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Ellem R, Pickering R, Marks D, Todd J, Brown J, Roberts S, Michaleff ZA. Emergency presentations for older persons with low back pain: An increasing clinical and economic challenge. Australas J Ageing 2023; 42:742-750. [PMID: 37799007 DOI: 10.1111/ajag.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To determine whether differences exist for older persons presenting to Emergency Departments (EDs) with lower back pain (LBP) in terms of management, health service resource use and cost when compared to younger patients with LBP. METHODS Retrospective analysis of routinely collected electronic medical record data from January 2015 to July 2021. Data from 11,098 adults presenting with LBP to two large regional Australian EDs were analysed over a 5-year period. Rates of presentation, investigation, medication use, spinal surgery and cost were assessed for all participants with respect to age groups (over or under 65 years of age), diagnosis and time. Multivariable logistic regression analysis was employed to assess the contribution of presentation characteristics to the risk of inpatient admission and to investigate the variable effect of patient age. RESULTS Older people represented 23% (n = 2565) of all LBP presentations, with a growing proportion of presentations over time. More than 1 in 4 patients over 65 were admitted (n = 703, 27%), with CT imaging being proportionately three times more prevalent (24% vs. 6%), and average cost double (AU$3973 vs. $1671) that of the younger population. Consultation by an ED physiotherapist was associated with lower admission risk across all adult presentations (OR 0.52, 95% CI [0.40 to 0.67]). CONCLUSIONS Older persons are over-represented amongst gradually increasing rates of LBP presentations to EDs and associated with escalating cost of care and hospital resource use. Older patients present a different clinical and economic profile to younger patients, supporting the provision of individualised management recommendations.
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Affiliation(s)
- Rod Ellem
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rowan Pickering
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - Darryn Marks
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - James Todd
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - Jarryd Brown
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Shelley Roberts
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- School of Health Science and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Zoe A Michaleff
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- New South Wales Health, St. Leonards, New South Wales, Australia
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Lindquist LA, Muhammad R, Miller-Winder AP, Opsasnick L, Kim KY, Benavente JY, Wolf M, Ramirez-Zohfeld V. Rationale and study design for decision making & implementation of aging-in-place/long term care plans among older adults. Contemp Clin Trials Commun 2021; 22:100756. [PMID: 33869887 PMCID: PMC8040099 DOI: 10.1016/j.conctc.2021.100756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/06/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Remaining in one's own home and community is a priority for many older adults as they age. Decision-making and planning is critical to ensure successful aging-in-place (AIP), especially when individuals experience age-related changes such as cognitive decline. Objectives: We are testing how decision-making and planning for AIP is impacted by changes in older adults' cognition and function, chronic conditions, social influences, environmental factors and identifying the mediating/moderating interactions between factors. We will also assess whether decision-making and planning for AIP translates into timely adoption of plans and goal concordance between older adults and their surrogate/caregiver decision makers. METHODS We will conduct a longitudinal single-group interventional clinical trial of community-dwelling older adults who are enrolled in LitCog, (R01AG03611) and expose them to an online intervention, PlanYourLifespan.org, which facilitates decision-making and planning for AIP. Enrolled participants (n = 398) will complete interviews at baseline, one month, and every six months up to 42 months in conjunction with the LitCog study, where cognitive, social, functional, and health literacy data is collected. Additionally, we will collect data on decision-making, resource use, communication of plans, timing of plan implementation, and goal concordance. PROJECTED OUTCOMES Findings from this study may generate evidence on how age-related changes in older adults may affect decision-making and implementation in relation to AIP as well as the impact of social relationships and support. Ultimately these findings may help shape the design of programs and practices that may improve the lives of older adults and the capacity of institutions to adapt to societal aging and AIP.
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Affiliation(s)
- Lee A. Lindquist
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ruqayyah Muhammad
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amber P. Miller-Winder
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kwang-Youn Kim
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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3
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Austin EJ, Neukirch J, Ong TD, Simpson L, Berger GN, Keller CS, Flum DR, Giusti E, Azen J, Davidson GH. Development and Implementation of a Complex Health System Intervention Targeting Transitions of Care from Hospital to Post-acute Care. J Gen Intern Med 2021; 36:358-365. [PMID: 32869191 PMCID: PMC7878619 DOI: 10.1007/s11606-020-06140-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 08/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Failure of effective transitions of care following hospitalization can lead to excess days in the hospital, readmissions, and adverse events. Evidence identifies both patient and system factors that influence poor care transitions, yet health systems struggle to translate evidence into complex interventions that have a meaningful impact on care transitions. OBJECTIVE We report on our experience developing, pilot testing, and evaluating a complex intervention (Addressing Complex Transitions program, or ACT program) that aims to improve care transitions for complex patients. DESIGN Following the Medical Research Council (MRC) framework, we engaged in iterative, stakeholder-driven work to develop a complex care intervention, assess feasibility and pilot methods, evaluate the intervention in practice, and facilitate ongoing implementation monitoring and dissemination. PARTICIPANTS Patients receiving care from UW Medicine's health system including 4 hospitals and 20-site Post-Acute Care network. INTERVENTION Literature review and prospective data collection activities informed ACT program design. ACT program components include a tailored risk calculator that provides real-time scoring of transitions of care risk factors, a multidisciplinary team with the capacity to address complex barriers to safe transitions, and enhanced discharge workflows to improve care transitions for complex patients. KEY MEASURES Program evaluation metrics included estimated hospital days saved and program acceptance by care team members. KEY RESULTS During the 6-month pilot, 565 patients were screened and 97 enrolled in the ACT program. An estimated 664 hospital days were saved for the index admission of ACT program participants. Analysis of pre/post-hospital utilization for ACT program participants showed an estimated 3227 fewer hospital days after ACT program enrollment. CONCLUSIONS Health systems need to address increasingly difficult challenges in care delivery. The use of evidence-based frameworks, such as the MRC framework, can guide systems to design complex interventions that respond to their local context and stakeholder needs.
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Affiliation(s)
- Elizabeth J. Austin
- Surgical Outcomes Research Center, University of Washington , Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Jen Neukirch
- UW Medicine Post-Acute Care, University of Washington, Seattle, WA USA
| | - Thuan D. Ong
- UW Medicine Post-Acute Care, University of Washington, Seattle, WA USA
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA USA
| | - Louise Simpson
- UW Medicine Post-Acute Care, University of Washington, Seattle, WA USA
| | - Gabrielle N. Berger
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Carolyn Sy Keller
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - David R Flum
- Surgical Outcomes Research Center, University of Washington , Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Elaine Giusti
- Center for Clinical Excellence, University of Washington, Seattle, WA USA
| | - Jennifer Azen
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Giana H. Davidson
- Surgical Outcomes Research Center, University of Washington , Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
- UW Medicine Post-Acute Care, University of Washington, Seattle, WA USA
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4
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Longman J, Johnston J, Ewald D, Gilliland A, Burke M, Mutonga T, Passey M. What could prevent chronic condition admissions assessed as preventable in rural and metropolitan contexts? An analysis of clinicians' perspectives from the DaPPHne study. PLoS One 2021; 16:e0244313. [PMID: 33411717 PMCID: PMC7790391 DOI: 10.1371/journal.pone.0244313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Reducing potentially preventable hospitalisations (PPH) is a priority for health services. This paper describes the factors that clinicians perceived contributed to preventable admissions for angina, diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), and what they considered might have been done in the three months leading up to an admission to prevent it. METHODS The study was conducted in a rural and a metropolitan health district in NSW, Australia. Expert Panels reviewed detailed case reports to assess preventability. For those admissions identified as preventable, comments from clinicians indicating what they perceived could have made a difference and/or been done differently to prevent each of the preventable admissions were analysed qualitatively. RESULTS 148 (46%) of 323 admissions were assessed as preventable. Across the two districts, the most commonly identified groups of contributing factors to preventable admissions were: 'Systems issues: Community based services missing or inadequate or not referred to'; 'Patient issues: Problems with adherence/self-management'; and 'Clinician issues: GP care inadequate'. In some instances, important differences drove these groups of factors. For example, in the rural district 'Systems issues: Community based services missing or inadequate or not referred to' was largely driven by social and welfare support services missing/inadequate/not referred to, whereas in the metropolitan district it was largely driven by community nursing, allied health, care coordination or integrated care services missing/inadequate/not referred to. Analyses revealed the complexity of system, clinician and patient factors contributing to each admission. Admissions for COPD (rural) and CHF (metropolitan) admissions showed greatest complexity. DISCUSSION AND CONCLUSION These findings suggest preventability of individual admissions is complex and context specific. There is no single, simple solution likely to reduce PPH. Rather, an approach addressing multiple factors is required. This need for comprehensiveness may explain why many programs seeking to reduce PPH have been unsuccessful.
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Affiliation(s)
- Jo Longman
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
- * E-mail:
| | - Jennifer Johnston
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Dan Ewald
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
- North Coast Primary Health Network, Ballina, NSW, Australia
| | | | - Michael Burke
- School of Medicine, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Tabeth Mutonga
- Mt Druitt Community Health Centre, Western Sydney Local Health District, Mt Druitt, NSW, Australia
| | - Megan Passey
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
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5
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Anandarajah A, Thirukumaran C, McCarthy K, McMahon S, Feng C, Ritchlin C. Identification and Characterization of a High-Need, High-Cost Group Among Hospitalized Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 74:648-655. [PMID: 33202104 DOI: 10.1002/acr.24510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify a high-need, high-cost (HNHC) group among hospitalized lupus patients and to compare clinical and social factors of the HNHC group with those of other patients with lupus. METHODS All hospitalizations for lupus in a tertiary care center over a 3-year period were recorded. The number of admissions, 30-day readmissions, length of stay (LOS), and cost of admissions were compared for high-risk patients with those of all other hospitalized lupus patients (OHLP) during this period. We then compared clinical measures (double-stranded DNA [dsDNA] levels, complement proteins, body mass index, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI] scores, and Case Mix Index [CMI] scores) for the HNHC cohort with those of the OHLP group. We additionally differentiated social factors (age, race and ethnicity, poverty, and medication adherence) between the 2 groups. RESULTS A total of 202 patients with lupus accounted for 467 hospitalizations over the study period. The total cost of admissions was $13,192,346. Forty-four patients had significantly higher admissions, 30-day readmissions, and LOS. Furthermore, the cost for this group was 6-fold that for the OHLP group, confirming the presence of an HNHC cohort. The HNHC group had significantly higher dsDNA levels, SDI scores, and CMI scores compared with the OHLP group. Infections were the most common cause of admission for both groups. Patients in the HNHC group were more likely to be African American, younger, diagnosed with lupus at an earlier age, to have lower medication adherence, and to be significantly more likely to live in areas of poverty. CONCLUSION A small group of patients with lupus (the HNHC group) accounts for most of the hospitalizations and cost. The HNHC group has both social and clinical factors significantly different from other patients with lupus.
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6
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Johnston JJ, Longman JM, Ewald DP, Rolfe MI, Diez Alvarez S, Gilliland AHB, Chung SC, Das SK, King JM, Passey ME. Validity of a tool designed to assess the preventability of potentially preventable hospitalizations for chronic conditions. Fam Pract 2020; 37:390-394. [PMID: 31848589 PMCID: PMC7377343 DOI: 10.1093/fampra/cmz086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Potentially preventable hospitalizations (PPH) are defined as unplanned hospital admissions which could potentially have been prevented with the provision of effective, timely outpatient care. To better understand and ultimately reduce rates of PPH, a means of identifying those which are actually preventable is required. The Preventability Assessment Tool (PAT) was designed for use by hospital clinicians to assess the preventability of unplanned admissions for chronic conditions. OBJECTIVE The present study examined the ability of the PAT to distinguish between those unplanned admissions which are preventable and those which are not, compared to the assessments of an Expert Panel. METHODS Data were collected between November 2014 and June 2017 at three hospitals in NSW, Australia. Participants were community-dwelling patients with unplanned hospital admissions for congestive heart failure, chronic obstructive pulmonary disease, diabetes complications or angina pectoris. A nurse and a doctor caring for the patient made assessments of the preventability of the admission using the PAT. Expert Panels made assessments of the preventability of each admission based on a comprehensive case report and consensus process. RESULTS There was little concordance between the hospital doctors and nurses regarding the preventability of admissions, nor between the assessments of the Expert Panel and the hospital nurse or the Expert Panel and the hospital doctor. CONCLUSIONS The PAT demonstrated poor concurrent validity and is not a valid tool for assessing the preventability of unplanned hospital admissions. The use of Expert Panels provides a more rigorous approach to assessing the preventability of such admissions.
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Affiliation(s)
| | - Jo M Longman
- University Centre for Rural Health, The University of Sydney, Lismore
| | - Dan P Ewald
- University Centre for Rural Health, The University of Sydney, Lismore.,North Coast Primary Health Network, Ballina
| | - Margaret I Rolfe
- University Centre for Rural Health, The University of Sydney, Lismore
| | | | | | - Steven C Chung
- Highfields Thoracic and Sleep Specialists, Port Macquarie
| | - Sumon K Das
- University Centre for Rural Health, The University of Sydney, Lismore.,Child Health Division, Menzies School of Health, Casuarina, Northern Territory
| | - Jonathan M King
- University Centre for Rural Health, The University of Sydney, Lismore.,The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Megan E Passey
- University Centre for Rural Health, The University of Sydney, Lismore
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7
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Fretian A, Bollweg TM, Okan O, Pinheiro P, Bauer U. Exploring Associated Factors of Subjective Health Literacy in School-Aged Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1720. [PMID: 32155711 PMCID: PMC7084889 DOI: 10.3390/ijerph17051720] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 01/01/2023]
Abstract
Low health literacy is considered to lead to worse health-related outcomes and behaviors and has therefore been recognized as a social determinant of health. While health literacy and its potential determinants have been studied in adults, little research has been conducted with children. This study aims to address this research gap by investigating factors associated with children's subjective health literacy. Cross-sectional data was collected from fourth graders at German schools with a self-report questionnaire. Sociodemographic characteristics, health-related attitudes, and motivation were analyzed. We used hierarchical multivariate linear regression to explain variance in the dependent variable "subjective health literacy". A total of n = 907 fourth graders were surveyed. Regarding health literacy, eight out of ten participants (82.2%) reported that it was "rather easy" or "very easy" to deal with health-related information. Family affluence, but not language spoken at home, was significantly related to subjective health literacy, after controlling for confounding. Moreover, parental health orientation, self-efficacy, and motivation are factors significantly associated with health literacy. Based on the results of this study, it is hypothesized that a general motivation to learn new things about health, as well as an environment promoting health-positive behavior, might foster children's health literacy.
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Affiliation(s)
- Alexandra Fretian
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Faculty of Educational Science, Bielefeld University, 33615 Bielefeld, Germany; (T.M.B.); (O.O.); (P.P.); (U.B.)
| | - Torsten Michael Bollweg
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Faculty of Educational Science, Bielefeld University, 33615 Bielefeld, Germany; (T.M.B.); (O.O.); (P.P.); (U.B.)
| | - Orkan Okan
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Faculty of Educational Science, Bielefeld University, 33615 Bielefeld, Germany; (T.M.B.); (O.O.); (P.P.); (U.B.)
| | - Paulo Pinheiro
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Faculty of Educational Science, Bielefeld University, 33615 Bielefeld, Germany; (T.M.B.); (O.O.); (P.P.); (U.B.)
| | - Ullrich Bauer
- Centre for Prevention and Intervention in Childhood and Adolescence (CPI), Faculty of Educational Science, Bielefeld University, 33615 Bielefeld, Germany; (T.M.B.); (O.O.); (P.P.); (U.B.)
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8
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Ishikawa H, Kiuchi T. Association of Health Literacy Levels Between Family Members. Front Public Health 2019; 7:169. [PMID: 31275918 PMCID: PMC6593243 DOI: 10.3389/fpubh.2019.00169] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Health literacy (HL) is not solely an individual skill but a distributed resource available within individual's social networks. This study explored the associations between individual and family member HL using two separate self-report measures of HL: the European Health Literacy Survey Questionnaire (HLS-EU-Q47) and the Communicative and Critical Health Literacy scale (CCHL). Methods: A self-administered questionnaire survey was conducted with 501 pairs of Japanese residents aged 30 to 79 and their family members whom they most often consulted for help with health issues. HL was measured using HLS-EU-Q47 and CCHL. Results: The HL scores of individuals and their family members were positively correlated for both measures. The correlation was stronger for the HLS-EU-Q47, presumably because it measures the perceived manageability of health-related tasks that implicitly depend on the availability of support for an individual. In contrast, the CCHL measures a single individual's perceived abilities. Both individual and family member CCHL scores were independently related to individual HLS-EU-Q47 scores, particularly when an individual had a family member with a higher CCHL score than his/her own. Conclusions: Limited individual ability to achieve health-related tasks might be compensated for by the higher ability of other family members. In addressing problems with limited health literacy, future studies should focus not only on the individual but also on people who can provide an individual with support.
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Affiliation(s)
- Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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9
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Goto E, Ishikawa H, Okuhara T, Kiuchi T. Relationship of health literacy with utilization of health-care services in a general Japanese population. Prev Med Rep 2019; 14:100811. [PMID: 30815332 PMCID: PMC6377410 DOI: 10.1016/j.pmedr.2019.01.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/18/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022] Open
Abstract
Many studies have explored the association between health literacy and health-care utilization; however, the majority assessed functional health literacy in terms of basic skills. Japan's health-care and medical examination system in workplaces is different from that of other major countries. This study examined the relationship of health literacy with health-care use (emergency visit, hospitalization, dental checkup, and health checkup or cancer screening); it focused on differences by occupation and health-care service utilization among general Japanese using the communicative and critical health literacy scale. We conducted a cross-sectional observational study of 1002 Japanese residents. Through a questionnaire, we investigated socioeconomic status, health status, health-care use, and health literacy. Among all participants and non-workers, logistic regression analyses revealed that health literacy was significantly associated with health checkup or cancer screening after adjusting for sex, age, marital status, education, and having a disease or disorder (adjusted odds ratio [OR] = 1.431, 95% confidence interval [CI], 1.131-1.810; adjusted OR = 1.614, 95% CI, 1.114-2.339, respectively). Among workers, we observed no significant association between health literacy and health-care utilization. These results indicate that health literacy is closely related to use of preventive health-care. Japan's health-care system in workplaces may promote use of preventive health-care services regardless of health literacy, whereas improving health literacy may be more critical among non-workers.
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Affiliation(s)
- Eiko Goto
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hirono Ishikawa
- Graduate School of Public Health, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Tsuyoshi Okuhara
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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10
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Borg B, Douglas IS, Hull M, Keniston A, Moss M, Clark BJ. Alcohol misuse and outpatient follow-up after hospital discharge: a retrospective cohort study. Addict Sci Clin Pract 2018; 13:24. [PMID: 30514357 PMCID: PMC6278064 DOI: 10.1186/s13722-018-0125-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/29/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose Patients with alcohol misuse are less likely to receive preventive health services but more likely to utilize emergency health services. However, the association between alcohol misuse and outpatient follow-up after hospitalization is unknown and may depend on whether a patient experiences a critical illness. We sought to determine whether alcohol misuse was associated with lower rates of outpatient follow-up after hospital discharge and whether the magnitude of this association differed in patients who experienced a critical illness. Materials and methods This was a retrospective cohort study using administrative data from an urban safety net hospital. Patients were included if they were admitted between 2011 and 2015, were between the ages of 18 and 89, resided within the safety net county, were discharged home, and were at moderate to high risk for hospital readmission within the subsequent 30 days. Alcohol misuse was identified using a combination of ICD-9 codes and response to a single screening question. The primary outcome was a combined measure of follow-up with a primary care physician or specialist provider in the 30 days following hospital discharge. Multivariable logistic regression was used to adjust for factors known to be associated with healthcare utilization. Results Overall, 17,575 patients were included in the analysis; 4984 (28%) had alcohol misuse. In the 30 days following hospital discharge, 46% of patients saw any outpatient provider. In an unadjusted analysis, the association between alcohol misuse and attending any outpatient follow-up was dependent on whether patients had a critical illness (p value < 0.0001) with the highest rates of follow-up in survivors of critical illness without alcohol misuse (53%, 95% CI 51%, 55%) followed by patients without alcohol misuse or critical illness (49%; 95% CI 48%, 50%), patients with alcohol misuse without critical illness (38%; 95% CI 36%, 39%), and patients with alcohol misuse and a critical illness (37%; 95% CI 35%, 40%). Adjusting for factors associated with healthcare utilization, these findings were modestly attenuated but unchanged. Conclusions Patients with alcohol misuse who are at moderate to high risk for hospital readmission may benefit from targeted interventions to increase rates of outpatient follow-up after hospital discharge. Electronic supplementary material The online version of this article (10.1186/s13722-018-0125-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bryan Borg
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ivor S Douglas
- Denver Health Medical Center, Denver, CO, USA.,Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Box C272, RC2, 9th Floor, 12700 East 19th Avenue, Aurora, CO, 80045, USA
| | | | | | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Box C272, RC2, 9th Floor, 12700 East 19th Avenue, Aurora, CO, 80045, USA
| | - Brendan J Clark
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Box C272, RC2, 9th Floor, 12700 East 19th Avenue, Aurora, CO, 80045, USA. .,Division of Substance Dependence, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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11
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Ishikawa H, Yamaguchi I, Nutbeam D, Kato M, Okuhara T, Okada M, Kiuchi T. Improving health literacy in a Japanese community population-A pilot study to develop an educational programme. Health Expect 2018; 21:814-821. [PMID: 29602238 PMCID: PMC6117484 DOI: 10.1111/hex.12678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 11/28/2022] Open
Abstract
Objective Although a growing number of interventional studies on health literacy have been conducted recently, the majority were designed in clinical settings, focusing mainly on functional health literacy. This study evaluated a programme designed to improve health literacy in a community population, with a scope of going beyond functional health literacy. Methods In collaboration with an Approved Specified Nonprofit organization (NPO), we evaluated a five‐session programme designed to provide basic knowledge on health‐care policy and systems, current issues in health care in Japan, patient roles and relationships with health‐care providers and interpersonal skills. In total, 67 of 81 programme participants agreed to participate in the study, and 54 returned the completed questionnaires at baseline and at follow‐up. Health literacy and trust in the medical profession were measured at baseline and at follow‐up. Participants’ learning through the programme was qualitatively analysed by thematic analysis. Results Quantitative examinations of the changes in health literacy and degree of trust in medical professionals between the baseline and follow‐up suggested that health literacy significantly improved after implementing the programme. The thematic analysis of participants’ learning throughout the programme suggested that they not only acquired knowledge and skills but also experienced a shift in their beliefs and behaviours. Discussion Providing individuals who are motivated to learn about health‐care systems and collaborate with health‐care providers with the necessary knowledge and skills may improve their health literacy, which could enable them to maintain and promote their health and that of their family and other people around them.
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Affiliation(s)
- Hirono Ishikawa
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Ikuko Yamaguchi
- Approved Specified Nonprofit Organization COML, Osaka, Japan
| | - Don Nutbeam
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Mio Kato
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masafumi Okada
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan
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Sentell T, Pitt R, Buchthal OV. Health Literacy in a Social Context: Review of Quantitative Evidence. Health Lit Res Pract 2017; 1:e41-e70. [PMID: 31294251 PMCID: PMC6607851 DOI: 10.3928/24748307-20170427-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background Conceptual literature has consistently noted that health literacy exists within a social context. This review examined how the intersection of social context and health literacy has been operationalized in quantitative, empirical research. Methods Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched seven databases, including PubMed and CINAHL (The Cumulative Index to Nursing and Allied Health Literature), using a range of potentially relevant keywords, and we hand-searched bibliographies. Inclusion criteria were quantitative studies of any design in which measurement of health literacy and measurement of social context intersected. We identified 1,052 unduplicated articles; 34 met inclusion criteria. Key Results We found three distinct perspectives on the intersection between health literacy and social context. Most common (n = 23) were studies measuring an association between individual health literacy and individual social capital, social support, or social engagement, particularly whether social support varied by health literacy and/or if this relationship mediated health outcomes. Another group of studies (n = 6) took the perspective that being health literate by definition included social context, including access to and/or use of social support as a domain in individual health literacy assessment. Five studies considered the social context of health literacy as an independent property measured beyond the individual level; two measured community-level health literacy and three measured health literacy capacity/concordance in caregiving dyads. The studies showed significant definitional and measurement complexity and overlap. In the most dramatic example, a similar question was used across various studies to measure (1) health literacy, (2) a social support domain in health literacy, (3) social support, and (4) a study outcome distinct from, but associated with, health literacy. Potential useful methods, such as social network analyses, were missing from the literature. Discussion Existing quantitative research on health literacy in a social context supports more attention to this topic. This review quantified evidence, revealed gaps, noted limitations, and identified important questions for future research. [Health Literacy Research and Practice . 2017;1(2):e41-e70.]. Plain Language Summary This study systemically compiles existing quantitative empirical research (34 articles) focusing on the intersection of health literacy in the social context. We find considerable measurement complexity in the current body of work on this topic and identify three distinct perspectives that researchers have taken while considering this topic. This information will be useful for future development of this important research area.
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Flythe JE, Hilbert J, Kshirsagar A, Gilet CA. Psychosocial Factors and 30-Day Hospital Readmission among Individuals Receiving Maintenance Dialysis: A Prospective Study. Am J Nephrol 2017; 45:400-408. [PMID: 28407633 PMCID: PMC5483850 DOI: 10.1159/000470917] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thirty-day hospital readmissions are common among maintenance dialysis patients. Prior studies have evaluated easily measurable readmission risk factors such as comorbid conditions, laboratory results, and hospital discharge day. We undertook this prospective study to investigate the associations between hospital-assessed depression, health literacy, social support, and self-rated health (separately) and 30-day hospital readmission among dialysis patients. METHODS Participants were recruited from the University of North Carolina Hospitals, 2014-2016. Validated depression, health literacy, social support, and self-rated health screening instruments were administered during index hospitalizations. Multivariable logistic regression models with 30-day readmission as the dependent outcome were used to examine readmission risk factors. RESULTS Of the 154 participants, 58 (37.7%) had a 30-day hospital readmission. In unadjusted analyses, individuals with positive screening for depression, lower health literacy, and poorer social support were more likely to have a 30-day readmission (vs. negative screening). Positive depression screening and poorer social support remained significantly associated with 30-day readmission in models adjusted for race, heart failure, admitting service, weekend discharge day, and serum albumin: adjusted OR (95% CI) 2.33 (1.02-5.15) for positive depressive symptoms and 2.57 (1.10-5.91) for poorer social support. The area under the receiver operating characteristic curve (AUC) of the multivariable model adjusted for social support status was significantly greater than the AUC of the multivariable model without social support status (test for equality; p value = 0.04). CONCLUSION Poor social support and depressive symptoms identified during hospitalizations may represent targetable readmission risk factors among dialysis patients. Our findings suggest that hospital-based assessments of select psychosocial factors may improve readmission risk prediction.
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Affiliation(s)
- Jennifer E. Flythe
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | | | - Abhijit Kshirsagar
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC
| | - Constance A. Gilet
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC
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Racial and Ethnic Disparities in Preventable Hospitalizations for Chronic Disease: Prevalence and Risk Factors. J Racial Ethn Health Disparities 2016; 4:1100-1106. [PMID: 27924622 DOI: 10.1007/s40615-016-0315-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/12/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hospitalizations due to ambulatory care sensitive conditions (ACSCs) result in high morbidity and economic burden on the American healthcare system. Admissions due to chronic ACSCs, in particular, cost the American healthcare system over 30 billion dollars annually. OBJECTIVES AND METHODS This paper presents the current research on racial and ethnic disparities in the burden of hospitalizations due to chronic ACSCs. For this narrative review, we evaluated over 800 abstracts from MEDLINE and Google Scholar and cited 62 articles. RESULTS Since 1998, racial and ethnic disparities in hospitalizations from chronic ACSCs have increased resulting in over 430,000 excess hospitalizations among non-Hispanic Blacks compared to non-Hispanic Whites. CONCLUSIONS Racial disparities in chronic ACSCs hospitalizations are pervasive in the USA. There is need for more research on the pathways through which an individual's race modifies the risk for hospitalizations due to chronic ACSCs.
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Passey ME, Longman JM, Johnston JJ, Jorm L, Ewald D, Morgan GG, Rolfe M, Chalker B. Diagnosing Potentially Preventable Hospitalisations (DaPPHne): protocol for a mixed-methods data-linkage study. BMJ Open 2015; 5:e009879. [PMID: 26597867 PMCID: PMC4663419 DOI: 10.1136/bmjopen-2015-009879] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Rates of potentially preventable hospitalisations (PPH) are used as a proxy measure of effectiveness of, or access to community-based health services. The validity of PPH as an indicator in Australia has not been confirmed. Available evidence suggests that patient-related, clinician-related and systems-related factors are associated with PPH, with differences between rural and metropolitan settings. Furthermore, the proportion of PPHs which are actually preventable is unknown. The Diagnosing Potentially Preventable Hospitalisations study will determine the proportion of PPHs for chronic conditions that are deemed preventable and identify potentially modifiable factors driving these, in order to develop effective interventions to reduce admissions and improve measures of health system performance. METHODS AND ANALYSIS This mixed methods data linkage study of approximately 1000 eligible patients with chronic PPH admissions to one metropolitan and two regional hospitals over 12 months will combine data from multiple sources to assess the: extent of preventability of chronic PPH admissions; validity of the Preventability Assessment Tool (PAT) in identifying preventable admissions; factors contributing to chronic PPH admissions. Data collected from patients (quantitative and qualitative methods), their general practitioners, hospital clinicians and hospital records, will be linked with routinely collected New South Wales (NSW) Admitted Patient Data Collection, the NSW Registry of Births, Death and Marriages death registration and Australian Bureau of Statistics mortality data. The validity of the PAT will be assessed by determining concordance between clinician assessment and that of a 'gold standard' panel. Multivariable logistic regression will identify the main predictor variables of admissions deemed preventable, using study-specific and linked data. ETHICS AND DISSEMINATION The NSW Population and Health Services Research Ethics Committee granted ethical approval. Dissemination mechanisms include engagement of policy stakeholders through a project Steering Committee, and the production of summary reports for policy and clinical audiences in addition to peer-review papers.
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Affiliation(s)
- Megan E Passey
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Jo M Longman
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Jennifer J Johnston
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Dan Ewald
- North Coast Primary Health Network, Ballina, New South Wales, Australia
| | - Geoff G Morgan
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Margaret Rolfe
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Bronwyn Chalker
- Mid North Coast Local Health District, South West Rocks, New South Wales, Australia
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Longman JM, Passey ME, Ewald DP, Rix E, Morgan GG. Admissions for chronic ambulatory care sensitive conditions - a useful measure of potentially preventable admission? BMC Health Serv Res 2015; 15:472. [PMID: 26475293 PMCID: PMC4608278 DOI: 10.1186/s12913-015-1137-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 10/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Potentially preventable hospital admission (an admission deemed to be potentially preventable given appropriate care in the community-based healthcare setting) has been a topic of international research attention for almost three decades. Recently this has been largely driven by the imperative to reduce ever-increasing unplanned hospital admissions. However, identifying potentially preventable admissions is difficult. As a result, the population level indicator of admissions for ambulatory care sensitive conditions (ACSCs) has been used as a proxy measure for potentially preventable admission. The adoption of this measure has become common, and in Australia, the rate of admissions for chronic ACSCs is now an important component of measuring health system performance and accountability, and is directly linked to funding. Admission for a chronic ACSC is also used to identify individuals for targeting of interventions to reduce preventable admissions. DISCUSSION Hospital admission for chronic ACSCs is a population measure based on admission diagnoses, it therefore should not be used to identify individual preventable admissions. At present we are unable to determine individual admissions that are deemed to be preventable or, therefore, articulate the factors associated with admissions which are preventable. As we are currently unable to identify individual admissions that are preventable, little is understood about the underlying causes and factors contributing to preventable admissions. A means of assessing preventability of individual admissions is required. Only then can we explore the antecedents, and patient and clinician perspectives on preventable admissions. Until we have a clearer understanding of this, our capacity to inform policy and program development remains compromised.
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Affiliation(s)
- Jo M Longman
- University Centre for Rural Health - North Coast, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
| | - Megan E Passey
- University Centre for Rural Health - North Coast, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
| | - Dan P Ewald
- North Coast Primary Health Network, Lismore, 2480, Australia.
| | - Elizabeth Rix
- University Centre for Rural Health - North Coast, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
| | - Geoffrey G Morgan
- University Centre for Rural Health - North Coast, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
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The Relationship of Health Literacy with Health Status, Preventive Behaviors and Health Services Utilization in Baluchistan, Iran. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2015. [DOI: 10.20286/jech-02036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Karimi S, Keyvanara M, Hosseini M, Jazi MJ, Khorasani E. The relationship between health literacy with health status and healthcare utilization in 18-64 years old people in Isfahan. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2014; 3:75. [PMID: 25077168 PMCID: PMC4113988 DOI: 10.4103/2277-9531.134910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Today, much attention has been paid to the patient role as the central factor in the management of their own health. It is focused on the issue that the patient has a more critical role compared with the health-care provider in controlling the patient own health. defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. OBJECTIVE The objective of this study was to determine health literacy, health status, healthcare utilization and the relationship between them in 18 - 64 years old people in Isfahan. STRUCTURE AND DESIGN This study was a descriptive analytical survey, which was conducted on 300 subjects of 18-64 years old in Isfahan with Multi-stage sampling method proportional to selected sample size. MATERIALS AND METHODS For collecting the data, questionnaire adapted from CHAP (Consumer Assessment of Healthcare Providers and Systems) health literacy questionnaire was used. Health status was measured based on an assessment of the physical and mental health over the past 6 months by 5° Likert scale. Data analysis was performed by using SPSS 18, descriptive statistics, Chi-square test and multivariate analysis of variance. RESULTS There was no significant correlation between health literacy, health status and healthcare utilization. Utilization was less in the urban area No. 6 of the city. In the bachelor's degree group, the health status was lower than the other groups in these cases: Older ages, married, women, large family size, undergraduates, and urban area No. 14. CONCLUSIONS Due to the average prevalence of health literacy in 18-64 years old individuals in Isfahan and low- healthcare utilization, the followings are recommended: Necessity of more attention to the issue of health literacy, improving the physician-patient relationship and community awareness, whether through health promotion programs or media for the optimum use of available resources.
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Affiliation(s)
- Saeed Karimi
- Department of Health Services Management, Health Management and Economic Research Center, Isfahan, Iran
| | - Mahmoud Keyvanara
- Department of Health Services Management, Social Determinate of Health Research Center, Isfahan, Iran
| | - Mohsen Hosseini
- Department of Biostatistics and Epidemiology, School of Health, Isfahan, Iran
| | - Marzie Jafarian Jazi
- Department of Health Services Management, School of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Khorasani
- Department of Health Services Management, School of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran
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Stewart DW, Reitzel LR, Correa-Fernández V, Cano MÁ, Adams CE, Cao Y, Li Y, Waters AJ, Wetter DW, Vidrine JI. Social support mediates the association of health literacy and depression among racially/ethnically diverse smokers with low socioeconomic status. J Behav Med 2014; 37:1169-79. [PMID: 25391450 DOI: 10.1007/s10865-014-9566-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/31/2014] [Indexed: 01/10/2023]
Abstract
Nearly half of U.S. adults have health literacy (HL) difficulties, and lack the ability to effectively obtain, process, and understand health information. Poor HL is associated with depression, yet mechanisms of this relation are unclear. This study examined whether social support mediated the relation between HL and depressive symptoms in 200 low-socioeconomic status (SES), racially/ethnically diverse smokers enrolled in cessation treatment. Mediation analyses were conducted using bootstrapping and controlling for SES and nicotine dependence. In simple mediation models, social support [Interpersonal Support Evaluation List (ISEL) total, subscales (Appraisal, Belonging, Tangible)] mediated the effect of HL on depression, such that lower HL was associated with lower perceived support, which predicted higher depressive symptoms (ps < .05). A multiple mediation model, with ISEL subscales entered simultaneously as mediators, was significant (p < .05) but only the Belonging subscale demonstrating independent significance (p < .05). Thus, social support may be a critical factor underlying the HL-depression relationship in low-SES, racially/ethnically diverse smokers.
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Affiliation(s)
- Diana W Stewart
- Department of Health Disparities Research, Unit 1440, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77230-1402, USA,
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Abstract
Low health literacy is common among adults and is related to adverse health outcomes. It also impacts health management and one’s ability to control his or her chronic illness. The current study examined the association of health literacy and diabetes management self-efficacy with employment among 126 individuals with diabetes. No relationship was found between health literacy and employment. Diabetes-management self-efficacy was not directly related to employment but it was indirectly linked to it through physical health and lack of interference of diabetes with activities of daily living. This research suggests that strategies to improve self-efficacy may contribute to improved health and employment outcomes. Implications for rehabilitation counseling practice and research are discussed.
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Javadzade SH, Sharifirad G, Radjati F, Mostafavi F, Reisi M, Hasanzade A. Relationship between health literacy, health status, and healthy behaviors among older adults in Isfahan, Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2012; 1:31. [PMID: 23555134 PMCID: PMC3577376 DOI: 10.4103/2277-9531.100160] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Health literacy is a measure of an individual's ability to read, comprehend, and act on medical instructions. Limited health literacy can reduce the adults' ability to comprehend and use basic health-related materials, such as prescription, food labels, health education pamphlets, articles, appointment slips, and health insurance plans, which can affect their ability to take appropriate and timely health care action. Nowadays, low health literacy is considered a worldwide health threat. So, the purpose of this study was to assess health literacy level in older adults and to investigate the relationships between health literacy and health status, health care utilization, and health preventive behaviors. MATERIALS AND METHODS A cross-sectional survey of 354 older adults was conducted in Isfahan. The method of sampling was clustering. Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA). Data were collected using home interviewing. Health status was measured based on self-rated general health. Health care utilization was measured based on self-reported outpatient clinic visits, emergency room visits, and hospitalizations, and health preventive behaviors were measured based on self-reported preventive health services use. RESULTS Approximately 79.6% of adults were found to have inadequate health literacy. They tended to be older, had fewer years of schooling, lower household income, and were females. Inadequate health literacy was associated with poorer general health (P < 0.001). Health literacy level was negatively associated with outpatient visits (P = 0.003) and hospitalization (P = 0.01). No significant association was found between health literacy level and emergency room utilization. Self-reported lack of PSA (Prostate-Specific Antigen) test (P < 0.001) and fecal occult blood test (FOBT; P = 0.003) was higher among individuals with inadequate health literacy than those with adequate health literacy. No significant association was found between health literacy level and mammogram in the last 2 years. CONCLUSION Low health literacy is more prevalent in older adults. It indicates the importance of health literacy issue in health promotion. So, with simple educational materials and effective interventions for low health literacy group, we can improve health promotion in the society and mitigate the adverse health effects of low health literacy.
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Affiliation(s)
- Seyed Homamodin Javadzade
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Sharifirad
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Radjati
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnoosh Reisi
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hasanzade
- Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Lee SYD, Tsai TI, Tsai YW, Kuo KN. Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health 2010; 10:614. [PMID: 20950479 PMCID: PMC2967535 DOI: 10.1186/1471-2458-10-614] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 10/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low health literacy is considered a worldwide health threat. The purpose of this study is to assess the prevalence and socio-demographic covariates of low health literacy in Taiwanese adults and to investigate the relationships between health literacy and health status and health care utilization. METHODS A national survey of 1493 adults was conducted in 2008. Health literacy was measured using the Mandarin Health Literacy Scale. Health status was measured based on self-rated physical and mental health. Health care utilization was measured based on self-reported outpatient clinic visits, emergency room visits, and hospitalizations. RESULTS Approximately thirty percent of adults were found to have low (inadequate or marginal) health literacy. They tended to be older, have fewer years of schooling, lower household income, and reside in less populated areas. Inadequate health literacy was associated with poorer mental health (OR, 0.57; 95% CI, 0.35-0.91). No association was found between health literacy and health care utilization even after adjusting for other covariates. CONCLUSIONS Low (inadequate and marginal) health literacy is prevalent in Taiwan. High prevalence of low health literacy is not necessarily indicative of the need for interventions. Systematic efforts to evaluate the impact of low health literacy on health outcomes in other countries would help to illuminate features of health care delivery and financing systems that may mitigate the adverse health effects of low health literacy.
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Affiliation(s)
- Shoou-Yih D Lee
- Department of Health Management and Policy, School of Public Health, University of Michigan, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - Tzu-I Tsai
- School of Nursing, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Ken N Kuo
- Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, 35, Keyan Road, Zhunan Town, Miaoli County, 350, Taiwan
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Merrick ESL, Hodgkin D, Garnick DW, Horgan CM, Panas L, Ryan M, Blow FC, Saitz R. Older adults' inpatient and emergency department utilization for ambulatory-care-sensitive conditions: relationship with alcohol consumption. J Aging Health 2010; 23:86-111. [PMID: 20935248 DOI: 10.1177/0898264310383156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study examined the relationship between drinking that exceeds guideline-recommended limits and acute-care utilization for ambulatory-care-sensitive conditions (ACSCs) by older Medicare beneficiaries. METHOD This secondary data analysis used the 2001-2006 Medicare Current Beneficiary Survey (unweighted n = 5,570 community dwelling, past-year drinkers, 65 years and older). Self-reported alcohol consumption (categorized as within guidelines, exceeding monthly but not daily limits, or heavy episodic) and covariates were used to predict ACSC hospitalization, emergency department visit not resulting in admission, and emergency department visit that did result in admission. RESULTS Heavy episodic drinking was significantly associated with higher likelihood of an ACSC emergency department visit not resulting in admission (adjusted odds ratio = 1.91, 95% CI: 1.11-3.30; p < .05). Drinking pattern was not significant for other ACSC measures. DISCUSSION Results partially support the hypothesis that excessive drinking may be related to ACSC acute-care utilization among older adults, suggesting increased risk of lower quality outpatient care.
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An evaluation of the relationship between the implementation of a newly designed prescription drug label at Target pharmacies and health outcomes. Med Care 2009; 47:1031-5. [PMID: 19648829 DOI: 10.1097/mlr.0b013e3181a81181] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medication errors represent a major public health concern, and inadequate prescription drug labels have been identified as a root cause of errors. A new prescription medication labeling system was implemented by Target pharmacies in May 2005 and aimed to improve health outcomes. OBJECTIVES To evaluate whether the new Target label influenced patient health services utilization. SUBJECTS Derived from 2 large health plans. RESEARCH DESIGN AND MEASURES: Using administrative claims, we identified patients with 1 of 9 chronic diseases who filled prescriptions at Target pharmacies and a matched sample who filled prescriptions at other community pharmacies. We stratified our cohort into new and prevalent medication users and evaluated the impact of the Target label on outpatient, emergency department and inpatient health services use. We used linear regression and segmented linear regression to evaluate the new-user and prevalent-user analyses, respectively. RESULTS Our sample included 23,745 Target pharmacy users and 162,369 matched non-Target pharmacy users. In the new-user analysis, we found no significant change in rates of both outpatient (event rate ratio: 0.53; 95% CI: 0.15-1.86) and inpatient and emergency department (Event rate ratio: 0.88; 95% CI: 0.62-1.24) health services utilization in Target users after implementation when compared with non-Target users. Similarly, in the prevalent user analysis, we found no change in the level or slope of outpatient or emergency/inpatient services in Target users after implementation of the new label when compared with non-Target users. CONCLUSIONS We found no statistically significant change in health services use attributable to the implementation of the new prescription drug label at Target pharmacies. These findings highlight the challenge of influencing health outcomes with interventions to improve health literacy.
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Abstract
OBJECTIVES Health information is an important resource for patients to understand and engage in the management of their health conditions. We discuss the role of health literacy (HL) in improving patient participation and propose future research in this field. METHODS Literature searches were conducted to review existing definitions and measures of HL and identify empirical findings of its impact on patient health/illness-related behaviours. We searched MEDLINE using 'health literacy' as a keyword and retrieved 371 articles published in English between 1985 and 2006. We also hand-searched publications of leading researchers and related institutes and followed the reference lists of relevant articles. RESULTS The World Health Organization has defined HL as 'the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.' Based on this definition, three levels of HL have been described: functional, communicative and critical. Studies of HL have increased dramatically over the past few years, but there is a gap between the conceptual definition of HL and its application. Thus, empirical evidence of its impact on patient health/illness-related behaviours is still limited. CONCLUSIONS The prevalence and consequence of inadequate HL as fully defined have not been determined. Further research is needed to develop measures of HL beyond the functional level and that consider the interaction of the individual patient HL with the health and social contexts in which the patient lives.
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Affiliation(s)
- Hirono Ishikawa
- Department of Medicine and Culture, Shiga University of Medical Science, Shiga, and Department of Public Health, Teikyo University School of Medicine, Tokyo, Japan.
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Piette JD, Kerr E, Richardson C, Heisler M. Veterans Affairs research on health information technologies for diabetes self-management support. J Diabetes Sci Technol 2008; 2:15-23. [PMID: 19885173 PMCID: PMC2769696 DOI: 10.1177/193229680800200104] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Like many patients with diabetes, Department of Veterans Affairs (VA) patients frequently fall short of self-management goals and experience multiple barriers to self-care. Health information technologies (HITs) may provide the tools that patients need to manage their illness under the direction of their primary care team. METHODS We describe several ongoing projects focused on HIT resources for self-management in VA. VA researchers are developing HITs that seek to bolster a variety of potential avenues for self-management support, including patients' relationships with other patients, connections with their informal care networks, and communication with their health care teams. RESULTS Veterans Affairs HIT research projects are developing services that can address the needs of patients with multiple challenges to disease self-care, including multimorbidity, health literacy deficits, and limited treatment access. These services include patient-to-patient interactive voice response (IVR) calling systems, IVR assessments with feedback to informal caregivers, novel information supports for clinical pharmacists based on medication refill data, and enhanced pedometers. CONCLUSION Large health care systems such as the VA can play a critical role in developing HITs for diabetes self-care. To be truly effective, these efforts should include a continuum of studies: observational research to identify barriers to self-management, developmental studies (e.g., usability testing), efficacy trials, and implementation studies to evaluate utility in real-world settings. VA HIT researchers partner with operations to promote the dissemination of efficacious services, and such relationships will be critical to move HIT innovations into practice.
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Affiliation(s)
- John D Piette
- Department of Veterans Affairs Center for Practice Management and Outcomes Research, Michigan Diabetes Research and Training Center, and University of Michigan, Ann Arbor, Michigan 48113-0710, USA.
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Stewart SH, Connors GJ. Perceived health status, alcohol-related problems, and readiness to change among medically hospitalized, alcohol-dependent patients. J Hosp Med 2007; 2:372-7. [PMID: 18080338 DOI: 10.1002/jhm.211] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Alcohol dependence is prevalent among medically hospitalized patients, and acute illness has the potential to increase motivation to change and provide a therapeutic window for treatment of alcohol dependence. This study evaluated the correlations of readiness to change drinking behavior with perceived physical and mental health status and specific alcohol-related consequences of medical inpatients. DESIGN AND MEASUREMENTS The study was a cross-sectional survey of 50 clinically recognized and subsequently confirmed alcohol-dependent patients admitted to general internal medicine teaching services with no evidence of chronic cognitive functional deficits. We estimated correlations of process-of-change variables (problem recognition, ambivalence about change, and taking steps to change drinking) with measures of patient perception of general physical and mental health status and self-reported alcohol-related consequences. RESULTS Problem recognition (r = -0.31, P = .028) and ambivalence about change (r = -0.41, P = .003), but not taking steps to change drinking (r = -0.26, P = .072) were significantly associated with perceived physical health. Perceived mental health was not associated with these variables, but greater alcohol-specific consequences were typically associated with greater recognition, ambivalence, and intent to change. CONCLUSIONS Among alcohol-dependent patients with acute medical illness requiring hospitalization, poorer perceived health status was associated with increased recognition of drinking problems and thoughts about changing drinking behavior. Future research should evaluate if problem recognition and ambivalence modify treatment involvement and outcomes following hospitalization and if hospital-based interventions designed to link medical conditions and their treatment to alcohol dependence enhance recognition and ambivalence.
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Affiliation(s)
- Scott H Stewart
- Center for Drug and Alcohol Programs, Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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