title: Potentially preventable use of emergency services: the role of low health literacy.
abstract: BACKGROUND
  Limited health literacy is a barrier for understanding health information and has been identified as a risk factor for overuse of the emergency department (ED). The association of health literacy with access to primary care services in patients presenting to the ED has not been fully explored.
  
  
  OBJECTIVE
  To examine the relationship between health literacy, access to primary care, and reasons for ED use among adults presenting for emergency care.
  
  
  METHODS
  Structured interviews that included health literacy assessment were performed involving 492 ED patients at one Southern academic medical center. Unadjusted and multivariable logistic regression models assessed the relationship between health literacy and (1) access to a personal physician; (2) doctor office visits; (3) ED visits; (4) hospitalizations; and (5) potentially preventable hospital admissions.
  
  
  RESULTS
  After adjusting for sociodemographic and health status, those with limited health literacy reported fewer doctor office visits [odds ratio (OR)=0.6; 95% confidence interval (CI), 0.4-1.0], greater ED use, (OR=1.6; 95% CI, 1.0-2.4), and had more potentially preventable hospital admissions (OR=1.7; 95% CI, 1.0-2.7) than those with adequate health literacy. After further controlling for insurance and employment status, fewer doctor office visits remained significantly associated with patient health literacy (OR=0.5; 95% CI, 0.3-0.9). Patients with limited health literacy reported a preference for emergency care, as the services were perceived as better.
  
  
  CONCLUSIONS
  Among ED patients, limited health literacy was independently associated with fewer doctor office visits and a preference for emergency care. Policies to reduce ED use should consider steps to limit barriers and improve attitudes toward primary care services.
authors.affiliation: Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53711, USA. jrschumacher@wisc.edu
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Schumacher
authors.forename: Allyson G
authors.initials: AG
authors.lastname: Hall
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Connie L
authors.initials: CL
authors.lastname: Arnold
authors.forename: Robert D
authors.initials: RD
authors.lastname: Bennett
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Donna L
authors.initials: DL
authors.lastname: Carden
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States