Outpatients' perceptions of collaboration across clinics and health literacy among patients with diabetes and at least one comorbidity: A hospital-level cross-sectional study.

Patients with multiple chronic conditions often face fragmented care and inconsistent information, increasing their risk of serious health issues. Their perceived collaboration across clinics may be shaped by difficulties in accessing and using information for informed decision-making. This study explored the association between patient-perceived collaboration across clinics and health literacy among outpatients with diabetes and at least one comorbidity at the hospital level. This cross-sectional study at the outpatient clinic at Steno Diabetes Center Aarhus included all patients with diabetes and at least one comorbidity who were simultaneously receiving treatment at another outpatient clinic within the hospital. The association between patient-perceived extensive collaboration across clinics (exposure) and patient health literacy (outcome) was assessed using four selected scales and regression models. Results were presented as both unadjusted and adjusted, accounting for potential confounders. A total of 3,435 outpatients received a survey, with 1,655 responses. Of these, 686 reported receiving cross-clinic treatment. Among the 552 respondents who answered the exposure-related question, 44.7% perceived extensive collaboration across clinics, while 55.3% perceived limited collaboration. Statistically significant differences were found in three out of four health literacy scales, with those who perceived limited collaboration scoring lower in areas related to managing their health and engaging with healthcare providers. The findings suggest that outpatients with comorbidities and perceived poor clinic collaboration may have low health literacy, highlighting the need to address this in their treatment and communication with healthcare providers. Future research is needed to determine whether limited perception arises from personal challenges, elements of the treatment process, or relational and organizational issues across clinics, in order to improve the perception of collaboration and clinical outcomes.