Disparate Risk, Similar Assessments: Gastroenterologistsʼ Assessment of Health Literacy Is Not Affected by Patient Ethnicity

Abstract

Introduction: Health literacy, the ability to acquire, understand, and process medical information, is associated with control of chronic diseases, avoidance of complications, and improvement in patient outcomes. High quality physician-patient encounters will include some assessment of the patient's understanding and capacity to incorporate recommendations into his/her routine. African American populations have been reported to have lower health literacy than others. This study evaluated physicians documentation of health literacy in patients of various racial/ethnic backgrounds. Methods: Using an electronic health record, we conducted a retrospective review of patients seen at an urban academic medical center during a one month period. Physicians were considered to have assessed health literacy if there was documentation of the patient's understanding of and ability to adhere to the plan of care. Data regarding physicians' assessment of health literacy and patient demographics were recorded. Statistical analysis was performed using Fisher's Exact Test with significance set at p < 0.05. Results: There were 300 visits comprising 139 African American patients (46.3%), 90 Caucasians (30.0%), 10 Asian patients (3.3%), nine Latinos (3%), and 52 (17.3%) of other or undocumented ethnicity. There was an assessment of health literacy in the office notes of 70 African Americans (50.4%). The assessments were documented for 36 (40.0%) Caucasians (p=0.1371), three (33.3%) Latinos (p=0.4944), and four (40%) Asians (p = 0.7453). Among those whose ethnicity was not known, 18 (34.6%) had documentation of health literacy. Conclusion: Our study revealed that gastroenterologists document their patients' health literacy less than half the time. Interestingly, there was not a statistically significant difference in rates of health literacy documentation between African American patients and those of other ethnicities. Health literacy is an important determinant of health outcomes. African Americans are at particular risk in gastroenterology as they have higher rates of advanced colon cancer and worse colon cancer outcomes. Assessing health literacy is always important, but this at-risk population warrants special attention.