Health Literacy Predicts the Discrepancy Between Patient and Provider Global Assessments of Rheumatoid Arthritis Activity at a Public Urban Rheumatology Clinic
Health Literacy Predicts the Discrepancy Between Patient and Provider Global Assessments of Rheumatoid Arthritis Activity at a Public Urban Rheumatology Clinic
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DOI：
10.3899/jrheum.090964
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发表时间：
2010-05-01
影响因子：
3.9
通讯作者：
Caplan, Liron
中科院分区：
文献类型：
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作者：
Hirsh, Joel M.;Boyle, Dennis J.;Caplan, Liron
Objective.许多研究报告，类风湿性关节炎（RA）的患者和提供者[医生]之间存在显著的不一致。我们研究了健康素养是否可以解释这种不一致。我们招募了讲英语的成年RA患者进行这项横断面研究。受试者使用多维健康评估问卷（MDHAQ）和28关节计数疾病活动性评分28（DAS 28）的标准术语完成了2个版本的患者疾病活动性总体评估（PTGA）。还获得了供应商全球评估（MDGA）。PTGA和MDGA之间的差异计算为这些评估之间的绝对差异。我们使用经过验证的工具：成人功能性健康素养的简短测试（S-TOFHLA）和成人医学素养的快速评估（REALM）]和线性回归来确定健康素养是否预测疾病测量差异。该研究包括110名受试者。有限的健康素养是REALM和S-TOFHLA的共同发现。PTGA和MDGA显示出良好的相关性（r = 0.66-0.68），尽管通过t检验，两种版本的PTGA均显著高于MDGA（p < 0.001）。S-TOFHLA和REALM均与MDGA和PTGA的绝对差异相关，多因素分析结果仍有统计学意义。健康素养与城市诊所讲英语的RA患者PTGA和MDGA之间的差异程度独立相关。这一发现应该会影响我们对疾病测量的解释。（2010年3月15日首次发布; J Rheumol 2010;37：961-6; doi：10.3899/jrheum.090964）
Objective. Numerous studies report that significant discordance exists between patient and provider [physician] measures of rheumatoid arthritis (RA). We examined whether health literacy explains this discordance.Methods. We recruited English-speaking adult patients with RA for this cross-sectional study. Subjects completed 2 versions of patient global assessments of disease activity (PTGA), using standard terminology from the Multi-Dimensional Health Assessment Questionnaire (MDHAQ) and the 28-joint count Disease Activity Score 28 (DAS28). The provider global assessment (MDGA) was also obtained. The discrepancy between PTGA and MDGA was calculated as the absolute difference between these assessments. We used validated instruments l:Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Rapid Estimate of Adult Literacy in Medicine (REALM)] and linear regression to determine whether health literacy predicts disease measure discrepancy.Results. The study included 110 subjects. Limited health literacy was a common finding by both the REALM and S-TOFHLA. PTGA and MDGA showed fair to good correlation (r = 0.66-0.68), although both versions of the PTGA were significantly higher than MDGA by the t-test (p < 0.001). The S-TOFHLA and REALM both were associated with the absolute difference between the MDGA and PTGA by linear regression, and results remained statistically significant in multivariate analysis.Conclusion. Health literacy was independently associated with the extent of discrepancy between PTGA and MDGA in English-speaking patients with RA at an urban clinic. This finding should influence our interpretation of disease measures. (First Release March 15 2010; J Rheumatol 2010;37:961-6; doi:10.3899/jrheum.090964)