Health Literacy and Emergency Department Utilization Among Community Adults With Mental and Chronic Health Conditions

Abstract

Reducing unnecessary emergency department (ED) utilization is a national health care priority. Low health literacy is a little explored but suggested cause of excess ED utilization. This study investigated the association between health literacy and ED utilization among a community sample of adults with common mental and chronic health conditions. Cross-sectional health interview survey data from Schenectady, New York, were used. Adults (aged ≥18 years) who were diagnosed with anxiety/emotional disorders, depression, asthma, or diabetes were included in the study. Health literacy was assessed using the three-question screener developed and validated by L. D. Chew et al. (2004). ED visits in the previous 12 months specific to these health conditions were analyzed. Multivariable regression models were fitted for each condition with incremental covariate adjustments of demographics, health care access, and number of comorbidities. Odds ratio (OR) and 95% confidence intervals (CI) were reported. Sample sizes were 404, 509, 409, and 237 for anxiety/emotional disorders, depression, asthma, and diabetes, respectively. Inadequate health literacy was significantly higher among individuals who had depression and visited an ED compared with individuals with depression without an ED visit (28.1% vs. 16.9%, p = 0.029). Significant and independent associations between inadequate health literacy and ED utilization was found among adults with anxiety/emotional disorder (fully-adjusted OR 2.22 [CI: 1.03, 4.76]) and among adults with depression (fully-adjusted OR 2.29 [CI: 1.18, 4.44]). No significant association was found among adults with asthma or diabetes. This study presented evidence that inadequate health literacy is common and independently associated with ED utilization among adults with mental health conditions. It supports an initiative to prioritize individuals with mental health conditions, and systematically screen, identify, and provide assistance to those with inadequate health literacy to reduce excess ED utilization. Several existing health literacy screening tools suitable for an emergency care setting are suggested.

Health Literacy and Serious or Persistent Mental Illness: A Mixed Methods Study

“…Inadequate levels of HL have been consistently associated with a lower likelihood of participating in self-care activities, less use of preventative care services, difficulty interpreting labels and health messages, and a greater likelihood of making riskier health choices (e.g., tobacco use), experiencing a work-related accident, experiencing difficulties with managing chronic diseases, and adhering to a medication regimen ( Berkman et al, 2011 ; WHO, 2013 ). Higher rates of health care utilization, including hospital admissions, readmissions, and expenditures among those with inadequate HL have been well-documented ( Bailey et al, 2015 ; Cartwright et al, 2017 ; Dahl & Hosler, 2020 ; Krishan et al, 2012 ; Mitchell et al, 2012 ; Rasu et al, 2015 ; Son & Won, 2020 ).…”