2918 Reader's Digestion: An Assessment of Health Literacy in IBD Patients on Biologic and Immunomodulator Therapies

Abstract

INTRODUCTION: Management of Inflammatory Bowel Disease (IBD) can include immunomodulators and biologics therapy. While these medications can have significant risks, patients may be inconsistently assessed for health literacy prior to initiating medications. Evaluation of health literacy is recommended to optimize patient understanding of clinical circumstances and management plans. This study assessed the rates of health literacy documentation in patients with IBD who are maintained on immunomodulators and biologics at a university medical center. METHODS: A retrospective chart review evaluating all IBD patients at a university medical center during a 5 year period was performed. Patient age, gender, IBD diagnosis, medication record (biologics, immunomodulators), and documented health literacy assessment with regard to medications and procedures were recorded. A database was generated using Microsoft Excel. Statistical analysis was performed using two-tailed Fisher's Exact Test with significance set at P < 0.05. The study was approved by the institutional IRB. RESULTS: Medical records of 392 IBD patients (175 men, 217 women) with mean age 44.3 (range 20-82; 259 <50 years old) were reviewed. 278 (70.9%) had ulcerative colitis, 96 (24.5%) Crohn's disease, 11 (2.8%) microscopic colitis and 7 (1.8%) with unspecified colitis. 295 were on immunomodulators (224 on immunomodulators alone, 31 also on a biologic). 78 were on biologics alone. Of those on biologics, 32 (41%) had documented health literacy assessment. Patients on biologics were more often assessed for health literacy compared to those not on biologics (P < 0.0001) or on immunomodulators alone (P = 0.0334). With respect to age, patients <50 were assessed for health literacy more frequently than patients >50 years (P = 0.0008). CONCLUSION: As physicians discuss therapeutic options with their IBD patients, it is important that physicians assess health literacy when initiating medications. This study demonstrates that there is insufficient documentation of health literacy in patients on biologic and other immunomodulatory therapies, especially in those older than 50. While this study was limited by retrospective design, small sample size and reliance on documentation, it identifies a potential opportunity for physicians to enhance quality of care and improve clinical outcomes in IBD patients.