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UNLABELLED - Development and pilot testing of a disease management program for low literacy patients with heart failure.
BACKGROUND - Randomized trials have shown that disease management programs can reduce hospitalizations and improve symptoms for patients with congestive heart failure. We sought to create and pilot test such a program for patients with low literacy skills.
METHODS - We used focus groups and individual cognitive response interviews (CRIs) to develop an educational booklet for low literacy patients with heart failure. We incorporated the booklet into a disease management intervention that also included an initial individualized 1-h educational session and scheduled supportive phone calls that were tapered over 6 weeks. We then conducted a 3-month before-after study on patients with low literacy skills (<9th grade literacy level) in a university internal medicine clinic to test the acceptability and efficacy of our program. Outcomes of interest included heart failure-related knowledge, self-care behavior and heart failure-related symptoms measured on the Minnesota Living with Heart Failure (MLwHF) scale.
RESULTS - Twenty-five patients were enrolled and 23 (92%) completed 3-month follow-up. Mean age was 60 years (range 35-74), 60% were men, 60% were African-American, and 74% had household income under $15,000 per year. The median reading level was fifth grade with 32% reading at or below the third grade level. Mean knowledge score at baseline was 67% and did not improve after the intervention. The proportion of patients reporting weighing themselves daily increased from 32% at baseline to 100% at 12 weeks. Mean improvement on the MLwHF scale was 9.9 points over the 3-month trial (95% CI: 0.5, 19.2), which corresponds to an improvement in one class on the New York Heart Association heart failure scale.
CONCLUSION - A heart failure disease management program designed specifically for patients with low literacy skills is acceptable and is associated with improvement in self-care behavior and heart failure related symptoms.
PURPOSE - This study examined the role of literacy in patients with poorly controlled diabetes who were participating in a diabetes management program that included low-literacy-oriented interventions.
METHODS - A before-after analysis was performed of a pharmacist-led diabetes management program for 159 patients with type 2 diabetes and poor glycemic control (hemoglobin A1c [A1C] > or = 8.0%). Clinic-based pharmacists offered one-to-one education and medication management for these patients using techniques that did not require high literacy. Literacy was measured by the Rapid Estimate of Adult Literacy in Medicine (REALM) test and dichotomized at the 6th-grade level. The A1C values were collected prior to enrollment, at enrollment, and approximately 6 months after enrollment.
RESULTS - Of the 111 patients with follow-up data, 55% had literacy levels at the 6th-grade level or below. Lower literacy was more common among African Americans, older patients, and patients who required medication assistance. There was no significant relationship between literacy status and A1C prior to enrollment or at enrollment. Over the 6-month study period, patients with low and high literacy had similar improvements in A1C.
CONCLUSIONS - This diabetes care program, which used individualized teaching with low-literacy techniques, significantly improved A1C values independent of literacy status.
Family caregivers, although uncompensated, provide daily care for more than 75% of the older adults who are dependent on home care technologies such as home enteral nutrition. The high complication rates and poor outcomes seen in older adults suggest that being an effective caregiver requires specialized training in home care technologies, and dietitians need to be more actively involved in discharge planning and follow-up home care. The level of knowledge and skill mastery required for technology-dependent care, along with the chronic, intensive nature of family caregiving and the disruptions in caregivers' daily lives, lead to negative emotional and physical consequences that may interfere with caregivers' ability to do caregiving well. Recognizing that care recipients and caregivers are underserved populations, dietitians should develop their professional competencies and expand their roles in technology-dependent home care. Dietitians can thereby contribute to better outcomes for both family caregivers and older home care recipients.