractable pain has the option to request or reject the use of any or all modalities in order to relieve his or her severe chronic intractable pain.
(b) A patient who suffers from severe chronic intractable pain has the option to choose opiate medications to relieve severe chronic intractable pain without first having to submit to an invasive medical procedure, which is defined as surgery, destruction of a nerve or other body tissue by manipulation, or the implantation of a drug delivery system or device, as long as the prescribing physician acts in conformance with the provisions of the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.
(c) The patient’s physician may refuse to prescribe opiate medication for the patient who requests a treatment for severe chronic intractable pain. However, that physician shall inform the patient that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates.
(d) A physician who uses opiate therapy to relieve severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve severe chronic intractable pain, as long as that prescribing is in conformance with the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.
(e) A patient may voluntarily request that his or her physician provide an identifying notice of the prescription for purposes of emergency treatment or law enforcement identification.
(f) Nothing in this section shall do either of the following:
(1) Limit any reporting or disciplinary provisions applicable to licensed physicians and surgeons who violate prescribing practices or other provisions set forth in the Medical Practice Act, Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, or the regulations adopted thereunder.
(2) Limit the applicability of any federal statute or federal regulation or any of the other statutes or regulations of this state that regulate dangerous drugs or controlled substances.

http://www.paincare.org/pain_management/advocacy/ca_bill.html

Addiction and Chronic Pain


Addiction and Chronic Pain

By: Jennifer P. Schneider, PhD
Chronic pain, especially chronic pain unrelated to cancer, is notoriously under-treated. In 1999, the American Pain Society surveyed 805 people who had chronic pain about the adequacy of treatment they received from their physicians.1 More than 50% of the survey respondents had been in pain for more than five years, and more than 40% of respondents with moderate-to-severe pain could not find adequate relief. For most sufferers, the cause was arthritis or back disorders. Almost half of the 805 patients had changed doctors at least once. The most common reasons for changing doctors were


•too much pain (42%),
•didn't know a lot about pain management (31%),
•the belief that the doctor didn't take their pain seriously enough (29%), and
•the doctor's unwillingness to treat their pain aggressively (27%).
Only 26% of those respondents who had "very severe" pain reported taking opioids (i.e., narcotics— the strongest pain relievers available) at the time of the survey.

Opioids are medications derived from morphine or chemically similar drugs created in the laboratory. They are the most effective pain relievers we have. Opioids have been used to treat pain for thousands of years. The most commonly used opioids are morphine, oxycodone, hydrocodone, fentanyl, hydromorphone, and methadone. All except methadone are short-acting medications. If your pain is present around the clock, you are likely to do better with formulations that are released slowly in the body, lasting longer before you need another dose. Morphine, oxycodone and hydromorphone are available in pills that need to be taken only once or twice a day, and in rare cases, three times. Fentanyl is available in a patch that lasts two to three days after it is applied to the skin. Hydrocodone is available only in a short-acting form in combination with aspirin or acetaminophen.


The Myths Surrounding Opioids

Why are some physicians reluctant to treat chronic pain with opioids – the most effective available class of medications for treating pain? It's for the same reasons that many patients fear strong pain medications – the many myths surrounding the use of opioids. These myths include:


•using opioids means you are a bad or weak person,
•opioids damage the body,
•people who use opioids are likely to become addicted, and
•the body gets used to the opioid dose, which then needs to be increased again and again in order to continue getting pain relief.
Every one of these beliefs is incorrect. Below we'll go over the facts one by one and see what the reality is.

Myth – Using opioids means you are a bad or weak person
Fact – Opioids are just another drug treatment for pain
Over and over again, when I've suggested an opioid to suffering patients, they say, "Morphine! That's a dangerous drug. My family would think I'm an addict," or "Methadone? That's what heroin addicts use. Not me!" Because opioids can be abused, their legitimate use for pain has become stigmatized. As a result, too many people suffer with pain.

Myth – Opioids damage the body
Fact – Opioids are very safe drugs when used as directed
You may be surprised to learn that the American Geriatric Society has determined that opioids are safer for older people than anti-inflammatories (NSAIDS) such as ibuprofen or naproxen. NSAIDs can increase the blood pressure, cause gastrointestinal bleeding, and damage the kidney. Opioids do not — opioids do not damage any organs. They do have some side effects, such as nausea and sedation, but these effects rapidly diminish as you continue using the drugs. Other side effects, such as constipation, don't lessen with time, but can be prevented or minimized by taking stool softeners and bowel stimulants on a regular basis. Some men on high doses of opioids experience decreased testosterone levels, but this hormone can be replaced by using a testosterone gel or patch.

Myth – People who use opioids are likely to become addicted
Fact – Most people who are treated with opioids do not become addicted
Addiction is a psychological and behavioral disorder. Addiction is characterized by the presence of all three of the following traits:


•loss of control (i.e., compulsive use),
•continuation despite adverse consequences, and
•obsession or preoccupation with obtaining and using the substance.
As an addiction advances, the person's life becomes progressively more constricted. The addiction becomes the addict's number one priority, and relationships with family and friends suffer. The addict's inner life becomes filled with preoccupation about the drug. Other activities are given up. Life revolves around obtaining and using the drug. This constriction is an important characteristic that distinguishes use of a drug by an addict from its appropriate use by a patient with chronic pain. Patients who take opioids for chronic pain hopefully expand their life, the opposite of what happens with addicts. Pain patients feel better and are able to increase their activities. They may begin gardening, going to movies, playing with children and grandchildren, and many are able to return to work.

A patient who is addicted to drugs may keep increasing the dose without discussing it with the doctor, might repeatedly use up the medications early, go to several physicians for opioids and lie about seeing other doctors, might inject their oral or topical drugs, or sell drugs to get money with which to buy other drugs. These behaviors are not typical of most pain patients.

Most pain patients taking opioids are not addicted to drugs. What is true of them is that they usually become physically dependent on the drug. Physical dependence has nothing to do with addiction. It simply means that a habituated user will experience certain symptoms if the drug is stopped abruptly. For opioids these withdrawal symptoms can include: anxiety, irritability, goose bumps, drooling, watery eyes, runny nose, sweating, nausea and vomiting, abdominal cramps, and insomnia. Withdrawal from morphine starts six to 12 hours after stopping the medication and peaks at one to three days. Longer-acting opioids, such as methadone, have a slower onset of these symptoms, and they are less severe than with shorter-acting drugs such as morphine and hydromorphone. Withdrawal symptoms can be avoided simply by tapering the drug dose over several days.

Myth – Opioid dosages will have to be increased because the body gets used to the drug
Fact – Significant tolerance to the pain-relieving effects of opioids is unlikely to occur
Tolerance means that a person needs more medication to continue getting the same effect. This is also true of addiction. With time, the addict needs more of the drug to obtain the same mood-altering effect. This is why cigarette smokers tend to increase the number of cigarettes they smoke. When opioids are taken for chronic pain, tolerance develops to some of the opioids' effects (e.g., nausea and sedation will lessen) but not to others (e.g., constipation and pain relief will continue as long as a patient takes the opioid). Unless the source of your pain progresses, as is true of many cancer patients, you are likely to remain on the same dose that gave you adequate pain relief when you first took the drug.


Tips for Getting the Treatment You Need

The treatment you need depends, first of all, on the diagnosis, so ask your doctor whether he or she is satisfied (s) he has finished working up your problem. For example, the solution to severe ongoing knee pain might be surgery to replace a knee joint damaged by osteoarthritis. You will need to be evaluated by an orthopedic surgeon. If medications are the key to treatment and non-opioids have not given you enough pain relief, ask your doctor what (s) he thinks about a trial of an opioid. Some doctors will be uncomfortable with this approach. You can also ask your doctor for referral to a pain clinic, where various options are available, including injections and medications. If you have been addicted to alcohol and/or drugs in the past, your doctor will be understandably reluctant to prescribe opioids. In that case, it would be worthwhile to get a consultation with a pain specialist who also understands addiction. A pain specialist with training in addiction can figure out a treatment plan that will provide you with pain relief but also addresses safety so as to minimize your chances of relapsing. This plan may or may not include opioids, depending on what substance you were addicted to, how long you've been clean and sober, and what you are doing to maintain recovery. If you have an active addiction as well as severe chronic pain, you will need addiction treatment before a physician will even consider treating your pain with opioids.

You can learn more about the various treatments for chronic pain, including medications, physical modalities, surgery, psychological approaches, and alternative treatments, by reading my book, living with Chronic Pain (2004). The book also addresses the issues relating to pain and addiction.

Jennifer Schneider, MD, PhD, practices pain medicine and addiction medicine in Tucson, Arizona. She is the author of Living with Chronic Pain (2004), available from www.amazon.com.

References
1. MDs struggle to treat chronic pain. The Quality Indicator Compendium on Pain, Nov. 2002, pp. 9-10.

http://www.nationalpainfoundation.org/articles/134/addiction-and-chronic-pain

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Chronic Pain and the Development of Pain Relieving Medications
It takes a village only after Research appreciates the villagers.
Published on July 29, 2011 by Dr. Mark Borigini in Overcoming Pain

Chronic pain remains an unsolved public health problem. Millions of Americans live with chronic pain, impacting many aspects of the lives of the sufferers-and those who interact with the sufferers, whether they be family, friends, or employers. In fact, chronic pain has a greater impact on the United States economy in terms of health insurance, lost wages and reduced productivity than virtually any other chronic health condition, including diabetes, hypertension, and heart disease.
There are several methodological issues that hinder the development of novel pain-relieving medications. For example, over the last couple of hundred years, most pain research has focused on more transient pain models that do not result in tissue damage, and thus do not reflect what is occurring in a chronic pain patient. On the other hand, studies focusing solely on patients suffering from chronic pain may miss time points when an intervention aimed at preventing chronic pain is most effective. Are there missed opportunities whereby central sensitization can be interrupted, effectively halting the metamorphosis of acute injury to chronic pain?
Scientists have sequenced the human genome, cloned all sorts of organisms, and developed a variety of biological agents to treat heretofore difficult to treat conditions. However, there have been few new drugs to treat pain over the last couple of decades.
Therefore, many researchers are beginning to call for a shift in the strategies utilized in the development of pain medications. It is important to understand the changes in the nervous system that result in the pain experience, and this encompasses the appreciation that acute and chronic pain are different entities. Researchers must measure many signs and symptoms when studying pain, not just whether a patient states their pain is a "2" or a "10".
The principles of pharmacogenomics may assist researchers in their quest for targeted pain relief. It might be possible to uncover a causal relationship between genetic make-up and the response to medications.
It follows that the appropriate measures of patient response are crucial in establishing a pattern of response, or lack therof. A focus on the individual can thus lead to the identification of cohorts of pain sufferers whose genetic pain mechanism "fits" a particular pharmacologic intervention.
Answers to the conundrum of chronic pain, its relation to acute pain, and the genetic and psychological composition of the individual, are going to be found in the individual. This will go a long way to helping the general population of chronic pain patients.
It takes a village only after Research appreciates the villagers.
http://www.psychologytoday.com/blog/overcoming-pain/201107/chronic-pain-and-the-development-pain-relieving-medications