The Impact of Health Literacy Level in Patients with Chronic Obstructive Pulmonary Disease

Background: Over a third of adult patients have limited health literacy. Basic or below basic health literacy levels are correlated with increased health care costs, medication errors, and a lack of knowledge on care of chronic health conditions, such as Chronic Obstructive Pulmonary Disease (COPD). COPD is a progressive disease associated with an enhanced inflammatory response in the airways and lungs. This inflammatory response is chronic and irreversible. It is important that patients with COPD understand how to properly use their inhalers and other medications to prevent worsening of their condition. Objective: The primary objective of this study is to compare the improvement in patient inhaler technique between standard medication handouts and handouts tailored to patients with low health literacy. Methods: Institutional Review Board approval has been obtained for a prospective, experimental study will be performed at Community Hospital East in Indianapolis, Indiana. Participants will be recruited from October 2012 to August 2014. The study will include patients 18 to 89 years old with a diagnosis of COPD admitted to Community Hospital East and who are identified as having low health literacy. The study will exclude non-English speaking patients, those who are pregnant or prisoners, patients that do not manage their own medications, have plans to be discharged to a long-term care facility or skilled nursing facility, or have a documented impairment in cognitive functioning. The health literacy of each patient will be determined using the Rapid Assessment of Adult Literacy in Medicine – Short Form (REALM-SF). REALM-SF is a word recognition test that assesses the patient\u27s ability to read common medical words. Half of the patients with low health literacy will receive a handout tailored to their low health literacy level, while the other half of patients will receive a standard Krames On-Demand handout. After completing the REALM-SF and identifying prescribed inhalers, all patients will take a brief pre-assessment of simple questions related to the management of COPD and demonstrate how the patient currently uses prescribed inhalers. Participants will then receive the randomly assigned handout and review it for 15 minutes. After the review period, participants will be asked to demonstrate their inhaler technique, including any adjustments made based on the handout. The patient will then take a brief post-assessment, which will be compared to determine the efficacy of the counseling session and the education the patient received. Difference in the mean change in technique score and differences in satisfaction scores will be analyzed. Statistical analyses will be performed using Microsoft Excel and Social Science Version 17.0o (SPSS Inc., Chicago, IL)