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Literacy and numeracy skills and anticoagulation control
Carlos A Estrada1, Mary Martin-Hryniewicz, Brian T Peek
1Division of General Internal Medicine, Brody School of Medicine at East Carolina University, Asheville, North Carolina, USA.
The American Journal of the Medical Sciences
|August 18, 2004
Summary
Low health literacy and numeracy skills are common in patients taking warfarin and are linked to poorer blood thinning control. Improving these skills may enhance patient safety and treatment effectiveness.
Area of Science:
- Pharmacology and Therapeutics
- Patient Education and Health Literacy
Background:
- Functional health literacy (ability to read and understand health information) and numeracy (ability to perform calculations) are crucial for managing medications.
- Warfarin therapy requires precise dosing and regular monitoring, making adherence to schedules and understanding instructions vital for patient safety and treatment efficacy.
Purpose of the Study:
- To investigate the prevalence of literacy and numeracy deficits among patients undergoing warfarin therapy.
- To explore the association between these cognitive skills and the quality of anticoagulation control, measured by International Normalized Ratio (INR) variability and time within therapeutic range.
Main Methods:
- A prospective study enrolled 143 patients over 50 years old from two anticoagulation management units.
- Literacy, numeracy, and INR levels were assessed. Over a 3-month period, INR variability and time within the therapeutic range were calculated.
Main Results:
- Over half of the patients (52.4%) could not read health-related words at an eighth-grade level, and self-reported education levels often exceeded measured literacy.
- Nearly half of the patients (48.3%) demonstrated low numeracy skills, answering fewer than two out of six questions correctly.
- Lower literacy was significantly associated with higher INR variability (P=0.009), and lower numeracy was linked to increased INR variability (P=0.004) and more time spent above the therapeutic range (P=0.04).
Conclusions:
- A significant portion of patients on warfarin exhibit low literacy and numeracy skills.
- These deficits in cognitive skills are associated with poorer anticoagulation control, indicating potential risks for bleeding or ineffective treatment.