As a medical librarian I enthusiastically encourage more engaged, effective and clear communication between patients and their healthcare providers.
I teach consumer health classes that include mention of the Ask Me 3 (AM3) program of the National Patient Safety Foundation as part of health literacy education efforts. The program emphasizes focused patient questions of healthcare providers about 1) What is my main problem? 2) What do I need to do? and 3) Why is it important for me to do this? A description according to the healthcare provider page of Ask Me 3 includes
… a quick, effective tool designed to improve health communication between patients and providers. Through patient and provider education materials developed by leading health literacy experts Ask Me 3 promotes three simple but essential questions that patients should ask their providers in every health care interaction.
The problem? Preliminary research including the randomization of 10 practices receiving Ask Me 3 intervention and 10 serving as a control group has shown the program is not effective (with a possible catch).
Overall, they found that among 829 patients across the 20 practices, there were no clear benefits from the AM3 program. Ninety-two percent of patients in both the intervention and control groups asked at least one of the three questions. And patients in both groups averaged six to seven questions of any kind per visit. The two groups also showed little difference when it came to treatment compliance, based on interviews done within three weeks of their visit.
The research team, which will publish their results in the March/April 2010 Annals of Family Medicine, note that
…the study group had fairly strong scores on a questionnaire of “health literacy”
and research team leader Dr. James M. Galliher of the American Academy of Family Physicians National Research Network emailed Reuters with
We believe that programs like AM3 should be systematically implemented and studied across time with patients whose health literacy skills are challenged
The problem is how to accurately tell whose health literacy skills are challenged if across-the-board measures like AM3 aren’t the right strategy. Should new patients take a health literacy questionnaire in addition to the rest of the paperwork they usually have with intake? Read an ice cream label ? Have healthcare providers engage in profiling despite the ‘my patients are well educated enough to understand’ myth? A Public Health Literacy blog entry elaborates on the slippery subtext slope of that last possibility better than I ever could.
It is discouraging news if a tool developed by ‘leading health literacy experts’ didn’t lead to at least some type of positive measurable difference regardless of the study population. The March/April edition isn’t available to me online yet but I look forward to reading this article for more detailed information.