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Vater M, Davis A, Jaser S. Evaluation of health literacy and its association with medication adherence and quality of life in childhood-onset systemic lupus erythematosus. Lupus 2024; 33:9612033241258189. [PMID: 38830236 PMCID: PMC11295410 DOI: 10.1177/09612033241258189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Little is known about health literacy in childhood-onset systemic lupus erythematosus (cSLE) and how health literacy relates to medication adherence and psychosocial outcomes in this high-risk population. The objective of this study was to evaluate health literacy in adolescents and young adults with cSLE and its association with medication adherence and quality of life. METHODS Youth 10-24 years with cSLE (n = 48) completed the Brief Healthy Literacy Screen (BHLS) and the Newest Vital Sign (NVS) to assess health literacy. Participants also completed validated measures of medication adherence and quality of life. Descriptive analyses were used to determine levels of health literacy. Bivariate correlations were used to evaluate associations between measures of health literacy with adherence and quality of life. A multivariable regression analyses was used to determine if health literacy was a significant predictor of adherence or quality of life, after adjusting for age, sex, race, and household income. RESULTS Inadequate health literacy was common in this population, with 67% of youth categorized as having inadequate health literacy by the BHLS and 42% by the NVS. Higher medication adherence was associated with a higher BHLS score (r=.36, p = .017). BHLS was also significantly associated with better quality of life (r = 0.31, p = .034). CONCLUSION Inadequate health literacy is prevalent among youth with cSLE. Higher health literacy is associated with higher medication adherence and better quality of life, suggesting that attention to health literacy could improve outcomes for this vulnerable population.
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Affiliation(s)
- McKenzie Vater
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Rheumatology, Nashville, TN, USA
| | - Alaina Davis
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Rheumatology, Nashville, TN, USA
| | - Sarah Jaser
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Psychology, Nashville, TN, USA
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Joseph D, Hu R, Min R, Jolly M, Hassan S. Use and Utility of Patient After-Visit Instructions at a University Rheumatology Outpatient Clinic: Status and Randomized Prospective Pilot Intervention Study. ACR Open Rheumatol 2024; 6:321-329. [PMID: 38387613 PMCID: PMC11089441 DOI: 10.1002/acr2.11659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the use of after-visit instructions (AVIs) in an academic rheumatology clinic and assess the impact of standardized AVIs (sAVIs) and teach-back (TB) on comprehension of health information. METHODS A retrospective review of adult patients seen between October 1 and 8, 2021, at the rheumatology clinic collected data on patient demographics, clinical features, and the presence, content, and readability of AVIs. During a subsequent prospective proof-of-concept study, routinely scheduled patients seen at the rheumatology clinic were randomized into three groups: control (received standard of care), received sAVIs only, and received sAVIs plus TB. Patients completed a health literacy questionnaire, satisfaction survey, and a one- to two-week postvisit telephone survey to assess AVI comprehension. RESULTS Out of 316 retrospective patient visits, 82 (25.9%) received AVIs. Among 210 of 316 patients (66.5%) with management changes, 76 (36.1%) received AVI, with 74.2% of the instructions considered concordant with the provider's note. Use of AVIs was higher with management changes, new patient visits, and medical trainee/teaching clinics. AVIs were written at a median 6.8 grade level. A total of 75 patients completed the prospective study: 31 (41.3%) were in the control group, 19 (25.3%) were in the group that received sAVIs only, and 25 (33.3%) were in the group that received AVIs with TB. There were no differences in overall postvisit survey comprehension/retention scores among the three patient groups evaluated. CONCLUSION Although a lack of AVI use was identified, implementation of sAVIs did not appear to impact patient retention or comprehension of discharge health information.
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Affiliation(s)
- Dijo Joseph
- Rush University Medical CenterChicagoIllinois
| | - Rong Hu
- Rush University Medical CenterChicagoIllinois
| | - Robert Min
- Rush University Medical CenterChicagoIllinois
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Peng W, Huang Q, Mao B. Evaluating variations in the barriers to colorectal cancer screening associated with telehealth use in rural U.S. Pacific Northwest. Cancer Causes Control 2024; 35:635-645. [PMID: 38001334 DOI: 10.1007/s10552-023-01819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE The incidence and mortality rates of colorectal cancer (CRC) remain consistently high in rural populations. Telehealth can improve screening uptake by overcoming individual and environmental disadvantages in rural communities. The present study aimed to characterize varying barriers to CRC screening between rural individuals with and without experience in using telehealth. METHOD The cross-sectional study surveyed 250 adults aged 45-75 residing in rural U.S. states of Alaska, Idaho, Oregon, and Washington from June to September 2022. The associations between CRC screening and four sets of individual and environmental factors specific to rural populations (i.e., demographic characteristics, accessibility, patient-provider factors, and psychological factors) were assessed among respondents with and without past telehealth adoption. RESULT Respondents with past telehealth use were more likely to screen if they were married, had a better health status, had experienced discrimination in health care, and had perceived susceptibility, screening efficacy, and cancer fear, but less likely to screen when they worried about privacy or had feelings of embarrassment, pain, and discomfort. Among respondents without past telehealth use, the odds of CRC screening decreased with busy schedules, travel burden, discrimination in health care, and lower perceived needs. CONCLUSION Rural individuals with and without previous telehealth experience face different barriers to CRC screening. The finding suggests the potential efficacy of telehealth in mitigating critical barriers to CRC screening associated with social, health care, and built environments of rural communities.
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Affiliation(s)
- Wei Peng
- Edward R. Murrow College of Communication, Washington State University, Murrow Hall 211, Pullman, WA, 99164, USA.
| | - Qian Huang
- Department of Communication, University of North Dakota, Grand Forks, ND, USA
| | - Bingjing Mao
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Leach MJ, Nichols S, Trenholm S, Jones M. Health Literacy of Parents and Carers in a Regional Community: A Cross-Sectional Study. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 43:275-282. [PMID: 34096382 DOI: 10.1177/0272684x211022572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Supporting a child's healthy development is determined, in part, by a parent's ability to seek, access, interpret and effectively utilize health information. This aspect of parenting draws on a set of skills referred to as health literacy. OBJECTIVE To assess the level of health literacy among parents/carers in a regional South Australian community. METHODS Parents/carers of primary school-aged children, residing in Whyalla, South Australia, were invited to complete the 13-item All Aspects of Health Literacy Survey. RESULTS 155 parents/carers completed the survey (79% mothers). Most participants were English-speaking (97%), employed (62%) and had 2-3 children (62%), with 52% completing tertiary education. Median total health literacy scores were mostly in the moderate-high range (median 27, IQR 26,27), as were critical health literacy scores (median 7, IQR 6,8). Higher scores were reported for functional health literacy (median 8, IQR 7,9), communicative health literacy (median 9, IQR 8,9) and empowerment health literacy (median 4, IQR 3,5). CONCLUSIONS Our findings reveal modest levels of health literacy among a sample of parents/carers of primary school-aged children in a regional South Australian community. Further work is needed to understand the differential effect of parental health literacy on child health outcomes, and the types of strategies that may mitigate the impact of these barriers on a child's healthy development.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, New South Wales, Australia
| | - Sue Nichols
- School of Education, University of South Australia, Magill, South Australia, Australia
| | - Sven Trenholm
- School of Education, University of South Australia, Magill, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
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Quinlivan A, Lester S, Barrett C, Whittle S, Rowett D, Black R, Chand V, Marine F, March L, Sinnathurai P, Buchbinder R, Hill C. Attitudes of Australians with inflammatory arthritis to biologic therapy and biosimilars. Rheumatol Adv Pract 2022; 6:rkac099. [PMID: 36424984 PMCID: PMC9682816 DOI: 10.1093/rap/rkac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To investigate the knowledge and beliefs of Australian patients with inflammatory arthritis regarding biologic/targeted synthetic DMARDs (b/tsDMARDs) and biosimilars and their sources of information. METHODS Participants enrolled in the Australian Rheumatology Association Database (ARAD) with RA, PsA and axial SpA were sent an online survey. They were asked about information sources for b/tsDMARDs and how positive or negative this information was. The Beliefs about Medicine Questionnaire (BMQ) was used to measure beliefs about b/tsDMARDs with scores ranging from 1 (strongly disagree) to 5 (strongly agree). Participants were asked about their knowledge of biosimilars and willingness to switch to biosimilar. RESULTS There was a response rate of 66% (994/1498; 67% female, median age 62 years). Participants currently taking b/tsDMARDs (n = 794) had a high b/tsDMARD-specific BMQ 'necessity' score {median 4.2 [interquartile range (IQR) 3.6-4.8]}, with a lower specific 'concerns' score [median 2.4 (IQR 2.0- 3.0)]. Participants consulted multiple information sources [median 3 (IQR 2-5)]. Positive sources were rheumatologists and educational websites and negative were chat rooms and social media. Only 18% were familiar with biosimilars, with half knowing of availability in Australia. Following a short paragraph describing biosimilars, 75% (744) of participants indicated they would consider switching if recommended by their rheumatologist, with nearly half identifying safety and efficacy of biosimilars as an important concern. CONCLUSION Australian patients have positive attitudes towards b/tsDMARDs overall, although little knowledge of biosimilars specifically. They have a high degree of trust in their rheumatologist regarding treatment decisions, even if they are unfamiliar with the medication recommended.
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Affiliation(s)
- Alannah Quinlivan
- Correspondence to: Alannah Quinlivan, Rheumatology Department, St Vincent’s Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, VIC 3065, Australia. E-mail:
| | - Susan Lester
- Rheumatology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia,University of Adelaide, Adelaide, SA, Australia
| | - Claire Barrett
- Redcliffe Hospital, Redcliffe, QLD, Australia,Discipline of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Samuel Whittle
- Rheumatology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Brisbane, VIC, Australia,Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
| | - Debra Rowett
- UniSA Clinical and Health Science, University of South Australia, Adelaide, SA, Australia,Drug and Therapeutics Information Service, Southern Adelaide Local Health Network, Daw Park, SA, Australia
| | - Rachel Black
- Rheumatology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia,University of Adelaide, Adelaide, SA, Australia,Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Vibhasha Chand
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Brisbane, VIC, Australia,Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
| | | | - Lyn March
- Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia,Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Premarani Sinnathurai
- Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia,Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia,NPS MedicineWise, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Brisbane, VIC, Australia,Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
| | - Catherine Hill
- Rheumatology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia,University of Adelaide, Adelaide, SA, Australia,Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
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Rao N, Tighe EL, Feinberg I. The Dispersion of Health Information Seeking Behavior and Health Literacy in a State in the Southern United States: A Cross-Sectional Study (Preprint). JMIR Form Res 2021; 6:e34708. [PMID: 35704357 PMCID: PMC9244650 DOI: 10.2196/34708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/28/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Nikita Rao
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Elizabeth L Tighe
- Deparment of Psychology, Georgia State University, Atlanta, GA, United States
| | - Iris Feinberg
- Adult Literacy Research Center, Department of Learning Sciences, Georgia State University, Atlanta, GA, United States
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Gurgel do Amaral MS, Reijneveld SA, Geboers B, Navis GJ, Winter AFD. Low Health Literacy is Associated with the Onset of CKD during the Life Course. J Am Soc Nephrol 2021; 32:1436-1443. [PMID: 33766810 PMCID: PMC8259635 DOI: 10.1681/asn.2020081155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/30/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Health literacy, the ability to deal with information related to one's health, is a predictor of health outcomes in CKD. However, research has not explored whether low health literacy predicts the onset of CKD. METHODS We used data from participants of Lifelines, a prospective population-based cohort study of individuals living in The Netherlands, to assess the share of individuals with low health literacy by eGFR category, whether low health literacy is associated with CKD onset in the general population and in the subgroup of older adults, and whether established CKD risk factors mediate this association. RESULTS In the total sample of 93,885 adults (mean follow-up 3.9 years), low health literacy was more likely among individuals in worse eGFR categories, increasing from 26.4% in eGFR category 1 to 50.0% in category 5 (P=0.02). Low health literacy, compared with adequate health literacy, was associated with the onset of CKD in the total sample (3.0% versus 2.1%) and in the subgroup of older adults (13.4% versus 11.3%), with odds ratios (ORs) of 1.44 (95% confidence interval (95% CI), 1.31 to 1.59) and 1.21 (95% CI, 1.04 to 1.41), respectively. After adjustment for sex, age, education, and income, health literacy was associated with CKD onset only in older adults (OR, 1.25; 95% CI, 1.04 to 1.50). This association was mediated by hypertension and high body mass index (BMI) in the crude model, but only by BMI after adjustment (with BMI explaining 18.8% of the association). CONCLUSIONS Low health literacy is a risk factor for CKD onset among older adults, which suggests that CKD prevention might benefit from strategies to address low health literacy.
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Affiliation(s)
- Matheus S Gurgel do Amaral
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Bas Geboers
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
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Markotic F, Curkovic M, Pekez-Pavlisko T, Vrdoljak D, Vojvodic Z, Jurisic D, Puljiz M, Novinscak M, Bonassin K, Permozer Hajdarovic S, Tomicic M, Diminic-Lisica I, Fabris Ivsic S, Nejasmic D, Miosic I, Novak I, Puljak L. Differences in the Pattern of Non-Recreational Sharing of Prescription Analgesics among Patients in Rural and Urban Areas. Healthcare (Basel) 2021; 9:healthcare9050541. [PMID: 34066610 PMCID: PMC8148597 DOI: 10.3390/healthcare9050541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: This study aimed to analyze differences in sharing of prescription analgesics between rural and urban populations. Methods: We surveyed 1000 participants in outpatient family medicine settings in Croatia. We used a 35-item questionnaire to analyze patients’ characteristics, pain intensity, prescription analgesic sharing behavior, and perception of risks regarding sharing prescription medications. Results: Prescription analgesic sharing was significantly more frequent in the rural (64%) than in the urban population 55% (p = 0.01). Participants from rural areas more commonly asked for verbal or written information than those from urban areas when taking others’ prescription analgesics (p < 0.001) or giving such analgesics (p < 0.001). Participants from rural areas more commonly informed their physician about such behavior compared to those from urban areas (p < 0.01), and they were significantly more often asked about such behavior by their physician (p < 0.01). Perceptions about risks associated with sharing prescription medication were similar between rural and urban populations. Conclusions: There are systematic differences in the frequency of prescription analgesics and associated behaviors between patients in family medicine who live in rural and urban areas. Patients from rural areas were more prone to share prescription analgesics. Future studies should examine reasons for differences in sharing prescription analgesics between rural and urban areas.
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Affiliation(s)
- Filipa Markotic
- Department for Assessment of Safety and Efficacy, Croatian Agency for Medicinal Products and Medical Devices, 10000 Zagreb, Croatia
- Correspondence: or ; Tel.: +385-91-325-8885
| | - Mario Curkovic
- Department of Family Medicine, School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | | | - Davorka Vrdoljak
- Department of Family Medicine, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Zeljko Vojvodic
- Department of Family Medicine, Health Centre Osijek, 31204 Bijelo Brdo, Croatia;
| | - Dinka Jurisic
- Department of Family Medicine, Health Centre Sisak, 44272 Lekenik, Croatia;
| | - Marijana Puljiz
- Department of Family Medicine, Health Centre Imotski, 21262 Kamenmost, Croatia;
| | - Martina Novinscak
- Department of Family Medicine, Health Centre Cakovec, 40000 Cakovec, Croatia;
| | - Karmela Bonassin
- Department of Family Medicine, Istrian Health Centre, 52341 Zminj, Croatia; (K.B.); (S.F.I.)
| | | | - Marion Tomicic
- Department of Family Medicine, School of Medicine, University of Split, 21000 Split, Croatia;
- Department of Family Medicine, Split-Dalmatia Health Center, 21000 Split, Croatia
| | - Ines Diminic-Lisica
- Department of Family Medicine, School of Medicine, University of Rijeka, 51221 Kostrena, Croatia;
| | - Sonja Fabris Ivsic
- Department of Family Medicine, Istrian Health Centre, 52341 Zminj, Croatia; (K.B.); (S.F.I.)
| | - Danijel Nejasmic
- Department of Physics, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Ivana Miosic
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000 Zagreb, Croatia; (I.M.); (I.N.); (L.P.)
| | - Ivana Novak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000 Zagreb, Croatia; (I.M.); (I.N.); (L.P.)
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000 Zagreb, Croatia; (I.M.); (I.N.); (L.P.)
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Mafruhah OR, Huang YM, Shiyanbola OO, Shen GL, Lin HW. Ideal instruments used to measure health literacy related to medication use: A systematic review. Res Social Adm Pharm 2021; 17:1663-1672. [PMID: 33674228 DOI: 10.1016/j.sapharm.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prior studies showed the association between inadequate health literacy (HL) and poor medication-related skills, while none of the published studies have reviewed and compared the existing instruments used to measure medication-related HL. This systematic review comprehensively summarizes the existing instruments that assess medication-related HL. OBJECTIVES To identify appropriate HL instruments related to medication use as screening tools for enhancing patients' ability to use medications correctly. METHODS This review retrieved medication-related HL instruments that were published between 2000 and 2019 from three databases (i.e., PubMed, Scopus, EMBASE) and by hand-searching. The PRISMA procedure was followed as well as the SURGE guideline to assess the quality of studies. Psychometric properties, HL dimensions, and types of medication information gleaned from the items in three types of HL instruments (i.e., general, disease-specific, medication-specific) were compared to identify appropriate medication-related HL instruments. RESULT Forty-eight instruments were identified from 44 studies, whereas 70.8% instruments were either disease- or medication-specific HL instruments. Most instruments with different sample sizes showed certain an extent of reliability and validity. The distributions of HL dimensions and types of medication information among the relevant items were varied across different types of instruments. The five instruments (named as the 16SQ, AKQ-CQ, DHLKI, AKT, and ChMLM) were identified as the most appropriate instruments for three types of medication-related HL, respectively. These appropriate instruments consistently covered items related to HL dimensions of literacy and comprehension and medication-related information regarding dosing, treatment indication, and side effects/precautions. CONCLUSION Of 48 identified instruments mainly derived from disease- or medication-specific studies, the five most appropriate medication-related HL instruments were identified to support clinicians in facilitating patients' correct medication use. Further confirmation to explore the usefulness among these instruments are needed.
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Affiliation(s)
- Okti Ratna Mafruhah
- School of Pharmacy and Graduate Institute, China Medical University, Taichung City, 404333, Taiwan; Department of Pharmacy, Universitas Islam Indonesia, Daerah Istimewa Yogyakarta, 55584, Indonesia
| | - Yen-Ming Huang
- College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD, 57007, USA; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, 100025, Taiwan
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, 53705, USA
| | - Guan-Lin Shen
- School of Pharmacy and Graduate Institute, China Medical University, Taichung City, 404333, Taiwan
| | - Hsiang-Wen Lin
- School of Pharmacy and Graduate Institute, China Medical University, Taichung City, 404333, Taiwan; Department of Pharmacy, China Medical University Hospital, Taichung City, 404332, Taiwan; Department of Pharmacy System, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, IL, 60607, USA.
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Katz P, Dall’Era M, Trupin L, Rush S, Murphy LB, Lanata C, Criswell LA, Yazdany J. Impact of Limited Health Literacy on Patient-Reported Outcomes in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2021; 73:110-119. [PMID: 32741118 PMCID: PMC7775267 DOI: 10.1002/acr.24361] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Health disparities in patient-reported outcomes by income and education are well documented; however, the impact of health literacy on patient-reported outcomes has received less attention. We examined independent effects of income, education, and health literacy on patient-reported outcomes in systemic lupus erythematosus (SLE). METHODS Data from the California Lupus Epidemiology Study (n = 323 participants) were used. Health literacy was assessed with a validated 3-item measure (ability to understand written information, reliance on others to understand written information, confidence in completing written forms). Patient-reported outcomes were administered by interview in English, Spanish, Cantonese, or Mandarin. Generic and disease-specific patient-reported outcomes were examined using the following: 10 Patient-Reported Outcomes Measurement Information System (PROMIS) short forms; the 8 Short Form 36 (SF-36) health survey subscales; and 3 patient-reported SLE disease activity and damage measures. We conducted 2 sets of multivariable analyses: the first examined education, income, or health literacy individually; the second included all 3 simultaneously. All multivariable models included age, sex, race/ethnicity, language, disease duration, and physician-assessed disease activity and damage. RESULTS More than one-third of participants (38%) had limited health literacy (LHL), including >25% with greater than high school education. In multivariable analyses simultaneously considering education, income, and health literacy, LHL was associated with significantly worse scores on all patient-reported outcomes except disease damage. In contrast, disparities by income were seen in only 3 PROMIS scales, 3 SF-36 subscales, and 1 disease activity measure. No disparities by education level were noted. CONCLUSION We found significantly worse patient-reported outcome scores among individuals with LHL, even after controlling for disease activity and damage. Whether disparities are due to actual differences in health or measurement issues requires further study.
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Wong PKK. How good is "Dr Google"? Int J Rheum Dis 2020; 23:1611-1612. [PMID: 33342064 DOI: 10.1111/1756-185x.13945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Peter K K Wong
- Department of Rheumatology, Westmead Hospital, Sydney and University of New South Wales Rural Medical School, Coffs Harbour, NSW, Australia
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12
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Miller PA, Burgoon ML, Hoover-Hankerson B, Strand N, Ross H. Utilizing Oral Surveys to Better Understand Patient Satisfaction in a Low-Income, Urban Surgical Clinic. Am Surg 2020; 87:1267-1274. [PMID: 33342256 DOI: 10.1177/0003134820973350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oral surveys allow patients to elaborate on their experience in the hospital, giving context to numerical values often used to assess patient satisfaction. This allows patients to speak about factors affecting satisfaction, which is important in complex, low-income populations. Spoken surveys were administered to 80 patients in surgery clinics at Temple University Hospital. Responses were transcribed and coded to analyze patient responses. Relationships among patient responses were identified, and responses were categorized to determine the most important factors related to patient satisfaction. Numerical data were also used to assess satisfaction. Patients were satisfied with their experience with the physician and the hospital, reporting averages scores of 9.73 and 9.19, respectively. Regarding physician satisfaction, patients cited effective communication and professionalism as being most important. As long as nothing went wrong, patients scored their experience outside their interactions with the physician highly. Negative experiences were mainly related to wait times and ineffective communication with office staff and were seldom related to the physician. By using a spoken survey, patients could elaborate on their responses which provides context to the numerical data. Despite the positive feedback for physicians, patients spoke openly about communication. In low-income populations, communication failures can be exacerbated by the power differential present between the patient and physician. Our study demonstrates the utility of oral surveys in understanding complex patient populations, and the results can be used to shape surgical and nonsurgical practices in similar patient populations.
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Affiliation(s)
- Parker A Miller
- Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
| | - Montgomry L Burgoon
- Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
| | | | - Nicolle Strand
- Center for Urban Bioethics, Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
| | - Howard Ross
- Department of Colorectal Surgery, 25139Temple University Hospital, Philadelphia, PA, USA
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13
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Chia KSW, Brown K, Kotlyar E, Wong PKK, Faux SG, Shiner CT. 'Tired, afraid, breathless … .' An international survey of the exercise experience for people living with pulmonary hypertension. Pulm Circ 2020; 10:2045894020968023. [PMID: 33240490 PMCID: PMC7675876 DOI: 10.1177/2045894020968023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022] Open
Abstract
Patients with pulmonary hypertension are more sedentary than the general population, but attitudes and experiences that may influence their exercise behaviour remain poorly understood. This study identified patterns of behaviour, attitudes towards exercise, barriers and enablers of exercise for people living with pulmonary hypertension. Accessibility of rehabilitation services from a patient perspective was also explored. A voluntary, international survey of people living with pulmonary hypertension was conducted, with mixed quantitative and qualitative data collection. Data from 187 participants in 19 countries were included in the analyses. In total, 52% (95/183) of people with pulmonary hypertension reported that they attempted to engage in regular physical activity. This was less than the proportion who did so prior to diagnosis (61%, 112/184, p = 0.006) and was accompanied by uncertainty and anxiety about exercise. In total, 63% (113/180) of the cohort reported experiencing previous adverse events while exercising, which was associated with a greater likelihood of ongoing exercise concerns and anxiety. Fear, frustration and uncertainty about exercise were noted as common barriers to engaging in exercise with pulmonary hypertension. Other barriers to exercise included intrinsic factors such as debilitating breathlessness and fatigue, and external factors such as cost and access to appropriate services. Most respondents (76%, 128/169) did not have access to a multi-disciplinary rehabilitation service, although an overwhelming majority (92%, 159/172) reported that this would be helpful. Respondents rated education; a supervised, structured exercise programme; and psychology input as the most important components of a multi-disciplinary rehabilitation service for pulmonary hypertension. Health professionals must work together with consumers to co-design rehabilitation services that will facilitate exercise and increased activity for people living with pulmonary hypertension.
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Affiliation(s)
- Karen S W Chia
- Department of Rehabilitation, St Vincent's Hospital Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Brown
- Department of Cardiology, St Vincent's Hospital Sydney, NSW, Australia
| | - Eugene Kotlyar
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Cardiology, St Vincent's Hospital Sydney, NSW, Australia
| | - Peter K K Wong
- Department of Rheumatology, Western Sydney Local Health District, Westmead, NSW, Australia.,UNSW Rural Clinical School, Coffs Harbour, NSW, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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Hirsh J, Wood P, Keniston A, Boyle D, Quinzanos I, Caplan L, Davis L. Universal Health Literacy Precautions Are Associated With a Significant Increase in Medication Adherence in Vulnerable Rheumatology Patients. ACR Open Rheumatol 2020; 2:110-118. [PMID: 31957348 PMCID: PMC7011426 DOI: 10.1002/acr2.11108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Our objective was to determine the impact of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, on medication adherence, patient satisfaction, and feasibility in all patients; its effect on the clinical disease activity index (CDAI) was studied in a rheumatoid arthritis (RA) subpopulation. METHODS Data collected during a 6-month prospective quality assurance intervention was compared with data from a prior 6-month period. Interventions included 1) encouraging questions, 2) teach-back communication, and 3) brown-bag medication review. Analysis was performed using linear regression or generalized estimating equation (GEE) regression. RESULTS During the intervention period, 46 physicians completed 1737 patient visits. Questions were encouraged, and teach-back communication was performed in more than 90% of visits. Brown-bag medication reviews were performed in 47% of visits overall and 69% of visits in a subgroup that received additional reminder calls. Visit duration and patient satisfaction were not significantly increased. Adherence for rheumatology-related medications that were prescribed both before and during the intervention increased by 22% (P ≤ 0.001; by GEE). Teach-back communication predicted a statistically significant improvement in medication adherence in this subpopulation (by linear regression). The mean CDAI did not improve; however, African American race and Hispanic ethnicity were associated with a decreased CDAI (by GEE). CONCLUSION Implementation of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, improved medication adherence in our safety-net clinic, with particularly strong effects seen with teach-back communication. In certain populations, use of the toolkit may also improve RA disease activity. This is the first study to document improved medication adherence with this intervention in a real-world setting.
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Affiliation(s)
- Joel Hirsh
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Patrick Wood
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Angela Keniston
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Dennis Boyle
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Itziar Quinzanos
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Liron Caplan
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Lisa Davis
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
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15
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Moore MD, Gray KD, Panjwani S, Finnerty B, Ciecerega T, Afaneh C, Fahey TJ, Crawford CV, Zarnegar R. Impact of procedural multimedia instructions for pH BRAVO testing on patient comprehension: a prospective randomized study. Dis Esophagus 2020; 33:5532834. [PMID: 31313807 DOI: 10.1093/dote/doz068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/12/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
The positive impact on patient comprehension and improved procedural outcomes when multimedia is utilized to convey instructions preprocedurally has been previously shown for gastrointestinal procedures such as colonoscopy. However, in gastroesophageal reflux testing (GERD), we continue to utilize verbal and written instructions to establish this diagnosis when we use BRAVO pH testing. This is arguably a more complex procedure involving stopping medications, placement of a device, and maintaining an accurate diary for the duration of the testing. We hypothesize that by utilizing multimedia to relay complex textual information, patients will have improved comprehension of periprocedural instructions thereby improving data entry and satisfaction of expectations during the procedure. Prospective randomized study of 120 patients undergoing endoscopic placement of the BRAVO pH monitoring capsule for evaluation of GERD receive either written preoperative instructions (control) or written plus video instructions (video group). A composite comprehension score was calculated using procedure-specific parameters of data entry over the 48-hour monitoring period. Patient satisfaction was evaluated on the basis of a five-point Likert scale. Extent of patient satisfaction was defined by the fulfillment of patient expectations. Exclusion criteria included patients who did not have access to the video or did not complete follow-up. Seventy-eight patients completed all follow-up evaluations. The video group (n = 44) had a significantly higher mean comprehension score when compared to the control group (n = 34) (9.6 ± 1.4 vs. 7.4 ± 2.0, P = 0.01). Overall satisfaction with instructions was significantly higher in the intervention group (91% vs. 47%, p 0.01). We detected no significant difference in comprehension or satisfaction scores in subgroup analyses of the video group comparing patients <65 and ≥65 years of age and by education level. Compared to standard written instructions, video instructions improved patient comprehension based on data evaluation, and satisfaction. Therefore, clinicians should consider incorporation of multimedia instructions to enhance patient periprocedural expectations and understanding of reflux pH testing using the BRAVO procedure.
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Affiliation(s)
- M D Moore
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - K D Gray
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - S Panjwani
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - B Finnerty
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - T Ciecerega
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - C Afaneh
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - T J Fahey
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - C V Crawford
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - R Zarnegar
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
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16
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Drumond N. Future Perspectives for Patient-Centric Pharmaceutical Drug Product Design with Regard to Solid Oral Dosage Forms. J Pharm Innov 2019. [DOI: 10.1007/s12247-019-09407-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Purpose
Additional costs for healthcare provision are expected for cases where the level of care provided is not according to the patient’s needs and demands. To address these issues and reduce costs, fundamental changes need to be made on how healthcare provision is administered to patients, which raises the opportunity for the implementation of patient-centric systems.
Methods
This review addresses the importance of implementing a patient-centric approach in current healthcare provision and emphasizes the need to adjust current development and business models for a successful application of patient-centric care.
Results
To increase awareness and avoid confusion, the purpose of patient-centric pharmaceutical drug product design is reviewed in detail and future market opportunities for patient-centric drug products are discussed.
Conclusions
With regard to solid oral dosage forms, the subject of patient-centric pharmaceutical drug product design will focus more on the customization of existing technologies (e.g., dosage form size reduction) to address the needs of specific patient populations such as pediatrics, geriatrics, dysphagia patients, or the cognitively impaired.
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17
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Lazaroff SM, Meara A, Tompkins MK, Peters E, Ardoin SP. How Do Health Literacy, Numeric Competencies, and Patient Activation Relate to Transition Readiness in Adolescents and Young Adults With Rheumatic Diseases? Arthritis Care Res (Hoboken) 2019; 71:1264-1269. [PMID: 30156761 DOI: 10.1002/acr.23739] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/21/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate how demographics, health literacy, numeracy, and patient activation are related to transition readiness in adolescent and young adult (AYA) patients and to describe how parent/guardian (PG) performance on these metrics predicts AYA patients' transition readiness. METHODS In this single center, cross-sectional study, consecutive English-speaking AYA patients ages 17-21 years and PGs were recruited from outpatient rheumatology clinics. Participants completed the following self-reported instruments: demographic questionnaire, Short Test of Fundamental Health Literacy, Objective Numeracy Scale, Subjective Numeracy Scale, Symbolic-number mapping, Patient Activation Measure, and Transition Readiness Assessment Questionnaire (TRAQ; AYA patients only). RESULTS Ninety-one AYA patients participated in the study, of whom 64 of 91 (70%) had juvenile idiopathic arthritis, and 54 PGs. Mean ± SD TRAQ score was 4.0 ± 0.65, correlating with "I am starting to do this" stage of change. Most participants (98%) had adequate health literacy. Multivariable regression analysis showed that AYA patients of female sex, older age, and higher patient activation significantly predicted higher TRAQ scores (P < 0.05). No PG characteristics were linked to higher AYA patient TRAQ scores. CONCLUSIONS Transition readiness in AYA patients as measured by TRAQ is associated with female sex, older age, and higher patient activation. Though sex and age are nonmodifiable, interventions to boost patient activation represent a promising opportunity to improve transition readiness and outcomes.
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Affiliation(s)
| | | | | | | | - Stacy P Ardoin
- Ohio State University and Nationwide Children's Hospital, Columbus
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18
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Oliffe M, Thompson E, Johnston J, Freeman D, Bagga H, Wong PKK. Assessing the readability and patient comprehension of rheumatology medicine information sheets: a cross-sectional Health Literacy Study. BMJ Open 2019; 9:e024582. [PMID: 30813117 PMCID: PMC6377552 DOI: 10.1136/bmjopen-2018-024582] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 12/06/2018] [Accepted: 12/27/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Patients are often provided with medicine information sheets (MIS). However, up to 60% of patients have low health literacy. The recommended readability level for health-related information is ≤grade 8. We sought to assess the readability of MIS given to patients by rheumatologists in Australia, the UK and Canada and to examine Australian patient comprehension of these documents. DESIGN Cross-sectional study. SETTING Community-based regional rheumatology practice. PARTICIPANTS Random sample of patients attending the rheumatology practice. OUTCOME MEASURES Readability of MIS was assessed using readability formulae (Flesch Reading Ease formula, Simple Measure of Gobbledygook scale, FORCAST (named after the authors FORd, CAylor, STicht) and the Gunning Fog scale). Literal comprehension was assessed by asking patients to read various Australian MIS and immediately answer five simple multiple choice questions about the MIS. RESULTS The mean (±SD) grade level for the MIS from Australia, the UK and Canada was 11.6±0.1, 11.8±0.1 and 9.7±0.1 respectively. The Flesch Reading Ease score for the Australian (50.8±0.6) and UK (48.5±1.5) MIS classified the documents as 'fairly difficult' to 'difficult'. The Canadian MIS (66.1±1.0) were classified as 'standard'. The five questions assessing comprehension were correctly answered by 9/21 patients for the adalimumab MIS, 7/11 for the methotrexate MIS, 6/28 for the non-steroidal anti-inflammatory MIS, 10/11 for the prednisone MIS and 13/24 for the abatacept MIS. CONCLUSIONS The readability of MIS used by rheumatologists in Australia, the UK and Canada exceeds grade 8 level. This may explain why patient literal comprehension of these documents may be poor. Simpler, shorter MIS with pictures and infographics may improve patient comprehension. This may lead to improved medication adherence and better health outcomes.
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Affiliation(s)
- Michael Oliffe
- Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
| | - Emma Thompson
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
| | - Jenny Johnston
- School of Education, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Dianne Freeman
- Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
| | - Hanish Bagga
- Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
| | - Peter K K Wong
- Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
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19
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Validation of the Integrated Model of Health Literacy in Patients With Breast Cancer. Cancer Nurs 2018; 41:498-505. [DOI: 10.1097/ncc.0000000000000540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Smolle C, Sendlhofer G, Cambiaso-Daniel J, Sljivich M, Friedl H, Kamolz LP, Brunner G. Official definitions for undesirable medical events : Are they correctly applied in medicine? Wien Klin Wochenschr 2018; 131:23-28. [PMID: 30003411 PMCID: PMC6342869 DOI: 10.1007/s00508-018-1362-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Abstract
Background In Austria, elaborate definitions exist for the undesirable medical events side effect, adverse event, complication and medical malpractice. We aimed at investigating whether the official definitions for the abovementioned terms can be understood by a sample population representing a cross-section of the Austrian population. Methods In this study 1021 Austrian citizens were interviewed. Demographic parameters (age, gender, occupation, level of education, monthly income, number of inhabitants at place of residence) were assessed. Participants were told the official definitions for complication, side effect, adverse event and medical malpractice and asked to select the correct definition for “complication”. The impact of sample characteristics on the ability to identify the correct definition was investigated. Results Of the participants 315 (31%) identified the correct definition of a complication. Almost the same number (n = 302, 30%; χ2 for single samples: p = 0.087) falsely selected the definition for side effect. Significantly fewer (both p < 0.001) chose the definitions for adverse event (n = 220, 22%) and medical malpractice (n = 155, 15%). Only the respective state of origin showed significant influence on the probability of choosing the correct definition out of the four. The probability was highest in Vorarlberg (0.400) and lowest in Upper Austria (0.216, p < 0.001). Conclusion For the majority the present official definitions for undesirable medical events are too complex to understand. Simple definitions for undesirable medical events should be included into patient education.
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Affiliation(s)
- Christian Smolle
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria. .,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria. .,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, TX, USA.,Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Michaela Sljivich
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.,School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Herwig Friedl
- Institute of Statistics, Graz University of Technology, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
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21
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Betancourt BY, Biehl A, Katz JD, Subedi A. Pharmacotherapy Pearls in Rheumatology for the Care of Older Adult Patients: Focus on Oral Disease-Modifying Antirheumatic Drugs and the Newest Small Molecule Inhibitors. Rheum Dis Clin North Am 2018; 44:371-391. [PMID: 30001781 DOI: 10.1016/j.rdc.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Providing safe and effective pharmacotherapy to geriatric patients with rheumatologic disorders is challenging. Multidisciplinary care involving rheumatologists, primary care physicians, and other specialties can optimize benefit and reduce adverse outcomes. Oral disease-modifying antirheumatic drugs, including methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide, and the small molecule inhibitors tofacitinib and apremilast have distinctive monitoring requirements and specific adverse reaction profiles. This article provides clinically relevant pearls for use of these interventions in older patients.
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Affiliation(s)
- Blas Y Betancourt
- National Institutes of Arthritis and Musculoskeletal and Skin Disease, National Institutes of Health Clinical Center, Bethesda, MD 20814, Maryland, USA.
| | - Ann Biehl
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, FDA, 10001 New Hampshire Avenue, Hillandale Building, 4th Floor Silver Spring, MD 20993, USA
| | - James D Katz
- National Institutes of Arthritis and Musculoskeletal and Skin Disease, National Institutes of Health Clinical Center, Bethesda, MD 20814, Maryland, USA
| | - Ananta Subedi
- National Institutes of Arthritis and Musculoskeletal and Skin Disease, National Institutes of Health Clinical Center, Bethesda, MD 20814, Maryland, USA
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22
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Does musculoskeletal health literacy differ between urban and rural orthopaedic patients? CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Biehl AJ, Katz JD. Pharmacotherapy Pearls for the Geriatrician: Focus on Oral Disease-Modifying Antirheumatic Drugs Including Newer Agents. Clin Geriatr Med 2016; 33:1-15. [PMID: 27886691 DOI: 10.1016/j.cger.2016.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Providing safe and effective pharmacotherapy to the geriatric patients with rheumatological disorders is an ongoing struggle for the rheumatologist and geriatrician alike. Cohesive communication and partnership can improve the care of these patients and subvert adverse outcomes. Disease-modifying antirheumatic drugs, including methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide, and the newest oral agent for treatment of rheumatoid arthritis, tofacitinib, have distinctive monitoring and adverse effect profiles. This article provides the general practitioner or geriatrician with clinically relevant pearls regarding the use of these interventions in older patients.
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Affiliation(s)
- Ann J Biehl
- Department of Pharmacy, National Institutes of Health Clinical Center, 10 Center Drive, Room 1C240, Bethesda, MD 20892-1196, USA.
| | - James D Katz
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 6N-216F, Building 10, 9000 Rockville Pike, Bethesda, MD 20892, USA
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Wong PKK. Medication adherence in patients with rheumatoid arthritis: why do patients not take what we prescribe? Rheumatol Int 2016; 36:1535-1542. [PMID: 27665289 DOI: 10.1007/s00296-016-3566-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which results in extensive articular and extra-articular morbidity and increased mortality from cardiovascular disease. Despite an increasing range of non-biological and biological disease-modifying agents, poor patient adherence with medication is a significant barrier to effective control of the inflammation associated with RA. This review seeks to identify factors that affect patient adherence with medication, examine the effectiveness of interventions to address this issue and offer practical suggestions to improve medication adherence. The impact of health literacy on medication adherence and the novel role of musculoskeletal ultrasound as an educational intervention will also be discussed.
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Affiliation(s)
- Peter K K Wong
- Mid-North Coast Arthritis Clinic, PO Box 6307, Coffs Harbour, NSW, 2450, Australia.
- Rural Clinical School, University of New South Wales, Coffs Harbour, NSW, Australia.
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25
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Hirsh JM. The Challenge and Opportunity of Capturing Patient Reported Measures of Rheumatoid Arthritis Disease Activity in Vulnerable Populations with Limited Health Literacy and Limited English Proficiency. Rheum Dis Clin North Am 2016; 42:347-62. [DOI: 10.1016/j.rdc.2016.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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26
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Joplin S, van der Zwan R, Joshua F, Wong PKK. Medication adherence in patients with rheumatoid arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. BIOMED RESEARCH INTERNATIONAL 2015; 2015:150658. [PMID: 26060812 PMCID: PMC4427825 DOI: 10.1155/2015/150658] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting <1% of the population. Incompletely controlled RA results in fatigue, joint and soft tissue pain, progressive joint damage, reduced quality of life, and increased cardiovascular mortality. Despite an increasing range of disease modifying agents which halt disease progression, poor patient adherence with medication is a significant barrier to management. OBJECTIVE The goal of this review was to examine the effectiveness of measures to improve patient medication adherence. METHODS Studies addressing treatment adherence in patients with RA were identified by trawling PsycINFO, Medline, Cochrane, Pubmed, and ProQuest for studies published between January 2000 and October 2014. Articles were independently reviewed to identify relevant studies. RESULTS Current strategies were of limited efficacy in improving patient adherence with medications used to treat RA. CONCLUSION Poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.
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Affiliation(s)
- Samantha Joplin
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Rick van der Zwan
- Department of Psychology, Southern Cross University, Coffs Harbour, NSW 2450, Australia
| | - Fredrick Joshua
- Department of Rheumatology, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia
- Prince of Wales Hospital Clinical School, University of New South Wales, Randwick, Sydney, NSW 2031, Australia
| | - Peter K. K. Wong
- Mid-North Coast Arthritis Clinic, Coffs Harbour, NSW 2450, Australia
- Rural Clinical School, University of New South Wales, Coffs Harbour, NSW 2450, Australia
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