Radhika Devraj

Health Literacy and Kidney Disease: Toward a New Line of Research

Health literacy has been recognized as an important public health issue over the past decade. Low health literacy is a widespread problem in the general population, affecting over 90 million Americans. A growing body of research has demonstrated the association between low health literacy and worse health outcomes in a variety of chronic conditions. Despite the increasing prevalence of chronic kidney disease (CKD) and the considerable interest in health literacy, there has been limited research examining the role of health literacy in individuals at all stages of CKD. This article examines the role of health literacy in kidney disease by reviewing early research on the topic, providing a conceptual model of the relationship between health literacy and health outcomes, and highlighting potential areas for future research on health literacy in CKD.

Relationship between Health Literacy and Kidney Function

Low health literacy (HL) may contribute to poor self‐management of chronic kidney disease (CKD) and poor kidney function. This study aimed to assess the relationship between HL and estimated glomerular filtration rate (eGFR).

Pain Awareness and Medication Knowledge: A Health Literacy Evaluation

ABSTRACT Chronic pain is a significant burden to the US health care system. Patient-related barriers such as low health literacy can prevent optimal management of pain. This study aimed to determine the relationship between health literacy, pain awareness, and medication knowledge. Chronic pain patients visiting a family health center were administered a survey addressing the study objectives. Health literacy was measured using the Newest Vital Sign. A total of 139 chronic pain patients participated in the study. Patients with low health literacy had significantly lower overall pain medication knowledge (mean score = 63.3± 18.9 versus 74.3 ± 18.5, p <0.05), and did not know where to find health care professionals to help manage their pain. Patients with low health literacy lacked knowledge of non-medication modes of treating pain, and did not know which non-prescription medications could provide pain relief. The mean Visual Analogue Scale score for the entire sample was 51.54 mm (range = 0 − 100 mm). Pain intensity was not related to health literacy (p > 0.05). Multivariate analyses showed a significant relationship between health literacy and medication knowledge after controlling for demographics. Patients with low health literacy have poor knowledge of pain medications. Educational interventions to meet the needs of patients with low health literacy are essential to safely relieve pain.

Time for Consensus on a New Approach for Assessments

With the impending changes in the Accreditation Council for Pharmacy Education (ACPE) Standards projected for implementation in 2016, the academy is at another crossroads with respect to pharmacy education.1 One of the more controversial items is Standard 25.2, relating to standardized and comparative assessments.2 It states that “the assessment plan must include standardized assessments as required by ACPE that allow for national comparisons and college- or school-determined peer comparisons.” Specifically the Pharmacy Curriculum Outcomes Assessment (PCOA) is given as an example of a structured assessment that would help provide preadvanced pharmacy practice experiences (APPEs) assessment of foundational knowledge. The concept of standardized assessment is a response to a call from the Department of Education for more accountability to the public.3 The suggestion of using PCOA for preAPPE assessment of knowledge has generated reactions from the academy including criticism of the PCOA examination’s validity as a tool for curricular revision. Schools contend that each school’s curriculum is unique and that a standardized tool would be too prescriptive and stifle creativity among schools. Others do not like the idea of National Association of the Boards of Pharmacy (NABP) being involved in curricular assessment. Another concern is the additional cost and hurdle pharmacy students would incur. The profession currently regulates entry to practice pharmacy and protects the public with the National Association Pharmacy Licensure Examination (NAPLEX). Even though the blueprint for NAPLEX has evolved, with resulting changes in curricular content, the examination has never been a direct measure of curricular effectiveness nor has it assessed the skills and affective domains required for practice of direct patient-centered care as intended by the curricular outcome standards for the PharmD degree.4 The affective patient-centered skills are even more critical as we prepare for the evolving role of the pharmacist as a health care provider. The academy should be proactive in addressing the need for standardized and comparative assessments of curricular effectiveness. A standardized assessment model that intersects with the licensure to practice pharmacy should be advocated for. The model should assess competencies not only in knowledge, but also in skills and the affective domains to meet curricular outcomes. Most schools of pharmacy having limited resources, it would be more cost-effective for an institution like the NABP to collaborate with the academy and ACPE to focus on a new approach to licensure that would address the need for curricular assessment and address assessment needs for professional licensure to protect the public. The United States Medical Licensing Examination (USMLE), which uses a stepped approach to licensure, is worth considering as a model as both pharmacy’s and medicine’s curricula are intended to prepare graduates for patient-centered roles.5 The USMLE currently consists of 3 steps. Step 1 consists of multiple-choice questions that assess foundational sciences using clinical vignettes. Students complete it at the end of the second year of medical school. Step 2 consists of 2 parts: assessing clinical science knowledge using multiple-choice questions and assessing clinical, communication, and interpersonal skills using standardized patients. Students complete this step at end of fourth year of medical school. The third step is assessment of clinical science and competencies in management using multiple-choice questions and computerized case simulations. Step 3 is completed between the first and third year of residency. The model for pharmacy licensure could similarly be a 3-step approach that assesses knowledge, skills, and affective curricular domains of the ACPE Standards. Instead of administering a separate PCOA tool to assess the didactic curriculum prior to APPEs, the first step in the licensure process could be an assessment of core foundational knowledge administered upon completion of the preAPPE components of the curriculum (Step 1: PreAPPE Examination). Completion of the first step would be required for matriculating into APPEs. The examination would be developed and validated to address foundational knowledge delineated in the ACPE Standards, which would circumvent the issue of a separate PCOA examination. The second step would be to assess skills and the affective domains of the ACPE Standards (Step 2: Clinical and Patient-Care Skills). This step would include objective structured clinical examination (OSCE)-like processes and clinical/patient care case assessments administered upon completion of the APPE curriculum components. The third and final step would be an objective examination assessing knowledge of federal and state law and application of clinical knowledge to patient care (Step 3: Law and Clinical Applications Examination). This step would be completed upon graduation. The NABP could be responsible for creating the blueprint and administering all 3 steps of the examination. Such a model would benefit the academy and provide a stepwise assessment approach that would build on a solid scientific and clinical knowledge base and ultimately culminate in the ability of graduates to apply knowledge to practice. A standardized assessment model such as the USMLE would serve as the gateway for licensure to practice pharmacy, thereby addressing ACPE assessment standards and validating the curricular outcome expectations (knowledge, skills, and affective domains) for PharmD graduates. Moreover, it would address the need to protect the public because not only knowledge but also patient care skills would be assessed. If the academy, ACPE, and NABP can reach a consensus, it would enable the profession to proactively ensure that the public is protected by properly credentialed pharmacists who can competently deliver patient-centered care.

Interprofessional Online Global Health Course

Objective. The design and evaluation of an online global health course targeted for pharmacy and other undergraduates is presented. Design. Enrolled students represented nursing, health education, pharmacy and a variety of other disciplines. The course was designed as an entirely online one with no class meetings. The course consisted of eight modules addressing global health competencies and interprofessional education competencies. Readings, quizzes, study question and team projects were tailored to the goals of each module. Students worked in interprofessional teams for their team projects. Assessment. Assessments consisted of pre and post course perceptions and course evaluation. Rubrics were designed to evaluate team assignments and peer assessment of team participation. Conclusion. Course was successful in enhancing perceptions of global health knowledge and understanding of roles and responsibilities of various health disciplines in addressing challenges of global health. No changes in teamwork perceptions were documented after completing the course. The overall course structure was successful in meeting course goals.

Awareness, self-management behaviors, health literacy and kidney function relationships in specialty practice

AIM To determine the relationship between chronic kidney disease (CKD) awareness (CKD-A), self-management behaviors (CKD-SMB) knowledge, performance of CKD-SMBs, health literacy (HL) and kidney function. METHODS Participants were eligible patients attending an outpatient nephrology clinic. Participants were administered: Newest Vital Sign to measure HL, CKD self-management knowledge tool (CKD-SMKT) to assess knowledge, past performance of CKD-SMB, CKD-A. Estimated GFR (eGFR) was determined using the MDRD-4 equation. Duration of clinic participation and CKD cause were extracted from medical charts. RESULTS One-hundred-fifty patients participated in the study. eGFRs ranged from 17-152 mL/min per 1.73 m2. Majority (83%) of respondents had stage 3 or 4 CKD, low HL (63%), and were CKD aware (88%). Approximately 40% (10/25) of patients in stages 1 and 2 and 6.4% (8/125) in stages 3 and 4 were unaware of their CKD. CKD-A differed with stage (P < 0.001) but not by HL level, duration of clinic participation, or CKD cause. Majority of respondents (≥ 90%) correctly answered one or more CKD-SMKT items. Knowledge of one behavior, “controlling blood pressure” differed significantly by CKD-A. CKD-A was associated with past performance of two CKD-SMBs, “controlling blood pressure” (P = 0.02), and “keeping healthy body weight” (P = 0.01). Adjusted multivariate analyses between CKD-A and: (1) HL; and (2) CKD-SMB knowledge were non-significant. However, there was a significant relationship between CKD-A and kidney function after controlling for demographics, HL, and CKD-SMB (P < 0.05). CONCLUSION CKD-A is not associated with HL, or better CKD-SMBs. CKD-A is significantly associated with kidney function and substantially lower eGFR, suggesting the need for focused patient education in CKD stages 1.