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The Effect of Health Literacy on Asthma Control

The Effect of Health Literacy on Asthma Control

Studies have shown that only about half of American adults have basic reading and numerical skills, and a lack of these skills can compromise health literacy. Low health literacy has been associated with poorer health outcomes, higher health costs, and reduced patient satisfaction with healthcare providers. “Low health literacy is especially prevalent among patients with low socioeconomic status, the elderly, and those whose primary language is not English,” explains Andrea J. Apter, MD, MSc. “This reflects the limited educational opportunities that are available for these patient groups. In these same patients, the prevalence of asthma morbidity is high.” Low numeric literacy or numeracy has also been linked to lower asthma-related quality of life (QOL) and prior ED visits and hospitalizations for asthma. Numeric & Print Literacy The mechanisms governing the relationship between low health literacy and poor outcomes in asthma have not been well defined in clinical research. To address this gap, Dr. Apter and colleagues conducted a study to assess whether literacy is related to subsequent asthma self-management and asthma outcomes. Published in the Journal of Allergy and Clinical Immunology, the study assessed numeric and print literacy in adults with moderate or severe asthma and its impact on subsequent electronically monitored adherence and asthma outcomes for 26 weeks.   According to findings, participants with higher health literacy had better asthma-related QOL and improved disease control than those with lower health literacy. For every point higher that patients scored on a measure of health-related print literacy, better QOL and asthma control was observed, as indicated by a 0.63-unit increase in the Mini-Asthma Quality of Life Questionnaire and a 0.52-point...
Enhancing Diabetes Knowledge in Patients

Enhancing Diabetes Knowledge in Patients

The National Diabetes Education Program (NDEP) was established, in part, to improve treatment and outcomes for people with diabetes by increasing knowledge of A1C, blood pressure (BP), and LDL cholesterol; together, these components make up the “ABCs” of diabetes. Few studies, however, have explored patient knowledge of their ABC levels and the association between having this knowledge and adhering to treatment recommendations for each of the ABC components. ABC Diabetes Knowledge From Patients Still Lacking In Diabetes Care, my colleagues and I had a study published in which we sought to assess patient knowledge of ABC levels and the association between this knowledge and meeting the ABC target goals. We also evaluated the association between specific demographic and diabetes-related factors and ABC knowledge. The purpose was to see if these data could help physicians and researchers identify high-risk patients who had particularly low knowledge.   According to our findings, knowledge of the ABCs was suboptimal. Among patients with diabetes, our data showed that: 48% could report their last A1C level. 63% could report their BP level. 22% could report their last LDL level. Knowledge was lower among Mexican Americans when compared with non-Hispanic whites and in people with less income and education. Having routine foot exams performed by physicians in the past year was associated with higher A1C knowledge. Nearly 20% of study participants reported that their healthcare provider did not specify an A1C goal. About three of every five participants reported that they were not informed of their BP or LDL cholesterol goals (47% and 41%, respectively). Significant Implications on Controlling Diabetes Physician communication of the ABC goals...
Reducing Readmissions in Community-Acquired Pneumonia

Reducing Readmissions in Community-Acquired Pneumonia

In the United States, community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality due to infection and most often strikes the elderly and individuals with comorbidities. The 30-day mortality rate for Medicare patients admitted to the hospital for CAP is about 12% and has not changed significantly in decades (Table 1). CAP has been shown to increase long-term mortality to as high as 40% within 1 year of admission. The infection is one of seven conditions that account for nearly 30% of potentially preventable readmissions in the 15-day window after initial hospital discharge. Estimates show that the cost of treating CAP exceeds $17 billion per year. Hospitalizing Patients With Community-Acquired Pneumonia “The decision on whether or not hospitalization is necessary for CAP is critical because there are multiple consequences,” says Thomas M. File, Jr., MD, MSc. “Hospitalizations can influence the cost of care, the intensity of diagnostic testing, and the selection of antimicrobial agents.” There are several advantages to outpatient treatment of CAP—when used appropriately—including cost, patient preference, faster convalescence, and fewer nosocomial complications. Hospitalization decisions should be based on several factors, including (among others): age over 50; significant underlying coexisting conditions; elevated blood urea nitrogen levels; and the presence of altered mental status or significant abnormalities in vital signs. “Readmission for CAP patients recently discharged after hospitalization represents an important, expensive, and often preventable adverse outcome,” Dr. File says. “The risk of readmission can be modified by the quality and type of care that is provided. Improving CAP readmission rates is the joint responsibility of hospitals and clinicians.” He adds that measuring readmission rates can help...
Patient Safety & Pain Management

Patient Safety & Pain Management

According to current estimates, more than 76 million people in the United States suffer from chronic or acute pain. Opioid analgesics are a widely accepted treatment for severe acute pain, but use of these medications to treat some types of chronic pain remains controversial. “The challenge with chronic pain is that it can occur in the context of numerous diseases and syndromes,” explains Daniel J. Castillo, MD. “The problems associated with opioid use—including underprescribing, overprescribing, tolerance, dependence, and drug abuse—highlight the importance of safe opioid use in hospitals and other healthcare settings.” Research has shown that pain is a leading cause of disability and can have deleterious effects on ability to work, functional status, and other quality-of-life domains. Unalleviated pain can impair the immune response, impede wound healing, affect gastrointestinal and pulmonary functions, suppress appetite, and delay ambulation after surgery. The number of opioid prescriptions for pain management has increased substantially over the last 20 years, in part due to a growing consensus that opioids are appropriate for some patients with pain. At the same time, there has been an increase in prescription opioid misuse and associated mortality, affecting adolescents and adults of all ages.   A Sentinel Event Alert issued by the Joint Commission in 2012 provides a number of actions that can be taken by hospitals to avoid the unintended consequences of opioid use among hospital inpatients (Table 1). It also provides clinicians with strategies for avoiding accidental opioid overuse (Table 2). “Opioids can be helpful for some patients, but it’s important that clinicians recognize and understand that there are risks to consider,” Dr. Castillo says. Joint...
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