Physicians recognize the importance of counselling patients about their medications. Biologic therapy has potential adverse reactions about which inflammatory bowel disease (IBD) patients must be aware. However, effective counselling is dependent upon understanding patients' level of health literacy. US Health Services and Resource Administration advocates health literacy assessments to aid patients' understanding of medical conditions and treatment options. It is uncertain if physicians consistently assess health literacy in IBD patients who have been prescribed biologic agents. This study evaluated the frequency of physicians' health literacy assessment in IBD patients who are counselled about their biologic medications.Methods:
A retrospective chart review of all IBD patients receiving biologic medications in a gastroenterology practice at an urban academic medical center in a 6 month period was performed. There were no exclusion criteria. Patient gender, disease type and medication regimen were obtained. Biologic agents included Anti-TNF (infliximab, adalimumab, certolizumab pegol) and anti-integrin medications (vedolizumab). Charts were assessed for physicians' performance of health literacy and counselling. Counselling was considered performed if there was documentation that the physician provided information regarding the disease process and management options. Health literacy was considered performed if there was documentation that indicated that the patient understood the medical information provided. A database was created maintaining patient confidentiality. Statistical analysis was conducted using the Fisher Exact Test, with significance set at P < 0.05. The study was approved by the university Institutional Review Board.Results:
One hundred-three patients (43 male, 60 female; 81 Crohns disease 22 ulcerative colitis) were prescribed a biologic agent. Fifty-four patients received infliximab, 41 adalimumab, 2 certolizumab pegol and 6 vedolizumab. Eighty-three (80.6%) patients (29 male, 54 female; 68 Crohns disease, 15 ulcerative colitis) received counselling. Female patients receiving more counselling (P = 0.005) about biologic therapy than males. There was no difference (P = 0.12) in the rate of counselling based upon disease type. Twenty (19.4%) patients (6 males, 14 females; 19 Crohns disease, 1 ulcerative colitis) received health literacy assessments. Crohns disease patients more frequently (P = 0.03) had health literacy assessments compared to patients with ulcerative colitis. There was no difference in the rate (P = 0.31) of health literacy assessment based upon gender. There was no difference in counselling (P = 1.0) or health literacy (P = 1.0) assessment based upon medication type.Conclusions:
Biologic therapy is an important medication option for IBD patients. It is critical that patients are counselled about their medications and understand the information that is offered. This study demonstrates that physicians frequently counsel, but may infrequently assess health literacy in IBD patients receiving biologic medications. There was no difference in health literacy assessment based upon the type of biologic therapy. Further studies are necessary to evaluate the potential impact of gender and disease type upon counselling and health literacy assessment. The limitations of this study include its small patient population, retrospective design and performance at a single institution. However, it suggests that physicians should make increased efforts to ensure that patients understand the medical information provided to them to optimize IBD management.