Jacqueline R Halladay1, Katrina E Donahue2, Crystal W Cené3, Quefeng Li4, Doyle M Cummings5, Alan L Hinderliter6, Cassandra L Miller7, Beverly A Garcia7, Edwin Little8, Margorie Rachide8, Jim Tillman9, Alice S Ammerman7, Darren DeWalt3. 1. Department of Family Medicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA. Electronic address: Jacqueline_halladay@med.unc.edu. 2. Department of Family Medicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA. 3. Department of M edicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA. 4. Department of Biostatistics, UNC Chapel Hill, Chapel Hill, USA. 5. Department of Family medicine, East Carolina University, NC, USA. 6. Department of M edicine, UNC Chapel Hill, USA. 7. Center for Health Promotion and Disease Prevention, UNC Chapel Hill, USA. 8. Community Provider, Pink Hill, USA. 9. Community Care Plan of Eastern North Carolina, USA.
Abstract
OBJECTIVE: Lower health literacy is associated with poorer health outcomes. Few interventions poised to mitigate the impact of health literacy in hypertensive patients have been published. We tested if a multi-level quality improvement intervention could differentially improve Systolic Blood Pressure (SBP) more so in patients with low vs. higher health literacy. METHODS: We conducted a non-randomized prospective cohort trial of 525 patients referred with uncontrolled hypertension. Stakeholder informed and health literacy sensitive strategies were implemented at the practice and patient level. Outcomes were assessed at 0, 6, 12, 18 and 24 months. RESULTS: At 12 months, the low and higher health literacy groups had statistically significant decreases in mean SBP (6.6 and 5.3mmHg, respectively), but the between group difference was not significant (Δ 1.3mmHg, P=0.067). At 24 months, the low and higher health literacy groups reductions were 8.1 and 4.6mmHg, respectively, again the between group difference was not significant (Δ 3.5mmHg, p=0.25). CONCLUSIONS/PRACTICE IMPLICATIONS: A health literacy sensitive multi-level intervention may equally lower SBP in patients with low and higher health literacy. Practical health literacy appropriate tools and methods can be implemented in primary care settings using a quality improvement approach.
OBJECTIVE: Lower health literacy is associated with poorer health outcomes. Few interventions poised to mitigate the impact of health literacy in hypertensivepatients have been published. We tested if a multi-level quality improvement intervention could differentially improve Systolic Blood Pressure (SBP) more so in patients with low vs. higher health literacy. METHODS: We conducted a non-randomized prospective cohort trial of 525 patients referred with uncontrolled hypertension. Stakeholder informed and health literacy sensitive strategies were implemented at the practice and patient level. Outcomes were assessed at 0, 6, 12, 18 and 24 months. RESULTS: At 12 months, the low and higher health literacy groups had statistically significant decreases in mean SBP (6.6 and 5.3mmHg, respectively), but the between group difference was not significant (Δ 1.3mmHg, P=0.067). At 24 months, the low and higher health literacy groups reductions were 8.1 and 4.6mmHg, respectively, again the between group difference was not significant (Δ 3.5mmHg, p=0.25). CONCLUSIONS/PRACTICE IMPLICATIONS: A health literacy sensitive multi-level intervention may equally lower SBP in patients with low and higher health literacy. Practical health literacy appropriate tools and methods can be implemented in primary care settings using a quality improvement approach.
Authors: Nancy D Berkman; Stacey L Sheridan; Katrina E Donahue; David J Halpern; Karen Crotty Journal: Ann Intern Med Date: 2011-07-19 Impact factor: 25.391
Authors: Thomas C Keyserling; Stacey L Sheridan; Lindy B Draeger; Eric A Finkelstein; Ziya Gizlice; Eliza Kruger; Larry F Johnston; Philip D Sloane; Carmen Samuel-Hodge; Kelly R Evenson; Myron D Gross; Katrina E Donahue; Michael P Pignone; Maihan B Vu; Erika A Steinbacher; Bryan J Weiner; Shrikant I Bangdiwala; Alice S Ammerman Journal: JAMA Intern Med Date: 2014-07 Impact factor: 21.873
Authors: David W Baker; Darren A Dewalt; Dean Schillinger; Victoria Hawk; Bernice Ruo; Kirsten Bibbins-Domingo; Morris Weinberger; Aurelia Macabasco-O'Connell; Kathy L Grady; George M Holmes; Brian Erman; Kimberly A Broucksou; Michael Pignone Journal: J Card Fail Date: 2011-07-23 Impact factor: 5.712
Authors: Dean Schillinger; John Piette; Kevin Grumbach; Frances Wang; Clifford Wilson; Carolyn Daher; Krishelle Leong-Grotz; Cesar Castro; Andrew B Bindman Journal: Arch Intern Med Date: 2003-01-13
Authors: Darren A DeWalt; Dean Schillinger; Bernice Ruo; Kirsten Bibbins-Domingo; David W Baker; George M Holmes; Morris Weinberger; Aurelia Macabasco-O'Connell; Kimberly Broucksou; Victoria Hawk; Kathleen L Grady; Brian Erman; Carla A Sueta; Patricia P Chang; Crystal Wiley Cene; Jia-Rong Wu; Christine D Jones; Michael Pignone Journal: Circulation Date: 2012-05-09 Impact factor: 29.690
Authors: R Miranda; K A C Meeks; M B Snijder; B J van den Born; M P Fransen; R J Peters; K Stronks; C Agyemang Journal: Eur J Public Health Date: 2020-06-01 Impact factor: 3.367
Authors: Manfred E Beutel; Elmar Brähler; Mareike Ernst; Eva Klein; Iris Reiner; Jörg Wiltink; Matthias Michal; Philipp S Wild; Andreas Schulz; Thomas Münzel; Omar Hahad; Jochem König; Karl J Lackner; Norbert Pfeiffer; Ana N Tibubos Journal: Eur J Public Health Date: 2020-06-01 Impact factor: 3.367
Authors: Erika R Cappelletti; Andrea Greco; Alessandro Maloberti; Cristina Giannattasio; Patrizia Steca; Marco D'Addario Journal: BMC Public Health Date: 2020-03-12 Impact factor: 3.295
Authors: Jared W Magnani; Mahasin S Mujahid; Herbert D Aronow; Crystal W Cené; Victoria Vaughan Dickson; Edward Havranek; Lewis B Morgenstern; Michael K Paasche-Orlow; Amy Pollak; Joshua Z Willey Journal: Circulation Date: 2018-06-04 Impact factor: 29.690
Authors: Jacqueline R Halladay; Kaitlin C Lenhart; Kimberly Robasky; Wendell Jones; Wayne F Homan; Doyle M Cummings; Crystal W Cené; Alan L Hinderliter; Cassandra L Miller; Katrina E Donahue; Beverly A Garcia; Thomas C Keyserling; Alice S Ammerman; Cam Patterson; Darren A DeWalt; Larry F Johnston; Monte S Willis; Jonathan C Schisler Journal: J Pers Med Date: 2018-04-30