Treatment selection and medication adherence for stable angina: The role of area-based health literacy.
health literacy
medical decision making
medication adherence
social determinants of health
Journal
Journal of evaluation in clinical practice
ISSN: 1365-2753
Titre abrégé: J Eval Clin Pract
Pays: England
ID NLM: 9609066
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
26
09
2019
revised:
28
11
2019
accepted:
29
11
2019
pubmed:
30
1
2020
medline:
30
6
2021
entrez:
30
1
2020
Statut:
ppublish
Résumé
Clinical studies show equivalent health outcomes from interventional procedures and treatment with medication only for stable angina patients. However, patients may be subject to overuse or access barriers for interventional procedures and may exhibit suboptimal adherence to medications. Our objective is to evaluate whether community-level health literacy is associated with treatment selection and medication adherence patterns. The sample included Medicare fee-for-service beneficiaries (20% random sample) with stable angina in 2007-2013. We used an area-level health literacy variable because of the lack of an individual measure in claims. We measured the association between (a) area-based health literacy with treatment selection (medication only, percutaneous coronary intervention [PCI], or coronary artery bypass grafting (CABG) surgery) and (b) area-based health literacy with medication adherence. We controlled for other factors including demographics, co-morbidity burden, dual eligibility, and area deprivation index. We identified 8300 patients of whom 8.7% lived in a low health literacy area. Overall, 56% of patients received medication only, 28% received PCI, and 15% received CABG. Patients in low health literacy areas were less likely to receive CABG (-3.5 percentage points; 95% CI, -6.8 to -0.3) than were patients in high health literacy areas, but the significance was sensitive to specification. Overall, 81.5% and 71.5% of patients were adherent to antianginals and statins, respectively. Living in low health literacy areas was associated with lower adherence to antianginals (-3.3 percentage points; 95% CI, -6.1 to -0.6) but not statins. Low area-based health literacy was associated with being less likely to receive CABG and lower adherence, but the differences between low and high health literacy areas were small and sensitive to model specification. Individual factors such as dual eligibility status and race/ethnicity had stronger associations with outcomes than had area-based health literacy, suggesting that this area-based measure was inadequate to account for social determinants in this study.
Identifiants
pubmed: 31994280
doi: 10.1111/jep.13341
pmc: PMC7552995
mid: NIHMS1633968
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1711-1721Subventions
Organisme : The Cecil G. Sheps Center for Health Services Research
Organisme : NCATS NIH HHS
ID : UL1 TR002489
Pays : United States
Organisme : Agency for Healthcare Research and Quality
ID : T32-HS000032
Organisme : University of North Carolina at Chapel Hill
Organisme : NIA NIH HHS
ID : R01 AG046267
Pays : United States
Organisme : CER Strategic Initiative of UNC's Clinical Translational Science Award
ID : UL1TR001111
Organisme : NIA NIH HHS
ID : R01AG046267
Pays : United States
Organisme : AHRQ HHS
ID : T32 HS000032
Pays : United States
Organisme : UNC School of Medicine
Organisme : Cecil G. Sheps Center for Health Services Research
Organisme : Pharmacoepidemiology Gillings Innovation Lab (PEGIL)
ID : GIL200811.0010
Organisme : NCATS NIH HHS
ID : UL1 TR001111
Pays : United States
Organisme : UNC Gillings School of Global Public Health
Informations de copyright
© 2020 John Wiley & Sons, Ltd.
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