POS0113 THE PREDICTIVE VALUE OF HEALTH LITERACY ON DISEASE ACTIVITY AND MEDICATION USE OVER TIME IN RHEUMATOID ARTHRITIS PATIENTS.

Abstract

BackgroundHealth literacy is a multidimensional concept comprising various individual skills and situational resources and is increasingly recognized as a critical determinant of health. Limited health literacy has been demonstrated to associate negatively with health outcomes in multiple chronic diseases, but data on the relevance of health literacy for treatment and outcomes in rheumatoid arthritis (RA) is still limited.ObjectivesThe aim of this study was to explore the longitudinal association between health literacy profiles, disease activity and medication prescription in patients with RA.MethodsWe conducted a single center, retrospective, cohort study including patients from the Medisch Spectrum Twente hospital (Enschede, the Netherlands) who completed the Health Literacy Questionnaire (HLQ) and were previously clustered into 10 “health literacy profiles”.1 The 10 profiles were further aggregated, based on similarities in profile characteristics, into three groups: “several health literacy limitations”, “some health literacy limitations” and “good health literacy”. Up to 1 year of follow-up data on disease activity (DAS28-ESR) and medication use were obtained from patients’ electronic health records. Linear mixed modelling (LMM) was used to analyze DAS28-ESR scores over time using health literacy group, time and their interaction term as fixed effects and gender and age as random effects. Drug prescriptions were constant over time, therefore chi-square tests were used to compare prescribed medication between the health literacy groups.Results108 patients with RA were included and assigned to “several health literacy limitations” (n=21), “some health literacy limitations” (n=33) or “good health literacy” (n=54). LMM showed a significant main effect of health literacy group on DAS28-ESR scores over time (F (2,105) = 4.941, p=0.009). Post hoc contrast analysis showed that patients with “good health literacy” had significantly lower disease activity scores than patients with “several health literacy limitations”. In addition, there was a significant effect of time on DAS28-ESR scores (F (2,141) = 4.601, p=0.012) in the total sample, indicating significantly lower scores at the 6-month follow-up. There was no significant interaction between group and time (F (4,141) = 0.712, p=0.585). Figure 1 shows the estimated trajectories of DAS28-ESR scores over 12 months time for the three health literacy groups. Patients with “several health literacy limitations” were prescribed prednisolone significantly more often (52.4%) than patients with “some health literacy limitations” (21.2%) or “good health literacy” (22.2%) over time (p=0.019). Patients with “some health literacy limitations” were prescribed conventional DMARDs more often (72.7%) than patients with “good health literacy” (38.9%; p=0.008). There was no difference in biological DMARDs use between the health literacy groups.Figure 1.Mean (standard error) DAS28-ESR scores of health literacy (HL) groups over a 12-month time period.ConclusionWe found that among patients with RA, those with several health literacy limitations have higher disease activity scores over time and use prednisolone significantly more often than patients with higher health literacy levels. No difference was observed in biological DMARD use. These results grant more insight into the role of health literacy for treatment and outcomes in patients with RA and supports existing research in other chronic diseases.