If healthcare providers are serious about reducing readmissions and improving outcomes, they must address health literacy, the lack of which leads to more emergency care and hospitalizations, less use of preventive services, and poorer medication compliance.
That's not exactly news; researchers have described similar results in 2004. But it has been reinforced by an updated and exhaustive analysis of 96 studies, described in the Annals of Internal Medicine by researchers for the federal Agency for Healthcare Research and Quality.
Nancy Berkman and colleagues of the Program on Healthcare Quality and Outcomes based at the University of North Carolina in Chapel Hill found that patients with low health literacy were less likely to identify all their medications, couldn't manage medications in a mock exercise, and if elderly, were less able to open and take their medications.
Patients with poorer literacy had more trouble interpreting labels and health messages even on nutrition labeling, were more likely depressed, and had higher all-cause rates of mortality.
They were less likely to get mammography screening and influenza immunizations. Additionally, there is increasing evidence that lower health literacy "can explain, or partially explain, racial disparities in health outcomes," Berkman wrote.
"Our updated review should enhance the public's awareness that low health literacy can play a substantial role in the interrelationship among patient characteristics, use of healthcare services and resulting health outcomes," the researchers concluded. "Finding ways to reduce the effects of low health literacy on health outcomes warrants the attention of policymakers, clinician sand other stakeholders."
While they discovered higher levels of evidence on the above links, they found less or insufficient evidence or inconsistent results – sometimes because there were fewer studies or unadjusted analyses – on several other health behaviors. They found no relationship between literacy and Medicaid costs.
For example, there was less or insufficient evidence on whether people with low health literacy have poorer access to care, are less self-efficient, have more dental disease, and are less able to control their diabetes and its complications.
In an editorial published in the same issue, Cynthia Baur of the Centers for Disease Control and Prevention and Nancy Ostrove of the U.S. Food and Drug Administration wrote that Berkman's report "reinforces conventional wisdom that improving health literacy will help to improve outcomes."
They pointed out that without more research it remains unclear whether investments in improving health literacy will lead to healthcare savings. However, they said Berkman's work should prompt more research in this area.