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Literacy and blood pressure--do healthcare systems influence this relationship? A cross-sectional study.

Powers BJ, Olsen MK, Oddone EZ, Thorpe CT, Bosworth HB - BMC Health Serv Res (2008)

Bottom Line: Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes.There was a significant interaction between literacy and healthcare system for SBP.The attributes of the healthcare delivery system may influence the relationship between literacy and health outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Durham NC, USA. power017@mc.duke.edu

ABSTRACT

Background: Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes. We sought to determine the association between literacy and blood pressure in primary care patients with hypertension and to determine if this relationship was consistent across distinct systems of healthcare delivery.

Methods: We conducted a cross-sectional study of 1224 patients with hypertension utilizing baseline data from two separate, but similar randomized controlled trials. Patients were enrolled from primary care clinics in the Veterans Affairs healthcare system (VAHS) and a university healthcare system (UHS) in Durham, North Carolina. We compared the association between literacy and the primary outcome systolic blood pressure (SBP) and secondary outcomes of diastolic blood pressure (DBP) and blood pressure (BP) control across the two different healthcare systems.

Results: Patients who read below a 9th grade level comprised 38.4% of patients in the VAHS and 27.5% of the patients in the UHS. There was a significant interaction between literacy and healthcare system for SBP. In adjusted analyses, SBP for patients with limited literacy was 1.2 mmHg lower than patients with adequate literacy in the VAHS (95% CI, -4.8 to 2.3), but 6.1 mmHg higher than patients with adequate literacy in the UHS (95% CI, 2.1 to 10.1); (p = 0.003 for test of interaction). This literacy by healthcare system interaction was not statistically significant for DBP or BP control.

Conclusion: The relationship between patient literacy and systolic blood pressure varied significantly across different models of healthcare delivery. The attributes of the healthcare delivery system may influence the relationship between literacy and health outcomes.

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Related in: MedlinePlus

Adjusted systolic blood pressure by healthcare system and literacy. Adjusted for variables in model listed on Table 2. Error bars represent 95% confidence intervals. P value from test of interaction between literacy and healthcare system = 0.003.
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Figure 1: Adjusted systolic blood pressure by healthcare system and literacy. Adjusted for variables in model listed on Table 2. Error bars represent 95% confidence intervals. P value from test of interaction between literacy and healthcare system = 0.003.

Mentions: The results from the SBP multiple linear regression model are presented in Table 2. In the adjusted model, the individual variables that were significantly associated with SBP were patient age, race, and medication adherence. In addition to these main effects, there was a significant interaction between healthcare system and literacy on the outcome of SBP (p = 0.003), suggesting that the relationship between literacy and SBP differed significantly between the two healthcare systems When compared to patients with adequate literacy, the predicted mean SBP for patients with limited literacy was 1.2 mmHg lower in the VAHS (95% CI, -4.8 to 2.3), but 6.1 mmHg higher in the UHS (95% CI, 2.1 to 10.1) (Figure 1). As shown in Table 3, we also observed differences in DBP and BP control according to literacy status in the UHS compared to the VAHS. However, in adjusted analysis the interaction term between literacy and healthcare system was not statistically significant for either of these outcomes (P > 0.05).


Literacy and blood pressure--do healthcare systems influence this relationship? A cross-sectional study.

Powers BJ, Olsen MK, Oddone EZ, Thorpe CT, Bosworth HB - BMC Health Serv Res (2008)

Adjusted systolic blood pressure by healthcare system and literacy. Adjusted for variables in model listed on Table 2. Error bars represent 95% confidence intervals. P value from test of interaction between literacy and healthcare system = 0.003.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2600788&req=5

Figure 1: Adjusted systolic blood pressure by healthcare system and literacy. Adjusted for variables in model listed on Table 2. Error bars represent 95% confidence intervals. P value from test of interaction between literacy and healthcare system = 0.003.
Mentions: The results from the SBP multiple linear regression model are presented in Table 2. In the adjusted model, the individual variables that were significantly associated with SBP were patient age, race, and medication adherence. In addition to these main effects, there was a significant interaction between healthcare system and literacy on the outcome of SBP (p = 0.003), suggesting that the relationship between literacy and SBP differed significantly between the two healthcare systems When compared to patients with adequate literacy, the predicted mean SBP for patients with limited literacy was 1.2 mmHg lower in the VAHS (95% CI, -4.8 to 2.3), but 6.1 mmHg higher in the UHS (95% CI, 2.1 to 10.1) (Figure 1). As shown in Table 3, we also observed differences in DBP and BP control according to literacy status in the UHS compared to the VAHS. However, in adjusted analysis the interaction term between literacy and healthcare system was not statistically significant for either of these outcomes (P > 0.05).

Bottom Line: Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes.There was a significant interaction between literacy and healthcare system for SBP.The attributes of the healthcare delivery system may influence the relationship between literacy and health outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Durham NC, USA. power017@mc.duke.edu

ABSTRACT

Background: Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes. We sought to determine the association between literacy and blood pressure in primary care patients with hypertension and to determine if this relationship was consistent across distinct systems of healthcare delivery.

Methods: We conducted a cross-sectional study of 1224 patients with hypertension utilizing baseline data from two separate, but similar randomized controlled trials. Patients were enrolled from primary care clinics in the Veterans Affairs healthcare system (VAHS) and a university healthcare system (UHS) in Durham, North Carolina. We compared the association between literacy and the primary outcome systolic blood pressure (SBP) and secondary outcomes of diastolic blood pressure (DBP) and blood pressure (BP) control across the two different healthcare systems.

Results: Patients who read below a 9th grade level comprised 38.4% of patients in the VAHS and 27.5% of the patients in the UHS. There was a significant interaction between literacy and healthcare system for SBP. In adjusted analyses, SBP for patients with limited literacy was 1.2 mmHg lower than patients with adequate literacy in the VAHS (95% CI, -4.8 to 2.3), but 6.1 mmHg higher than patients with adequate literacy in the UHS (95% CI, 2.1 to 10.1); (p = 0.003 for test of interaction). This literacy by healthcare system interaction was not statistically significant for DBP or BP control.

Conclusion: The relationship between patient literacy and systolic blood pressure varied significantly across different models of healthcare delivery. The attributes of the healthcare delivery system may influence the relationship between literacy and health outcomes.

Show MeSH
Related in: MedlinePlus