Ask Me 3 Shows No Effect on Communication in NRN Study

AHRQ Literacy Toolkit to Be Evaluated

May 10, 2010 03:20 pm David Mitchell

Although years of research has shown that clear communication between physicians and patients can enhance patient satisfaction and improve health outcomes, a patient education program designed specifically to help patients understand health instructions failed to achieve the desired results, according to one recently published study.

The program, known as Ask Me 3(, encourages patients to ask three questions during each visit with their physicians:

  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do this?

Ask Me 3, which was pioneered by the nonprofit Partnership for Clear Health Communication in 2003, also emphasizes that physicians should ensure that patients understand the answers to those three questions.

However, a study( involving more than 800 patients that was conducted by the AAFP's National Research Network, or NRN, and published in the March/April issue of Annals of Family Medicine, found that patients at 10 primary care practices that promoted Ask Me 3 were no more likely to ask those specific questions than were patients who visited 10 practices in a control group.

Practices in the intervention group had Ask Me 3 brochures in their waiting rooms and also displayed Ask Me 3 posters in waiting rooms and exam rooms. Furthermore, patients were given pamphlets when they checked in and were reminded by staff to ask their physician the three questions when they were escorted to an exam room.

However, only 26 percent of patients in the intervention group asked any of the Ask Me 3 questions -- 5 percent less than patients in the control group.

In addition, patients in the intervention group were slightly less likely to fill their prescriptions than those in the control group and were only 1 percent more likely to attempt to adhere to recommended lifestyle changes.

NRN director James Galliher, Ph.D., said Ask Me 3 is, in theory, a good idea that is inexpensive and easy to implement in primary care settings.

"The problem, as far as this study was concerned, is that it showed no effects," Galliher said during an interview with AAFP News Now. "As we tried to suggest in the discussion (section of the study report), there may be several reasons for not showing an effect. Clearly, one of those may be (that the study was) addressing the wrong population."

Galliher said patients in the 20 practices studied already asked their physicians questions at a high rate and also demonstrated high levels of adherence to their physicians' advice. He said a study of patients with low health literacy is needed to fully evaluate whether Ask Me 3 has an effect on patient-clinician communication, the types of questions being asked and patients' knowledge about their condition.

"Practices are looking for something that's not expensive, that's not burdensome, that's easy to implement, and this (Ask Me 3 program) is (all of those things)," Galliher said. "The question is, is it effective? Our study concludes that with the population with which we assessed this, we did not find support for its effectiveness. That doesn't mean it's not effective in the long run under a different research design."

Galliher said practices have a responsibility to make sure patients understand what they are told about their health conditions and their medications.

"One of the problems with health literacy is that many patients with low health literacy may also have low levels of literacy, period," he said. "In fact, some patients may not be able to read at all. To assume, as physicians do, that they're getting their message across without verifying that (fact) leaves a lot to be desired in terms of the patient-centered medical home, shared decision-making and patient safety."

According to the Agency for Healthcare Research and Quality, or AHRQ, only 12 percent of U.S. adults have proficient health literacy. The agency has developed a health literacy toolkit( to help promote better understanding among patients.

The toolkit has been pilot-tested by eight practices in North Carolina, and AHRQ is preparing to mount a larger demonstration project.

Galliher said the NRN plans to apply to participate in that demonstration project and is looking for at least 12 practices to implement and evaluate the AHRQ toolkit.

Practices interested in participating can contact NRN senior research associate Brian Manning by e-mail or by calling (800) 274-2237, Ext. 3179.

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