[Federal Register Volume 74, Number 61 (Wednesday, April 1, 2009)]
[Notices]
[Pages 14803-14804]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-6957]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

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SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Assessing Organizational Responses to AHRQ's Health Literacy 
Pharmacy Tools.'' In accordance with the Paperwork Reduction Act of 
1995, 44 U.S.C. 3506(c)(2)(A), AHRQ invites the public to comment on 
this proposed information collection.
    This proposed information collection was previously published in 
the Federal Register on January 29th, 2009 and allowed 60 days for 
public comment. No comments were received. The purpose of this notice 
is to allow an additional 30 days for public comment.

DATES: Comments on this notice must be received by May 1, 2009.

ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk 
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by 
e-mail at [email protected] (attention: AHRQ's desk 
officer).
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by e-mail at 
[email protected].

SUPPLEMENTARY INFORMATION: Proposed Project: Assessing Organizational 
Responses to AHRQ's Health Literacy Pharmacy Tools.
    According to the 2003 National Assessment of Adult Literacy, only 
12 percent of adults have proficient health literacy--the capacity to 
obtain, process, and understand basic health information and services 
needed to make appropriate health decisions. Limited health literacy 
often leads to medication errors. For example, one study found that a 
majority of adults with low health literacy did not understand 
instructions to ``take medication on an empty stomach.'' Overall, it is 
estimated that low health literacy costs the U.S. health care system 
$50 billion to $73 billion per year. Pharmacies can serve as an 
important source of medication information for people with limited 
health literacy, but relatively few pharmacies have implemented health 
literacy practices (Praska et al., 2005).
    Recognizing that pharmacies may need outside knowledge and 
assistance to improve their health literacy practices, AHRQ, through a 
previous task order, supported the creation of the following four 
health literacy tools for pharmacy settings, which have been validated 
in institutional pharmacy settings.
    1. Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health 
Literacy Assessment Tool User's Guide (Jacobson et al., 2007).
    2. Strategies to improve Communication between Staff and Patients: 
Training Program for Pharmacy Staff (Kripalini & Jacobson, 2007).
    3. How to Create a Pill Card (Jacobson et al., 2008).
    4. Telephone Reminders: A Tool to Help Refill Medications on Time 
(Jacobson et al., 2008).
    AHRQ now proposes to distribute these tools to a more diverse set 
of pharmacies and to conduct in-depth case studies to enhance our 
understanding about the conditions that may facilitate or impede the 
adoption of the tools in these settings. AHRQ would use insights gained 
to develop materials (promotional implementation guides) that could 
assist interested pharmacies in putting the tools into practice and 
anticipating and overcoming obstacles to doing so.
    The pharmacy health literacy tools will be disseminated through an 
AHRQ Web site, which will also provide technical assistance to 
pharmacies that wish to implement the tools. A description of the tools 
and site will be distributed to pharmacists through national pharmacy 
organizations' trade publications and a direct mailing to chain 
pharmacy headquarters. We anticipate that we would be able to reach as 
many as 60,000 individual pharmacists across the country through these 
channels.
    This project is being conducted pursuant to AHRQ's statutory 
authority to conduct and support research on health care and on systems 
for the delivery of such care, including activities with respect to: 
The quality, effectiveness, efficiency, appropriateness and value of 
health care services; quality measurement and improvement; and health 
care costs, productivity, organization, and market forces. 42 U.S.C. 
299a(a)(1), (2), and (6).

Method of Collection

Case Studies

    Through its contractor, AHRQ proposes to conduct 7 in-depth case 
studies to assess pharmacies' experiences with implementation of one or 
more of these four health literacy tools, using interviews, site 
visits, review of documents and a survey of pharmacy staff from case 
study pharmacies. In addition, AHRQ will conduct 2 more limited studies 
of pharmacies that were aware of the tools but chose not to implement 
them.
    A 1-day site visit will be conducted with each of the 7 sites that 
implement at least one of the tools. Each site visit will include a 
walk-through of the pharmacy site to see the physical layout, an 
interview with the key informant or contact person, and individual 
interviews with up to four additional pharmacy employees, who may 
include the pharmacy manager, staff pharmacists, pharmacy technicians, 
and pharmacy clerks.
    Therefore, up to 35 interviews will be completed across the 7 sites 
that implement one or more of the tools. In addition, up to 12 pharmacy 
staff at each of the 7 implementation sites will complete the tool's 
Pharmacy Staff Survey contained in the Pharmacy Health Literacy 
Assessment Tool.
    For each of the two pharmacies which do not implement the tools, 
interviews will be conducted with up to 2 informants per site. The 
content of this interview will be similar, but not identical, to the 
interviews with staff at the implementing sites.

Web Site Visitors' Survey

    For pharmacists and other visitors to the AHRQ Web site, we will 
conduct a voluntary survey regarding health literacy in general, and 
feedback regarding AHRQ's health literacy tools. The Web site visitors' 
survey will be available on-line.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in the case studies. The staff 
interview at the implementing sites will be completed with up to 5 
total pharmacy staff members from each of the 7 pharmacies that 
implement at least one of the health literacy tools. Staff interviews 
at the two

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non-implementation sites will be completed with up to 2 individuals per 
pharmacy. The interviews are estimated to last 1 hour for each of the 5 
staff interviews at the 7 implementing sites and 30 minutes for each of 
the 2 staff interviews at the 2 non-implementing sites. The pharmacy 
staff survey will be completed by up to 12 staff from the 7 
implementation pharmacies and is estimated to take approximately 20 
minutes. Lastly, we estimate that the Web site visitor's survey will be 
completed by about 150 respondents and is estimated to take up to 12 
minutes to complete. The total burden hours for all data collections is 
estimated to be 95 hours.
    Exhibit 2 shows the estimated annualized cost burden for the 
respondents' time to provide the requested data. The estimated total 
cost burden is $2,882.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                     Number of
                                                     Number of     responses per     Hours per     Total burden
                    Form name                         sites/          sites/         response          hours
                                                    respondents     respondents
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Staff interview--implementing sites.............               7               5               1              35
Staff interview--non-implementing sites.........               2               2           30/60               2
Pharmacy staff survey...........................               7              12           20/60              28
Web site visitors survey........................             150               1           12/60              30
                                                 ---------------------------------------------------------------
    Total.......................................             166  ..............  ..............              95
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                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                     Number of
                    Form name                         sites/       Total burden   Average hourly    Total cost
                                                    respondents        hours        wage rate*        burden
----------------------------------------------------------------------------------------------------------------
Staff interview--implementing sites.............               7              35          $30.33          $1,062
Staff interview--non-implementing sites.........               2               2           30.33              61
Pharmacy staff survey...........................               7              28           30.33             849
Web site visitors survey........................             150              30           30.33             910
                                                 ---------------------------------------------------------------
    Total.......................................             166              95  ..............          2,882
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*The average hourly wage rate of $30.33 was calculated based on the following mean hourly wage rates:
  Pharmacists--$47.58; pharmacy manager [medical & health services manager category]--$50.34; pharmacy
  technicians--$13.25; and pharmacy aides--$10.15. The mean hourly wage rates for these occupations were
  obtained from the Bureau of Labor & Statistics on ``Occupational Employment and Wages, May 2007,'' found at:
  http://www.bls.gov/OES/current/oes291051.htm.

Estimated Annual Costs to the Government

    The total cost of this contract to the government is $400,000. The 
project extends over three fiscal years. Exhibit 3 shows a breakdown of 
the total cost as well as the annualized cost.

                        Exhibit 3--Estimated Cost
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                                                            Annualized
             Cost component                 Total cost         cost
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Project Development.....................         $54,822         $18,274
Data Collection Activities..............         111,509          37,170
Data Processing and Analysis............         129,089          43,030
Publication of Results..................          63,736          21,245
Project Management......................          40,845          13,615
                                         -------------------------------
    Total...............................         400,000         133,333
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Request for Comments

    In accordance with the above cited legislation, comments on the 
AHRQ information collection proposal are requested with regard to any 
of the following: (a) Whether the proposed collection of information is 
necessary for the proper performance of functions of AHRQ, including 
whether the information will have practical utility; (b) the accuracy 
of AHRQ's estimate of burden (including hours and costs) of the 
proposed collection of information; (c) ways to enhance the quality, 
utility, and clarity on the information to be collected; and (d) ways 
to minimize the burden of the collection of information on respondents, 
including the use of automated collection techniques or other forms of 
information technology.
    Comments submitted in response to this notice will be summarized 
and included in the request for OMB approval of the proposed 
information collection. All comments will become a matter of public 
record.

    Dated: March 20, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-6957 Filed 3-31-09; 8:45 am]
BILLING CODE 4160-90-M