Many dialysis patients may not understand important health information

Public release date: 5-May-2011

Contact: Shari Leventhal
sleventhal@asn-online.org
202-640-1394
American Society of Nephrology
Many dialysis patients may not understand important health information

Improving health literacy could benefit patients

Many patients on dialysis may not understand medical information critical to their wellbeing, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results suggest that clinicians must understand and address the limited health literacy of patients with kidney disease.

Patients with limited health literacy—the ability to obtain, process, and understand health information in order to make appropriate health decisions—may not fully understand written medical information, may not be able to communicate effectively with healthcare providers, or navigate the increasingly complex healthcare system. Studies suggest that limited health literacy may negatively affect patients' wellbeing and increase healthcare costs.

Health literacy is particularly important for kidney patients undergoing dialysis. They must attend treatment sessions several days a week, follow dietary and fluid restrictions, and adhere to complex medication regimens, all of which require patients to understand and act on complicated health-related information. Jamie Green, MD (University of Pittsburgh) and her colleagues tested 260 patients on long-term dialysis with a tool that assesses one's ability to read common medical words and lay terms for body parts and illnesses.

The investigators found that 16% of the patients on dialysis (41 of the 260 patients) had limited health literacy. There are currently more than 350,000 patients in the United States on dialysis, so this represents a significant number of individuals who could benefit from being better able to understand and manage their kidney health. While limited health literacy was present in all subgroups of patients, those with lower educational levels, African Americans, and veterans were less likely to effectively obtain and process relevant health information.

Patients with less than a high school education exhibited more than a 12-fold increased risk of low health literacy, and African Americans and veterans had more than a 3-fold increased risk of having limited health literacy. The researchers are currently following these individuals to determine if limited health literacy affects how patients adhere to dialysis treatment, whether they undergo kidney transplantation, and whether they die prematurely.

"We anticipate our findings will increase awareness of the importance of health literacy in patients with kidney disease, stimulate providers to consider literacy when communicating with patients, and lead to future studies to address limitations in health literacy," said Green.

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Study co-authors include Maria Mor, PhD, Mary Ann Sevick, Paul Palevsky, MD, Michael Fine, MD, Steven Weisbord, MD (VA Pittsburgh Healthcare System and University of Pittsburgh); Anne Marie Shields (VA Pittsburgh Healthcare System); and Robert Arnold, MD (University of Pittsburgh).

Disclosures: The authors reported no financial disclosures. The study was funded by a grant from the Department of Veterans Affairs Health Research and Development Service. Dr. Green is supported by a grant from the American Kidney Fund Clinical Scientist in Nephrology Program.

The article, entitled "Prevalence and Demographic and Clinical Associations of Health Literacy in Patients on Maintenance Hemodialysis" will appear online at http://cjasn.asnjournals.org/ on May 5, 2011, doi 10.2215/CJN.09761110. (SEE BELOW)

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http://www.eurekalert.org/pub_releases/2011-05/ason-mdp042811.php

Prevalence and Demographic and Clinical Associations of Health Literacy in Patients on Maintenance Hemodialysis
Jamie A. Green*, Maria K. Mor†‡, Anne Marie Shields†, Mary Ann Sevick†§, Paul M. Palevsky*¶, Michael J. Fine†§, Robert M. Arnold§‖, Steven D. Weisbord*†¶
+ Author Affiliations

*Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania;
†Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania;
¶Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania;
§Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
‖Section of Palliative Care, University of Pittsburgh, Pittsburgh, Pennsylvania; and
‡Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Correspondence:
Dr. Jamie Green, Renal-Electrolyte Division, University of Pittsburgh, A915 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261. Phone: 412-647-7157; Fax: 412-647-6222; E-mail: greenja@upmc.edu

Abstract

Summary

Background and objectives Although limited health literacy is estimated to affect over 90 million Americans and is recognized as an important public health concern, there have been few studies examining this issue in patients with chronic kidney disease. We sought to characterize the prevalence of and associations of demographic and clinical characteristics with limited health literacy in patients receiving maintenance hemodialysis.

Design, setting, participants, & measurements As part of a prospective clinical trial of symptom management strategies in 288 patients treated with chronic hemodialysis, we assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM). We defined limited health literacy as a REALM score ≤60 and evaluated independent associations of demographic and baseline clinical characteristics with limited health literacy using multivariable logistic regression.

Results Of the 260 patients who completed the REALM, 41 demonstrated limited health literacy. African-American race, lower educational level, and veteran status were independently associated with limited health literacy. There was no association of limited health literacy with age, gender, serologic values, dialysis adequacy, overall symptom burden, quality of life, or depression.

Conclusions Limited health literacy is common among patients receiving chronic hemodialysis. African-American race and socioeconomic factors are strong independent predictors of limited health literacy. These findings can help inform the design and implementation of interventions to improve health literacy in the hemodialysis population.

http://cjasn.asnjournals.org/content/early/2011/05/05/CJN.09761110.abstract?sid=043c57bc-0d61-4b90-80a8-f0d2c6442e65