| Objective To investigate the impact of health literacy on healthcare services utilization and medical costs in patients with systemic lupus erythematosus(SLE).Methods The SLE patients were recruited to complete the baseline survey in rheumatology outpatient and inpatient departments of two comprehensive hospitals in Hefei between December 15,2016 to September 30,2017.Health literacy was measured by the Scale of Health Literacy for Patients with Chronic Disease.Inadequate health literacy was defined as a score lower than 96.The group was prospectively followed up for one year and the outcomes were collected by the electronic health record and telephone.The outcomes included time to first hospital admission,annual day admits,the frequency of hospitalizations and outpatient visits,inpatient costs and outpatient costs in a year.Cox regression was used to examine the effect of health literacy on time to first hospital admission.Multiple regression analysis was used to analyze the effect of health literacy on annual day admits during the follow-up period.Negative binomial regression was used to analyze the effect of health literacy on the frequency of hospitalizations and outpatient visits during follow-up.The generalized linear model was used to estimate the effect of health literacy on medical costs.Results The mean age of 334 SLE patients was(37.63 ± 11.22)years.93.7% of the patients were female,197(59%)patients had inadequate health literacy.After 1 year follow-up,a total of 59(17.7%)patients were hospitalized due to SLE after enrollment.Cox regression analysis showed that there was no association between health literacy and time to first hospital admission(HR=0.969,95% CI=0.559~1.683,P=0.912),after controlling for age,health-related quality of life(HRQo L)and depression.A total of 65(19.5%)patients had been hospitalized at least once for all causes and the median number of hospital stays was 11.00(IQR=6.50~15.50)days.The total number of hospitalizations was 79,and the total number of outpatient visits was 1,540.Negative binomial regression analysis showed that there was no correlation between health literacy and the frequency of hospitalizations(IRR=1.060,95% CI=0.720~1.562,P=0.767),after adjusting for the physical component summary of HRQo L.After adjusting for age,number of chronic diseases,depression and the physical component summary of HRQo L,there was no correlation between health literacy and the frequency of outpatient visits(IRR=0.997,95% CI=0.973~1.021,P=0.775).The total costs for hospitalization and outpatient visits of the patients were 1,238,561 yuan and 2,750,995 yuan respectively.The total medical cost was 3,989,556 yuan.After adjusting for age,gender,ethnicity,medical insurance,disease duration and the physical component summary of HRQo L,there was no association between health literacy and inpatient costs(IRR=1.176,95% CI=0.648~2.136,P=0.594).After adjusting for age,ethnicity,number of chronic diseases and the physical component summary of HRQo L,there was no association between health literacy and outpatient costs(IRR=1.043,95% CI=0.869~1.252,P=0.648).After adjusting for age,gender,marital status,monthly household income,medical insurance,chronic disease number,and the physical component summary of HRQo L,there was no association between health literacy and total medical costs(IRR=1.058,95% CI=0.848~1.321,P=0.618).Conclusion Inadquate health literacy of the SLE patients was not associated with healthcare services utilization and medical costs.Young women,Han nationality,having less monthly household income,shorter disease duration,new rural cooperative medical insurance,with more chronic diseases,with depressive symptom and poor physical health were the main factors predicting healthcare services utilization and medical costs.Healthcare providers need to pay more attention to the SLE patients with these characteristics from the early stage when contacting with them.Some measures to reduce the medical expenses of patients and reduce medical costs should be considered from physical and mental health screening,improving patients' follow-up compliance and strengthening economic support,etc.Future studies can select subjects from multiple centers,recruit SLE patients with disease duration less than 6 months,or adjust the evaluation time of outcomes to investigate the predictive role of health literacy on healthcare services utilization and medical costs. |
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