Translating Medication Labels: Launching An Interprofessional Grassroots Advocacy Campaign for Health Equity Kristen Beiers-Jones, RN, MSN, Cheryl Coon, JD, Marius Ibuye, PharmD Candidate, Leann Knapp, Matthew Ngo, BSN, Brian Park, MD, MPH, Margot Presley DNP, FNP-C, Maysa Shakibnia-Shirazi, BSN
B A C K G R O U N D
I – C A N Rockwood Old Town Gresham CARES La Grande (2018) INTERPROFESSIONAL CARE Southeast Portland ACCESS NETWORK Monmouth I-CAN Partner sites Klamath Falls Reaching Rural Residents in IPE (R3) West Medford
S T U D E N T W O R K
P R O J E C T I M P E T U S
B A C K G R O U N D Limited English proficiency (LEP) correlates with: HEALTH HEALTH EDUCATION INSURANCE LITERACY POVERTY
B A C K G R O U N D - Information - Provider - Decisions instruction - Medication - Ethical adherence compromise - Appointment - Informed attendance consent Language barriers may affect the delivery of adequate care and rivals lack of insurance in predicting health service use. – Institute of Medicine, 2006
B A C K G R O U N D 1.5M $3.5B Medication errors harm 1.5 million people every year costing close to $3.5 billion annually. “The rate of adverse events associated with medication errors is 2.5 times greater in limited English proficiency patients compared to English speaking patients.” $ PEOPLE – International Journal for Quality in Health Care
S T E P O N E STEP ONE 15% 23% of people in Oregon of Oregonians speak do not speak English a language other than “well” or “at all.” English at home. COLLECT DATA ON LEP POPULATION
S T E P T W O IDENTIFY SYSTEM GAP IDENTIFY SYSTEM GAP ASSOCIATED WITH ASSOCIATED WITH Only 1 in 10 ACCESS TO PHARMACIES ACCESS TO PHARMACIES BY PEOPLE WITH LEP BY PEOPLE WITH LEP CLIENT SE Portland I-CAN PROVIDER PHARMACY clients knew the name, purpose, and frequency of all their medications. STEP ONE STEP ONE MEDICATION EFFICIENCY TIME KNOWLEDGE AND EFFICACY “ I spend so much time explaining STEP TWO STEP TWO what a More than 75% “ I’d say one in medication label of SE Portland I- three clients I says that I run CAN clients are see leaves not out of time to not taking understanding address other medications as their medication.” important health prescribed COLLECT DATA ON COLLECT DATA ON needs.” LEP POPULATION LEP POPULATION
C O M M U N I C A T I O N “The single biggest problem in communication is the illusion that it has taken place.” – George Bernard Shaw “Knowing enough English to nod can be dangerous.” – Marius Ibuye “Most LEP individuals endure the consequences of ineffective communication in silence.” – Language Services Guide for Pharmacists
A C T I O N CONTRIBUTE EQUITY AND HEALTH TO HIGH SOCIAL AND SAFETY HEALTHCARE JUSTICE ISSUE ISSUE COST
S T E P T H R E E IDENTIFY SYSTEM GAP IDENTIFY SYSTEM GAP ASSOCIATED WITH ASSOCIATED WITH ACCESS TO PHARMACIES ACCESS TO PHARMACIES BY PEOPLE WITH LEP BY PEOPLE WITH LEP STEP ONE STEP ONE STEP THREE STEP THREE STEP TWO STEP TWO COLLECT DATA ON COLLECT DATA ON NARROW FOCUS AND NARROW FOCUS AND LEP POPULATION LEP POPULATION DRAFT WHITE PAPER DRAFT WHITE PAPER
S T E P F O U R IDENTIFY SYSTEM GAP IDENTIFY SYSTEM GAP ASSOCIATED WITH ASSOCIATED WITH CONDUCT INTERVIEWS AND ATTEND CONDUCT INTERVIEWS AND ATTEND ACCESS TO PHARMACIES ACCESS TO PHARMACIES RELATIONAL MEETINGS WITH RELATIONAL MEETINGS WITH BY PEOPLE WITH LEP BY PEOPLE WITH LEP ADVOCATES AND STAKEHOLDERS ADVOCATES AND STAKEHOLDERS STEP ONE STEP ONE STEP THREE STEP THREE STEP TWO STEP TWO STEP FOUR STEP FOUR COLLECT DATA ON COLLECT DATA ON NARROW FOCUS AND NARROW FOCUS AND LEP POPULATION LEP POPULATION DRAFT WHITE PAPER DRAFT WHITE PAPER
S T E P F I V E IDENTIFY SYSTEM GAP IDENTIFY SYSTEM GAP ASSOCIATED WITH ASSOCIATED WITH END CONDUCT INTERVIEWS AND ATTEND CONDUCT INTERVIEWS AND ATTEND ACCESS TO PHARMACIES ACCESS TO PHARMACIES RELATIONAL MEETINGS WITH RELATIONAL MEETINGS WITH BY PEOPLE WITH LEP BY PEOPLE WITH LEP CIVIL RIGHTS ISSUE ADVOCATES AND STAKEHOLDERS ADVOCATES AND STAKEHOLDERS Title VI of the Civil Rights Act of 1964 The denial or delay of medical care because of language barriers STEP FIVE STEP ONE STEP ONE STEP THREE STEP THREE STEP FIVE STEP FIVE constitutes discrimination and requires that recipients of Medicaid or Medicare funds provide adequate language assistance to patients with limited English proficiency. STEP TWO STEP TWO STEP FOUR STEP FOUR “must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.” STUDY CURRENT COLLECT DATA ON COLLECT DATA ON NARROW FOCUS AND NARROW FOCUS AND STUDY CURRENT STUDY CURRENT OREGON LAWS AND LEP POPULATION LEP POPULATION DRAFT WHITE PAPER DRAFT WHITE PAPER OREGON LAWS AND OREGON LAWS AND SEEK LEGAL EXPERTISE SEEK LEGAL EXPERTISE SEEK LEGAL EXPERTISE Affordable Care Act Section 1557 Requires that health care organizations use “qualified” interpreters to communicate with LEP patients.
S T E P F I V E END LEGAL PRECEDENT: NEW YORK STEP FIVE “ The need to understand prescription information can literally be a matter of life and death. For those New Yorkers who do not speak English as a first language this agreement will ensure they have the medical information needed to protect their health and well-being and that of their families.” – Governor Cuomo of New York STUDY CURRENT In August 2009, the New York City Council passed the Language OREGON LAWS AND SEEK LEGAL EXPERTISE Access Pharmacies Act (LAPA).
S T E P F I V E END LEGAL PRECEDENT: CALIFORNIA STEP FIVE 15 directions in Chinese, Korean, Russian, Spanish, and Vietnamese. “Upon the request of a patient or patient’s representative, a dispenser shall provide translated directions for use, which shall be printed on the prescription container, label, or on a supplemental document.” STUDY CURRENT In January 2016, California passed the Prescription Drug Label bill (AB- OREGON LAWS AND 1073). SEEK LEGAL EXPERTISE
S T E P S I X IDENTIFY SYSTEM GAP ASSOCIATED WITH CONDUCT INTERVIEWS AND ATTEND ACCESS TO PHARMACIES RELATIONAL MEETINGS WITH BY PEOPLE WITH LEP ADVOCATES AND STAKEHOLDERS Marius Ibuye, Pharm.D. Candidate Kristen Beiers-Jones, RN, MSN OHSU College of Pharmacy OHSU School of Nursing Maysa Shakibnia-Shirazi, BSN Margot Presley, DNP, FNP-C STEP ONE STEP SIX STEP THREE STEP FIVE OHSU School of Nursing Primary Care Provider, Multnomah County Mid County Health Center Matthew Ngo, BSN STEP TWO STEP FOUR Brian Park, MD, MPH … and OHSU I -CAN nursing Primary Care Provider, OHSU students Family Medicine, Richmond FORM A CORE TEAM COLLECT DATA ON NARROW FOCUS AND STUDY CURRENT LEP POPULATION Cheryl Coon, JD DRAFT WHITE PAPER OREGON LAWS AND SEEK LEGAL EXPERTISE Executive Director, Refugee & Immigrant Services and Empowerment (RISE)
S T E P S E V E N MEET WITH LEGISLATORS MEET WITH LEGISLATORS STEP SIX STEP SIX Rep. Sheri Rep. Teresa Rep. Rob Rep. Mitch “This is a no - brainer.” Malstrom Alonso León Nosse Greenlick STEP SEVEN STEP SEVEN FORM A CORE TEAM FORM A CORE TEAM Rep. Alissa Sen. Laurie Sen. Elizabeth Keny-Guyer Monnes Anderson Steiner Hayward
S T E P E I G H T MEET WITH LEGISLATORS MEET WITH LEGISLATORS STEP SIX STEP SIX STEP EIGHT STEP EIGHT $ STEP SEVEN STEP SEVEN 1 2 3 4 5 6 SOFTWARE LIABILITY COSTS EFFICIENCY LABEL SIZE CULTURE FORM A CORE TEAM FORM A CORE TEAM UNDERSTAND AND UNDERSTAND AND ADDRESS CHALLENGES ADDRESS CHALLENGES
S T E P N I N E “To date, research and regulatory requirements for MEET WITH LEGISLATORS MEET WITH LEGISLATORS FUTURE PLANS… FUTURE PLANS… medication safety in the US have attended insufficiently to the patient-safety risk inherent in providing complex, English- language labels to non- English speaking families.” STEP SIX STEP SIX STEP EIGHT STEP EIGHT – Journal of the American Pharmacists Association, 2016 STEP SEVEN STEP SEVEN STEP NINE STEP NINE Leann Knapp Chief of Staff Office of Rep. Teresa Alonso Leon FORM A CORE TEAM FORM A CORE TEAM UNDERSTAND AND UNDERSTAND AND Oregon State Legislature House District 22 ADDRESS CHALLENGES ADDRESS CHALLENGES
Questions? ICAN@OHSU.EDU beiersjo@ohsu.edu
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