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Can patients with low health literacy be identified from routine primary care health records? A cross-sectional and prospective analysis.

Campbell, P; Lewis, M; Chen, Y; Lacey, RJ; Rowlands, G; Protheroe, J

Can patients with low health literacy be identified from routine primary care health records? A cross-sectional and prospective analysis. Thumbnail


Authors

Y Chen

RJ Lacey

G Rowlands



Abstract

BACKGROUND:
People with low health literacy (HL) are at increased risk of poor health outcomes, and receive less benefit from healthcare services. However, healthcare practitioners can effectively adapt healthcare information if they are aware of their patients' HL. Measurements are available to assess HL levels but may not be practical for use within primary care settings. New alternative methods based on demographic indicators have been successfully developed, and we aim to test if such methodology can be applied to routinely collected consultation records.

METHODS:
Secondary analysis was carried out from a recently completed prospective cohort study that investigated a primary care population who had consulted about a musculoskeletal pain problem. Participants completed questionnaires (assessing general health, HL, pain, and demographic information) at baseline and 6?months, with linked data from the participants' consultation records. The Single Item Literacy Screener was used as a benchmark for HL. We tested the performance of an existing demographic assessment of HL, whether this could be refined/improved further (using questionnaire data), and then test the application in primary care consultation data. Tests included accuracy, sensitivity, specificity, and area under the curve (AUC). Finally, the completed model was tested prospectively using logistic regression producing odds ratios (OR) in the prediction of poor health outcomes (physical health and pain intensity).

RESULTS:
In total 1501 participants were included within the analysis and 16.1% were categorised as having low HL. Tests for the existing demographic assessment showed poor performance (AUC 0.52), refinement using additional components derived from the questionnaire improved the model (AUC 0.69), and the final model using data only from consultation data remained improved (AUC 0.64). Tests of this final consultation model in the prediction of outcomes showed those with low HL were 5 times more likely to report poor health (OR 5.1) and almost 4 times more likely to report higher pain intensity (OR 3.9).

CONCLUSIONS:
This study has shown the feasibility of the assessment of HL using primary care consultation data, and that people indicated as having low HL have poorer health outcomes. Further refinement is now required to increase the accuracy of this method.

Journal Article Type Article
Acceptance Date Jul 11, 2019
Online Publication Date Jul 18, 2019
Publication Date Jul 18, 2019
Publicly Available Date Mar 29, 2024
Journal BMC Family Practice
Print ISSN 1471-2296
Publisher BioMed Central
Pages 101 -?
DOI https://doi.org/10.1186/s12875-019-0994-8
Keywords Electronic health records, Health literacy, Musculoskeletal pain, Primary care
Publisher URL http://doi.org/10.1186/s12875-019-0994-8
PMID 31319792