Health literacy associated differences of medication use in Crohn's disease
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PURPOSE: The aim of this study was to explore a difference in medication use (defined by medication selection and medication self-discontinuation) between patients with limited and adequate health literacy. This study also investigated whether the association between medication use and clinical remission of CD was different across the health literacy spectrum. METHODS: A cross-sectional study was conducted by analyzing an existing dataset from the IBD Health Literacy study in the Department of Gastroenterology at Boston Medical Center (BMC). Among 61 patients who were enrolled, 26 had limited health literacy and 35 had adequate health literacy. Medication use was defined by medication selection and medication self-discontinuation. Medication selection was further defined as whether patients with monotherapy were on one of the following medications including 5-ASAs, immunomodulators (including thiopurines and methotrexate), biologics and prednisone; medication self-discontinuation was further defined as whether patients had ever discontinued medications (including thiopurines and biologics) without physician recommendation. Harvey Bradshaw Index score was the assessment of clinical remission of CD. Newest Vital Sign scores were applied to assess health literacy. RESULTS: The odds ratios for patients who were on 5-ASAs and immune modulators (including thiopurines and methotrexate) monotherapy at the time of visit to have limited health literacy, compared to patients who were on monotherapy of biologic agent, were 3.75 (95%CI (0.46-38.26), p = 0.22) and 1.25 (95%CI (0.13-9.67), p = 0.83), respectively. The odds ratio for those whoever self-discontinued any medications to have limited health literacy versus those who did not was 1.62 (95%CI (0.42-6.24), p = 0.48). The odds ratio for patients whoever self-discontinued any medications to be in clinical remission against those who did not was 0.46 (95%CI (0.1-1.85), p = 0.27). The odds ratio for associations between medication self-discontinuation and clinical remission were 0.6 (95%CI (0.06-4.58), p = 0.63) in patients with limited health literacy and 0.5 (95%CI (0.06-4.62), p = 0.51) in patients with adequate health literacy. CONCLUSION: There were no differences of medication use between limited and adequate health literacy. The association between medication self-discontinuation and clinical remission of CD was indifferent across the health literacy levels. The results of this study provides a foundation for future studies on health literacy associated differences in CD populations and helps promote the effectiveness of treatment for CD by arousing more attention to different health literacy populations.