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      Health literacy and use of outpatient physician services by medicare managed care enrollees

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          Abstract

          To determine whether inadequate functional health literacy adversely affects use of physician outpatient services. Cohort study. Community. New Medicare managed care enrollees age 65 or older in 4 U.S. cities (N = 3,260). We measured functional health literacy using the Short Test of Functional Health Literacy in Adults. Administrative data were used to determine the time to first physician visit and the total number of visits during the 12 months after enrollment. The time until first visit, the proportion without any visit, and adjusted mean visits during the year after enrollment were unrelated to health literacy in crude and multivariate analyses. Participants with inadequate and marginal health literacy were more likely to have an emergency department (ED) visit than those with adequate health literacy (30.4%, 27.6%, and 21.8%, respectively; P =.01 and P <.001, respectively). In multivariate analysis, the adjusted relative risk of having 2 or more ED visits was 1.44 (95% confidence interval, 1.01 to 2.02) for enrollees with marginal health literacy and 1.34 (1.00 to 1.79) for those with inadequate health literacy compared to participants with adequate health literacy. Inadequate health literacy was not independently associated with the mean number of visits or the time to a first visit. This suggests that inadequate literacy is not a major barrier to accessing outpatient health care. Nevertheless, the higher rates of ED use by persons with low literacy may be caused by real or perceived barriers to using their usual source of outpatient care.

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          Most cited references14

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          The test of functional health literacy in adults

          To develop a valid, reliable instrument to measure the functional health literacy of patients.
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            The relationship of patient reading ability to self-reported health and use of health services.

            This study examined the relationship of functional health literacy to self-reported health and use of health services. Patients presenting to two large, urban public hospitals in Atlanta, Ga, and Torrance, Calif, were administered a health literacy test about their overall health and use of health care services during the 3 months preceding their visit. Patients with inadequate functional health literacy were more likely than patients with adequate literacy to report their health as poor. Number of years of school completed was less strongly associated with self-reported health. Literacy was not related to regular source of care or physician visits, but patients in Atlanta with inadequate literacy were more likely than patients with adequate literacy to report a hospitalization in the previous year. Low literacy is strongly associated with self-reported poor health and is more closely associated with self-reported health than number of years of school completed.
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              Development of a brief test to measure functional health literacy

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                Author and article information

                Journal
                Journal of General Internal Medicine
                J Gen Intern Med
                Wiley
                0884-8734
                1525-1497
                March 2004
                March 2004
                : 19
                : 3
                : 215-220
                Article
                10.1111/j.1525-1497.2004.21130.x
                1492157
                15009775
                fb5d83ce-8a5d-421b-8fdf-4348142723ca
                © 2004
                History

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