Levine Robyn, Javalkar Karina, Nazareth Meaghan, Faldowski Richard A, de Ferris Maria Diaz-Gonzalez, Cohen Sarah, Cuttance Jessica, Hooper Stephen R, Rak Eniko
University of North Carolina School of Medicine, Department of Pediatrics, USA; Alpert Medical School of Brown University, Department of Emergency Medicine, USA.
University of North Carolina School of Medicine, Department of Pediatrics, USA.
J Pediatr Nurs. 2018 Jan-Feb;38:57-61. doi: 10.1016/j.pedn.2017.10.008. Epub 2017 Oct 31.
Low health literacy adversely affects health outcomes in adults with chronic kidney disease. The current study examined associations between limited/inadequate health literacy and health services utilization among adolescents and young adults (AYA) with chronic or end-stage kidney disease (CKD or ESKD).
This was a retrospective cohort study that enrolled patients from both the pediatric- and adult-focused nephrology clinics of a major university hospital. Demographic information, patients' health literacy and numeracy skills (Newest Vital Sign), and health services utilization (emergency department visits, preventable hospitalizations, total hospitalizations, and length of stay in the hospital) were evaluated. A negative binomial regression model for counts tested the association between AYA patients' literacy/numeracy skills and health services utilization.
The study enrolled 142 participants, 66 (46.5%) patients from adult nephrology and 76 (53.5%) from pediatric nephrology clinics, with a mean age of 20.8±5.60years (range 12-31). Half of the sample (n=72, 51%) had limited health literacy skills. Health literacy/numeracy level was not significantly associated with total hospitalizations, preventable hospitalizations, emergency department (ED) visits, or length of hospital stay. However, public insurance/self-pay, minority race, and kidney transplant/dialysis diagnoses were associated with more preventable hospitalizations.
Among AYA with CKD/ESKD, there were no differences between the low and adequate health literacy groups on health care utilization outcomes when modeling clinical outcomes (total hospitalizations, preventable hospitalizations, ED visits, and length of hospital stay) after adjusting for demographics and disease type. This suggests that other factors warrant consideration in healthcare utilization rates.
健康素养低下对慢性肾脏病成人患者的健康结局有不利影响。本研究调查了患有慢性或终末期肾病（CKD或ESKD）的青少年和青年（AYA）健康素养有限/不足与医疗服务利用之间的关联。
这是一项回顾性队列研究，纳入了一家大型大学医院以儿科和成人为主的肾脏病诊所的患者。评估了人口统计学信息、患者的健康素养和算术技能（最新生命体征）以及医疗服务利用情况（急诊就诊、可预防的住院、总住院次数和住院时间）。针对计数的负二项回归模型测试了AYA患者的识字/算术技能与医疗服务利用之间的关联。
该研究纳入了142名参与者，其中66名（46.5%）来自成人肾脏病科，76名（53.5%）来自儿科肾脏病诊所，平均年龄为20.8±5.60岁（范围12 - 31岁）。一半的样本（n = 72，51%）健康素养技能有限。健康素养/算术水平与总住院次数、可预防的住院次数、急诊就诊或住院时间没有显著关联。然而，公共保险/自费、少数族裔以及肾移植/透析诊断与更多可预防的住院相关。
在患有CKD/ESKD的AYA中，在调整人口统计学和疾病类型后对临床结局（总住院次数、可预防的住院次数、急诊就诊和住院时间）进行建模时，健康素养低和健康素养充足的组在医疗保健利用结局方面没有差异。这表明在医疗利用率方面其他因素值得考虑。
