Healthy literacy is the degree to which an individual is able to process and understand basic health information necessary to participate in health care decisions. Patients with low literacy levels may have difficulty understanding their illness, completing health forms, understanding directions and managing their disease. Gastroenterologists universally assess patient understanding of endoscopic procedures. However, it is uncertain if there is consistency in health literacy assessment in patients in relation to non-procedure recommendations. This study evaluated the frequency at which gastroenterologists assess health literacy in IBD patients during procedure and non-procedure encounters.Methods:
A retrospective chart review of all IBD patients seen in a gastroenterology practice at an urban academic medical center during a 6 month period was performed. There were no exclusion criteria. Patient gender, ethnicity, disease type and recommendations during the clinic appointment were obtained. Charts were evaluated for the performance of a health literacy assessment. Health literacy was considered performed if there was documentation 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:
Two hundred seventy-one medical encounters of IBD patients were reviewed. There were 120 men and 151 women, with a mean age of 42.7 years. One hundred-sixty patients had Crohn's disease (85 women, 75 men), 110 patients had ulcerative colitis (66 women, 44 men) and 1 male patient had indeterminate colitis. There were 146 Caucasians, 81 African-Americans, 10 Asians, 6 Hispanics, and 28 of other or undocumented ethnicity. There were 182 encounters with non-procedure recommendations and 89 encounters with procedure recommendations. Nine (4.9%) of the non-procedure encounters and 65 (73%) of the procedure encounters had health literacy assessments documented. There was a significant difference in the rate (P = 0.0001) of health literacy assessments performed during encounters in which procedure and non-procedure recommendations were offered. Gender, ethnicity and disease type did not influence the rate (P = 0.1) of health literacy assessments.Conclusions:
Assessment of health literacy is essential to ensure that patients understand their medical condition and treatment. Endoscopic procedures have an important role in the diagnosis and management of inflammatory bowel disease. This study revealed that the majority of patients undergoing a procedure had an assessment of literacy. However, physicians infrequently document health literacy assessments on patients who have had a non-procedure encounter. While this study is limited based upon size of population and reliance upon documentation, it suggests that increased efforts are necessary to identify patients' health literacy levels during both procedure and non-procedure encounters to confirm patients' understanding of management plans and allow for communication adjustments that may be necessary to ensure optimal IBD care.