Is There an Association Between Hepatitis C Treatment Outcomes and Health Care Literacy?

Abstract

Purpose: 4.5 million Americans are believed to be infected with hepatitis C in the United States and the average lifetime cost is estimated to be about $100,000 for individual patients. Present therapy and drugs in development present an effective cure despite very high financial costs. Numerous studies utilizing (S-TOFHLA) Short test of functional health literacy in adults as a measure of functional health literacy have demonstrated that low health literacy has been linked with increased health care costs and poorer patient outcomes. Our aim was to evaluate the association between functional health literacy and treatment outcomes in patients with chronic Hepatitis C infection. Methods: Cross sectional study of patients presenting to the outpatient liver clinic at our institution between February to June 2012. In addition to the S-TOFHLA questionnaire, a survey questionnaire was also completed to address insight and knowledge of their disease. Results: 46 patients completed the questionnaire. Demographics: Table 1. 75% were on treatment and 25% were about to start treatment. 40% were on 2 drug therapy (Interferon and Ribavirin). 35% were on 3 drug therapy (ribavirin+interferon + telaprevir or boceprevir). 93% of patients demonstrated adequate health literacy with an average score of 30 (Adequate=S-TOFHLA score between 23-36).100% of patients who achieved Sustained Viral Response (SVR) (35% of patients who completed treatment) had adequate health literacy. 100% of patients who did not achieve SVR (65% of patients who completed treatment) i.e. treatment failure also had adequate health literacy and in addition were high school graduates. Also, there was no difference in the health literacy in those who achieved or did not achieve EVR (Early virological response) or RVR (Rapid virological response).Table 1: DemographicsConclusion: To our knowledge, this is the first study to measure the association of functional health care literacy and outcomes in patients undergoing treatment for hepatitis C with antiviral agents. However, we did not find any association. The bias in our study could be that patients from the liver clinic could be self selected and hence have good health literacy. Patient with poor health literacy and Hepatitis C infection might be out there in the community and not seeking medical attention. An outreach committee to encourage these patients to seek medical attention can be part of the solution.