P-171 Gastroenterologists Infrequently Evaluate Health Literacy in Women and African-Americans with Inflammatory Bowel Disease

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Abstract

Background:

Healthy literacy is the degree that an individual is able to process and understand basic health information necessary to make appropriate medical decisions. It is estimated that ∼35% of US adults have basic or below basic health literacy. Low health literacy is more prevalent among older adults, minority populations, those with low socioeconomic status and medically underserved. The US Health Services and Resource Administration (HRSA) supports providers performing health literacy assessments to assist in patients' understanding of their medical condition and navigating complex health care systems. This study evaluated gastroenterologists understanding of health literacy and the frequency at which health literacy was documented in medical records of patients with inflammatory bowel disease (IBD).

Methods:

An anonymous survey was electronically distributed to all gastroenterologists in an urban university medical center practice to assess their knowledge of health literacy and method of health literacy assessment. A retrospective chart review of all IBD patients seen by the gastroenterologists in clinic during a 6 month period were evaluated. There were no patient or physician exclusion factors. Patient age, gender, ethnicity and IBD type were obtained. A database was created maintaining physician and 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:

Twelve gastroenterologists (9 male, 3 female) completed the survey. Ten (83%) were able to accurately define health literacy, and all 12 (100%) described acceptable ways to informally assess patients' understanding of the medical information provided during an encounter. Two hundred seventy-one medical records 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. Forty male (33%) and 35 female (23%) patients had health literacy assessed, revealing a significant difference (P = 0.04) in the rate of health literacy assessments based upon gender. Forty-one (25.6%) Crohns disease and 14 (30.9%) ulcerative colitis patients had health literacy assessed, with no difference in the rate of assessment (P = 0.4) based upon IBD type. Forty-six Caucasians (32%), 16 African-Americans (20%), 2 Asians (20%), and 2 Hispanics (33%) had health literacy evaluated. Assessment of health literacy occurred more frequently (P = 0.0387) in Caucasian patients compared to African-Americans. The few number of Hispanics and Asians limited statistical evaluation.

Conclusions:

This study revealed that gastroenterologists understand the importance of health literacy, although infrequently document health literacy assessments in the medical record. Additionally, physicians more often assessed health literacy in men and in Caucasians. It is critical that physicians are aware of the level of health literacy in all of their patients. Interventions to increase physicians' health literacy assessments with a focus on eliminating gender and ethnic disparities can be considered. Further studies should be performed to evaluate health literacy assessments in IBD patients to ensure optimal care and outcome.

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