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Low Health Literacy Linked to Mortality in CHF Patients

Cheryl Clark, for HealthLeaders Media, April 28, 2011

Asking congestive heart failure patients just three simple questions can determine their health literacy level and might just keep them alive longer, according to a study by Kaiser Permanente and other researchers in Colorado.

"Measuring health literacy is extremely helpful, because clinicians make inferences about patients' literacy levels that are not always correct," says Pamela Peterson, MD, the lead author of the report and an affiliate investigator with Kaiser Permanente Colorado Institute for Health Research in Denver.

For example, she says, "the patient could be a PhD graduate, but may not be able to function well anymore or understand how to take care of himself. Knowing what you're dealing with is important from the beginning."

That way, she says, doctors and nurses can focus precious time on those patients who need more help understanding and following instructions and medication regimens to make sure they don't wind up in the hospital in worse condition. "You may want to have more layers of support in between visits to the doctor," she says.

It's expensive, and requires more personnel time. "But I think it's worth it," she says.

In the study, 17.5% of 1,494 CHF patients who agreed to participate, or nearly one in five was found to have low health literacy. Their risk of dying from any cause during the 1.2-year average follow-up was 17.6%, much higher than the 6.3% mortality in those whose responses indicated high health literacy.

After adjusting for demographic variables, socioeconomic status, education and co-morbidities, low health literacy "remained independently associated with an increased risk of mortality," the authors wrote

The report did not say why patients with low health literacy were more likely to die in the follow-up period, but the authors speculate that these patients may have "a greater misunderstanding of medications" and therefore have less ability to perform successful self-management of their chronic disease.

The study is published in Wednesday's edition of the Journal of the American Medical Association.

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