Health literacy and use of outpatient physician services by Medicare managed care enrollees.
OBJECTIVE
To determine whether inadequate functional health literacy adversely affects use of physician outpatient services.


METHODS
Cohort study.


METHODS
Community.


METHODS
New Medicare managed care enrollees age 65 or older in 4 U.S. cities (N = 3,260).


RESULTS
We measured functional health literacy using the Short Test of Functional Health Literacy in Adults. Administrative data were used to determine the time to first physician visit and the total number of visits during the 12 months after enrollment. The time until first visit, the proportion without any visit, and adjusted mean visits during the year after enrollment were unrelated to health literacy in crude and multivariate analyses. Participants with inadequate and marginal health literacy were more likely to have an emergency department (ED) visit than those with adequate health literacy (30.4%, 27.6%, and 21.8%, respectively; P =.01 and P <.001, respectively). In multivariate analysis, the adjusted relative risk of having 2 or more ED visits was 1.44 (95% confidence interval, 1.01 to 2.02) for enrollees with marginal health literacy and 1.34 (1.00 to 1.79) for those with inadequate health literacy compared to participants with adequate health literacy.


CONCLUSIONS
Inadequate health literacy was not independently associated with the mean number of visits or the time to a first visit. This suggests that inadequate literacy is not a major barrier to accessing outpatient health care. Nevertheless, the higher rates of ED use by persons with low literacy may be caused by real or perceived barriers to using their usual source of outpatient care.
Baker
David W
DW
Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Suite 200, 676 N. Clair Street, Chicago, IL 60611, USA. dwbaker@northwestern.edu
Gazmararian
Julie A
JA
Williams
Mark V
MV
Scott
Tracy
T
Parker
Ruth M
RM
Green
Diane
D
Ren
Junling
J
Peel
Jennifer
J
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards*; D015331:Cohort Studies; D004522:Educational Status; D004635:Emergency Medicine / Q000592:standards*; D005260:Female; D005431:Florida; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009820:Ohio; D013781:Texas; D013997:Time Factors