[Health literacy in patients with heart failure treated in primary care].
Ontology highlight
ABSTRACT: Objectives
The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area.Design
A multicentre cross-sectional study.Setting
10 Primary care centres from the metropolitan area of Barcelona.Participants
Patients diagnosed with heart failure.Inclusion criteria
to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation.Main measurements
Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model.Results
The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%).Conclusions
In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failure.
SUBMITTER: Santesmases-Masana R
PROVIDER: S-EPMC6875916 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundPrevious work has shown that there is a higher frequency of hospitalizations among black heart failure patients relative to white heart failure patients. We sought to determine whether racial differences exist in health literacy and access to outpatient medical care, and to identify factors associated with these differences.MethodsWe evaluated data from 1464 heart failure patients (644 black and 820 white). Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Revised (ie, REALM-R), and access to care was assessed through participants' self-report.ResultsBlack race was strongly associated with worse health literacy and all measures of poor access to care in unadjusted analyses. After adjusting for demographics, noncardiac comorbidity, social support, insurance status, and socioeconomic status (income and education), the strongest associations were seen between race and: health literacy (OR 2.13, 95% CI 1.46 to 3.10), absence of a medical home (OR 1.76, 1.19-2.61), and cost as a deterrent to seeking health care (OR 1.55, 1.07 to 2.23).ConclusionsOur findings highlight that important racial differences in health literacy and access to care exist among patients with heart failure. These differences persist even after adjustment for a broad range of potential mediators, including educational attainment, income, and insurance status.
| S-EPMC3053061 | biostudies-literature
Project description:BackgroundPatients hospitalized with heart failure are often readmitted. Health literacy may play a substantial role in the high rate of readmissions. The purpose of this study was to examine the association of health literacy with the composite end point of heart failure readmission rates and all-cause mortality in patients with heart failure living in rural areas.Methods and resultsRural adults (n = 575), hospitalized for heart failure within the past 6 months, completed the Short Test of Functional Health Literacy in Adults (STOFHLA) to measure health literacy and were followed for ≥2 years. The percentage of patients with the end point of heart failure readmission or all-cause death was different (P = .001) among the 3 STOFHLA score levels. Unadjusted analysis revealed that patients with inadequate and marginal health literacy were 1.94 (95% confidence interval [CI] 1.43-2.63; P < .001) times, and 1.91 (95% CI 1.36-2.67; P < .001) times, respectively, more likely to experience the outcome. After adjustment for covariates, health literacy remained a predictor of outcomes. Of the other covariates, worse functional class, higher comorbidity burden, and higher depression score predicted worse outcomes.ConclusionsInadequate or marginal health literacy is a risk factor for heart failure rehospitalization or all-cause mortality among rural patients with heart failure.
| S-EPMC4522326 | biostudies-literature
Project description:BACKGROUND:Numeracy, health literacy, and cognition are important for chronic disease management. Prior studies have found them to be associated with poorer selfcare and worse clinical outcomes, but limited data exists in the context of heart failure (HF), a condition that requires patients to monitor their weight, fluid intake, and dietary salt, especially in the posthospitalization period. OBJECTIVE:To examine the relationship between numeracy, health literacy, and cognition with 30-day readmissions among patients hospitalized for acute decompensated HF (ADHF). DESIGN, SETTING, PATIENTS:The Vanderbilt Inpatient Cohort Study is a prospective longitudinal study of adults hospitalized with acute coronary syndromes and/or ADHF. We studied 883 adults hospitalized with ADHF. MEASUREMENTS:During their hospitalization, a baseline interview was performed in which demographic characteristics, numeracy, health literacy, and cognition were assessed. Through chart review, clinical characteristics were determined. The outcome of interest was 30-day readmission to any acute care hospital. To examine the association between numeracy, health literacy, cognition, and 30-day readmissions, multivariable Poisson (log-linear) regression was used. RESULTS:Of the 883 patients admitted for ADHF, 23.8% (n = 210) were readmitted within 30 days; 33.9% of the study population had inadequate numeracy skills, 24.6% had inadequate/marginal literacy skills, and 53% had any cognitive impairment. Numeracy and cognition were not associated with 30-day readmissions. Though (objective) health literacy was associated with 30-day readmissions in unadjusted analyses, it was not in adjusted analyses. CONCLUSIONS:Numeracy, health literacy, and cognition were not associated with 30-day readmission among this sample of patients hospitalized with ADHF.
| S-EPMC5836748 | biostudies-literature
Project description:BackgroundPatients with inadequate health literacy often have poorer health outcomes and increased utilization and costs. The Institute of Medicine has recommended that health literacy assessment be incorporated into health care information systems, which would facilitate large-scale studies of the effects of health literacy, as well as evaluation of system interventions to improve care by addressing health literacy. As part of the Health Literacy Screening (HEALS) study, a Brief Health Literacy Screen (BHLS) was incorporated into the electronic health record (EHR) at a large academic medical center.MethodsChanges were implemented to the nursing intake documentation across all adult hospital units, the emergency department, and three primary care practices. The change involved replacing previous education screening items with the BHLS. Implementation was based on a quality improvement framework, with a focus on acceptability, adoption, appropriateness, feasibility, fidelity and sustainability. Support was gained from nursing leadership, education and training was provided, a documentation change was rolled out, feedback was obtained, and uptake of the new health literacy screening items was monitored.ResultsBetween November 2010 and April 2012, there were 55,611 adult inpatient admissions, and from November 2010 to September 2011, 23,186 adult patients made 39,595 clinic visits to the three primary care practices. The completion (uptake) rate was 91.8% for the hospital and 66.6% for the outpatient clinics.ConclusionsAlthough challenges exist, it is feasible to incorporate health literacy screening into clinical assessment and EHR documentation. Next steps are to evaluate the association of health literacy with processes and outcomes of care across inpatient and outpatient populations.
| S-EPMC4072202 | biostudies-literature
Project description:IntroductionThe promotion of health literacy of the population in a situation of migration, in the community, is a fundamental field of intervention in health promotion, for the reduction of inequalities in access to health care services. It is increasingly necessary to make health care services more equitable for migrant populations. The aim of the study was to characterize the level of health literacy of the population in a migrant situation, attending a primary health care unit in the Lisbon region, to identify priority areas for community intervention that will become the focus of intervention and contribute to the increase in the health literacy levels in this population.MethodsA cross-sectional study was carried out by applying the Health Literacy Survey (ILS-PT) to a sample of the population in a situation of migration, found by 27 participants.ResultsThe general health literacy index of the sample is inadequate (21.23 points). An analysis of the sub-indexes revealed that 75% of the participants had difficulties related to information about health care and 80% had difficulties in the field of health promotion.ConclusionsProblematic and inadequate levels of health literacy was significantly frequent among migrant population. So that enhancing health literacy among migrant is essential to reduce health inequalities to achieve better health outcomes and contribute to defense of human rights of this vulnerable population.
| S-EPMC8818741 | biostudies-literature
Project description:ObjectivesThe purpose of this study was to determine if health literacy is associated with mortality, hospitalizations, or emergency department (ED) visits among patients living with heart failure (HF).BackgroundGrowing evidence suggests an association between health literacy and health-related outcomes in patients with HF.MethodsWe searched Embase, MEDLINE, PsycINFO, and EBSCO CINAHL from inception through January 1, 2019, with the help of a medical librarian. Eligible studies evaluated health literacy among patients with HF and assessed mortality, hospitalizations, and ED visits for all causes with no exclusion by time, geography, or language. Two reviewers independently selected studies, extracted data, and assessed the methodological quality of the identified studies.ResultsWe included 15 studies, 11 with an overall high methodological quality. Among the observational studies, an average of 24% of patients had inadequate or marginal health literacy. Inadequate health literacy was associated with higher unadjusted risk for mortality (risk ratio [RR]: 1.67; 95% confidence interval [CI]: 1.18 to 2.36), hospitalizations (RR: 1.19; 95% CI: 1.09 to 1.29), and ED visits (RR: 1.17; 95% CI: 1.03 to 1.32). When the adjusted measurements were combined, inadequate health literacy remained statistically associated with mortality (RR: 1.41; 95% CI: 1.06 to 1.88) and hospitalizations (RR: 1.12; 95% CI: 1.01 to 1.25). Among the 4 interventional studies, 2 effectively improved outcomes among patients with inadequate health literacy.ConclusionsIn this study, the estimated prevalence of inadequate health literacy was high, and inadequate health literacy was associated with increased risk of death and hospitalizations. These findings have important clinical and public health implications and warrant measurement of health literacy and deployment of interventions to improve outcomes.
| S-EPMC7263350 | biostudies-literature
Project description:Determine the relationship between cognitive function and health literacy in heart failure (HF) knowledge in patients with HF.HF requires extensive, complex treatment; thus, cognition and health literacy may contribute to understanding and self-management of HF.Participants were 330 HF outpatients. Health literacy was assessed using the Medical Term Recognition Test and the Rapid Estimate of Adult Literacy in Medicine. Global cognitive function was screened with the Modified Mini-Mental Status Examination. HF knowledge was assessed with the Dutch Heart Failure Knowledge Scale (DHFKS).Health literacy (? = .26, p < .001) and cognition (? = .36, p < .001) were related to DHFKS. Both scores were independently associated with DHFKS (health literacy: ? = .13, p = .044 and cognition: ? = .30, p < .001).Impairments in health literacy and cognition were independently associated with reduced HF knowledge. Interventions should address both factors to be maximally effective.
| S-EPMC5147734 | biostudies-other
Project description:OBJECTIVES:General practitioners (GPs) play a key role in heart failure (HF) management. Despite multiple guidelines, the management of patients with HF in primary care is suboptimal. Therefore, all the qualitative evidence concerning GPs' perceptions of managing HF in primary care was synthesised to identify barriers and facilitators for optimal care, and ideas for improvement. DESIGN:Qualitative evidence synthesis. METHODS:Searches of MEDLINE, EMBASE, Web of Science and CINAHL databases up to 20/12/2015 were conducted. The Critical Appraisal Skills Programme's checklist for qualitative research was used for quality assessment. Thematic analysis was used as method of analysis. RESULTS:Of 5427 articles, 18 qualitative articles were included. Findings were organised in HF-specific factors, patient factors, physician factors and contextual factors. GPs' uncertainty in all areas of HF management was highlighted. HF management started with an uncertain diagnosis, leading to difficulties with communication, treatment and advance care planning. Lack of access to specialised care and lack of knowledge were identified as important contributors to this uncertainty. In an effort to overcome this, strategies bringing evidence into practice should be promoted. GPs expressed the need for a multidisciplinary chronic care approach for HF. However, mixed experiences were noted with regard to interprofessional collaboration. CONCLUSIONS:The main challenges identified in this synthesis were how to deal with GPs' uncertainty about clinical practice, how to bring evidence into practice and how to work together as a multiprofessional team. These barriers were situated predominantly on the physician and contextual level. Targets to improve GPs' HF care were identified.
| S-EPMC5168518 | biostudies-other
Project description:BackgroundPresence of chronic obstructive pulmonary disease (COPD) in heart failure (HF) has prognostic and therapeutic implications. Exact prevalence estimates are lacking because most previous studies estimated the prevalence of COPD among HF patients while unstable and in the presence of pulmonary congestion.MethodsCommunity-dwelling patients with an established diagnosis of HF and in a stable phase of their disease were invited for spirometry. COPD was defined according to the Global initiative for chronic Obstructive Lung Disease (GOLD) classification and considered present if the ratio of the post-bronchodilator forced expiratory volume in 1 second and forced vital capacity was below 0.7.ResultsThirty of the 106 patients with HF (mean age 76 [standard deviation] 11.9 years, 57% male) had COPD (prevalence 28.3% [95% confidence interval (CI) 19.7%-36.9%]), with similar rates among those with HF and a reduced ejection fraction (18 individuals; prevalence 28.6% [95% CI 20.0%-37.2%]) and HF with preserved ejection fraction (12 individuals; prevalence 27.9% [95% CI 19.4-36.4]). Twenty-one (70%) of the 30 participants were newly detected cases of COPD.ConclusionMore than a quarter of the patients with HF concomitantly have COPD, with the large majority being previously unrecognized. Coexistence of COPD should be considered more often in these patients.
| S-EPMC4492658 | biostudies-literature
Project description:AimsHealth literacy (HL) is a health determinant in cardiovascular diseases as the active participation of patients is essential for optimizing self-management of these conditions. We aimed to estimate the prevalence of low HL level in patients hospitalized for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and explore low HL determinants.Methods and resultsA prospective cross-sectional study was performed in three cardiology units. HL level was assessed using Brief Health Literacy Screen (BHLS) and categorized as low or adequate. Dimensions of HL were assessed with the Health Literacy Questionnaire (HLQ). Associations with sociodemographic factors, disease history, and comorbidities were explored. A total of 208 patients were included, mean ± SD age was 68.5 ± 14.9 years, and 65.9% were men. Patients with ADHF were significantly older and more often women than AMI patients. Prevalence of low HL was 36% overall, 51% in ADHF patients, and 21% in AMI patients (P < 0.001). After adjustment for sociodemographic factors, patients with lower income (€<10 000 per year, adjusted odds ratio = 10.46 95% confidence interval [2.38; 54.51], P = 0.003) and native language other than French (adjusted odds ratio = 14.36 95% confidence interval [3.76; 66.9], P < 0.002) were more likely to have low HL. ADHF patients presented significantly lower HLQ scores than AMI patients in five out of the nine HLQ dimensions reflecting challenges in access to healthcare.ConclusionsPrevalence of low HL was higher among ADHF patients than among AMI patients. Low HL ADHF patients needed more support when accessing healthcare services, and these would require more adaptation to respond to low HL patients' needs.
| S-EPMC8006735 | biostudies-literature