Candace D McNaughton1, Terry A Jacobson2, Sunil Kripalani3. 1. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA. Electronic address: candace.mcnaughton@vanderbilt.edu. 2. Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, USA. 3. Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, USA.
Abstract
OBJECTIVES: To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence. METHODS: Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression. RESULTS: Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06-2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant. CONCLUSION: Low literacy is independently associated with uncontrolled BP. PRACTICE IMPLICATIONS: Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.
OBJECTIVES: To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence. METHODS: Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression. RESULTS: Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06-2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant. CONCLUSION: Low literacy is independently associated with uncontrolled BP. PRACTICE IMPLICATIONS: Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.
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