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Abstract Number: 2430

The Impact of Inadequate Health Literacy  on Disease Activity in Patients with Rheumatoid Arthritis

Maria Celeste Orozco1, Maria Florencia Marengo2, Christian A. Waimann2, Ana Inés Marcos3, Amelia Granel3, Sofia Velez4, Federico Zazzetti5, Juan C. Barreira6, Paula Kohan7, Oscar L. Rillo8, María Victoria Collado9, Graciela Gómez10, Ricardo V. Juárez11, Veronica Lencina12, Andrea D'Orazio13, Gustavo Rodriguez Gil13, Mariana Salcedo14 and Gustavo Citera15, 1Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, 2Rheumatology section, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, 3Rheumatology, Hospital San Roque de Gonnet, La Plata, La Plata, Argentina, 4Rheumatology, Hospital Britanico, Buenos Aires, Argentina, 5Hospital Britanico, Buenos Aires, Argentina, 6Rheumatology, British Hospital, Buenos Aires, Argentina, 7rheumatology, Hospital Gral. de agudos Dr. E. Tornú, Buenos Aires, Argentina, 8Rheumatology Unit, Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina, 9Instituto de Investigaciones Medicas Alfredo Lanari, Buenos Aires, Argentina, 10Diaz Colodrero 2537 8° A, Insituto de Investigaciones Medicas de la UBA, Capital Federal, Argentina, 11Rheumatology Section, Hospital Señor del Milagro, Salta, Argentina, 12Rheumatology section, Hospital Señor del Milagro, Salta, Argentina, 13rheumatology, Hospital Municipal de agudos Dr. Leonidas Lucero, Bahía Blanca, Argentina, 14Consultorio Privado, San Nicolás, Argentina, 15Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Disease Activity, health literacy and rheumatoid arthritis (RA)

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Session Information

Session Title: Rheumatoid Arthritis - Clinical Aspects (ARHP): Clinical Practice/Patient Care

Session Type: Abstract Submissions (ARHP)

Background/Purpose: Health literacy is the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. It is being increasingly recognized as important determinant to health outcomes. Patients with low health literacy are less able to manage chronic conditions effectively. The aim of our study was to measure the level of health literacy in patients with Rheumatoid Arthritis (RA) and assess its association with clinical outcomes.

Methods: A multicenter cross-sectional study was conducted.  Patient were recruited from 7 outpatients clinics including consecutive patients with diagnosis of RA according to American College of Rheumatology (ACR) 1987 criteria and/or ACR/European League Against Rheumatism (EULAR) 2010 criteria. Health literacy was assessed using the Test of Functional Health Literacy in Adults (S-TOFHLA) (0-36, 0 worst health literacy). Patients were categorized as having low or adequate health literacy using the standard cutoff (<23). Patient reported clinical outcomes included the  Clinical Disease Activity Index (CDAI) and the Health Assessment Questionnaire (HAQ) . We also collected data regarding patient demographics, comorbidities and treatment adherence -. Adherence to treatment was assessed using the Compliance Questionnaire Rheumatology (CQR; 0 - 100, 0 low adherence).  The association between health literacy and clinical/functional outcomes were evaluated using univariate and multivariate models adjusting by age, gender, educational level, disease duration and treatment adherence.

Results: Three hundred and thirty-eight patients were included, 84 % were female, mean age was 53 ± 12 years, disease duration 13 ± 10 years, CDAI 13 ± 11 and HAQ 1.00 ± 0.75. Mean S-TOFHLA score was 26 ±12. Three hundred and two patients (76%) had adequate health literacy. These patients had significantly lower age (r=-0.22, p<0.01), higher level of education(r=0.40, p<0.01), less number of comorbidities(r=-0.13, p<0.01) and shorter disease duration(r=-0.14, p<0.01).  After adjusting for multiple confounders, patients with low level of health literacy showed significantly higher disease activity (b = 3.7, p=0.01). Health literacy was not associated with HAQ (b=0.14, p=0.14). Using S-TOFHLA as continuous variables did not affect the results.

Conclusion: A quarter of patients with rheumatoid arthritis had inadequate health literacy, showing higher level of disease activity. Physicians should recognize that literacy levels of their patients could affect clinical outcomes, and provide appropriate interventions to ease this burden.


Disclosure:

M. C. Orozco,
None;

M. F. Marengo,
None;

C. A. Waimann,
None;

A. I. Marcos,
None;

A. Granel,
None;

S. Velez,
None;

F. Zazzetti,
None;

J. C. Barreira,
None;

P. Kohan,
None;

O. L. Rillo,
None;

M. V. Collado,
None;

G. Gómez,
None;

R. V. Juárez,
None;

V. Lencina,
None;

A. D’Orazio,
None;

G. Rodriguez Gil,
None;

M. Salcedo,
None;

G. Citera,
None.

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