Health literacy and use of outpatient physician services by Medicare managed care enrollees
Health literacy and use of outpatient physician services by Medicare managed care enrollees
复制标题
DOI：
10.1111/j.1525-1497.2004.21130.x
复制
发表时间：
2004-03-01
影响因子：
5.7
通讯作者：
Peel, J
中科院分区：
文献类型：
--
作者：
Baker, DW;Gazmararian, JA;Peel, J
目的：为了确定是否不充分的功能性健康素养的不利影响使用的医生门诊service.Design：队列研究。设置：Community.Participants：新的医疗保险管理的医疗登记年龄65岁或以上的美国4个城市（N = 3,260）。MEASUAREMENTS和主要结果：我们测量功能性健康素养使用功能性健康素养的短期测试在成人。管理数据用于确定至首次医生访视的时间和入组后12个月内的总访视次数。在粗分析和多变量分析中，首次访视前的时间、未访视的比例和入组后一年内的校正平均访视与健康素养无关。健康素养不足和边缘的参与者比健康素养充足的参与者更有可能去急诊科（艾德）就诊（分别为30.4%、27.6%和21.8%; P = 0.01和P <0.001）。在多变量分析中，有2次或2次以上艾德就诊的校正相对风险为1.44（95%置信区间，1.01至2.02）对于具有边缘健康素养的注册者和1.34（1.00至1.79）对于那些没有足够的健康素养的参与者相比，有足够的健康素养。不充分的健康知识与平均就诊次数或首次就诊时间无关。这表明，识字率不足并不是获得门诊保健的主要障碍。然而，低识字率的人使用艾德的比例较高，可能是由于真实的或感觉到的障碍，使用他们通常的门诊服务。
OBJECTIVE: To determine whether inadequate functional health literacy adversely affects use of physician outpatient services.DESIGN: Cohort study.SETTING: Community.PARTICIPANTS: New Medicare managed care enrollees age 65 or older in 4 U.S. cities (N = 3,260).MEASUAREMENTS AND MAIN RESULTS: 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.CONCLUSIONS: 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.