J. Med. Internet Res. - Numeracy and literacy independently predict patients' ability to identify out-of-range test results.


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CKGROUND: Increasing numbers of patients have direct access to laboratory test results outside of clinical consultations. This offers increased opportunities for both self-management of chronic conditions and advance preparation for clinic visits if patients are able to identify test results that are outside the reference ranges.OBJECTIVE: Our objective was to assess whether adults can identify laboratory blood test values outside reference ranges when presented in a format similar to some current patient portals implemented within electronic health record (EHR) systems.METHODS: In an Internet-administered survey, adults aged 40-70 years, approximately half with diabetes, were asked to imagine that they had type 2 diabetes. They were shown laboratory test results displayed in a standard tabular format. We randomized hemoglobin A1c values to be slightly (7.1%) or moderately (8.4%) outside the reference range and randomized other test results to be within or outside their reference ranges (ie, multiple deviations). We assessed (1) whether respondents identified the hemoglobin A1c level as outside the reference range, (2) how respondents rated glycemic control, and (3) whether they would call their doctor. We also measured numeracy and health literacy.RESULTS: Among the 1817 adult participants, viewing test results with multiple deviations increased the probability of identifying hemoglobin A1c values as outside the reference range (participants with diabetes: OR 1.47, 95% CI 1.12-1.92, P=.005; participants without diabetes: OR 1.50, 95% CI 1.13-2.00, P=.005). Both numeracy and health literacy were significant predictors of correctly identifying out-of-range values. For participants with diabetes, numeracy OR 1.32 per unit on a 1-6 scale (95% CI 1.15-1.51, P<.001) and literacy OR 1.59 per unit of a 1-5 scale (95% CI 1.35-1.87, P<.001); for participants without diabetes, numeracy OR 1.36 per unit (95% CI 1.17-1.58, P<.001) and literacy OR 1.33 per unit (95% CI 1.12-1.58, P=.001). Predicted probabilities suggested 77% of higher numeracy and health literacy participants, but only 38% of lower numeracy and literacy participants, could correctly identify the hemoglobin A1c levels as outside the reference range. Correct identification reduced perceived blood glucose control (mean difference 1.68-1.71 points on a 0-10 scale, P<.001). For participants with diabetes, increased health literacy reduced the likelihood of calling one's doctor when hemoglobin A1c=7.1% (OR 0.66 per unit, 95% CI 0.52-0.82, P<.001) and increased numeracy increased intention to call when hemoglobin A1c=8.4% (OR 1.36 per unit, 95% CI 1.10-1.69, P=.005).CONCLUSIONS: Limited health literacy and numeracy skills are significant barriers to basic use of laboratory test result data as currently presented in some EHR portals. Regarding contacting their doctor, less numerate and literate participants with diabetes appear insensitive to the hemoglobin A1c level shown, whereas highly numerate and literate participants with diabetes appear very sensitive. Alternate approaches appear necessary to make test results more meaningful.

Resumo Limpo

ckground increas number patient direct access laboratori test result outsid clinic consult offer increas opportun selfmanag chronic condit advanc prepar clinic visit patient abl identifi test result outsid refer rangesobject object assess whether adult can identifi laboratori blood test valu outsid refer rang present format similar current patient portal implement within electron health record ehr systemsmethod internetadminist survey adult age year approxim half diabet ask imagin type diabet shown laboratori test result display standard tabular format random hemoglobin ac valu slight moder outsid refer rang random test result within outsid refer rang ie multipl deviat assess whether respond identifi hemoglobin ac level outsid refer rang respond rate glycem control whether call doctor also measur numeraci health literacyresult among adult particip view test result multipl deviat increas probabl identifi hemoglobin ac valu outsid refer rang particip diabet ci p particip without diabet ci p numeraci health literaci signific predictor correct identifi outofrang valu particip diabet numeraci per unit scale ci p literaci per unit scale ci p particip without diabet numeraci per unit ci p literaci per unit ci p predict probabl suggest higher numeraci health literaci particip lower numeraci literaci particip correct identifi hemoglobin ac level outsid refer rang correct identif reduc perceiv blood glucos control mean differ point scale p particip diabet increas health literaci reduc likelihood call one doctor hemoglobin ac per unit ci p increas numeraci increas intent call hemoglobin ac per unit ci pconclus limit health literaci numeraci skill signific barrier basic use laboratori test result data current present ehr portal regard contact doctor less numer liter particip diabet appear insensit hemoglobin ac level shown wherea high numer liter particip diabet appear sensit altern approach appear necessari make test result meaning

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