Association of Health Literacy and Health Care Utilization Among Glaucoma Patients.

Prcis: Among 7846 adults with self-reported glaucoma, low health literacy (LHL) was associated with fewer outpatient ophthalmological follow-up visits, utilization of a greater number of ocular hypotensive medication classes, and higher costs for glaucoma medications.

Purpose: Previous studies found LHL is associated with increased difficulty with treatment adherence among adults with glaucoma, which can lead to poor outcomes. This study examined patterns of glaucoma health care utilization associated with LHL.

Methods: We analyzed 7846 adults with self-reported glaucoma enrolled in the 1996-2017 Medical Expenditure Panel Survey. Adult glaucoma patients with LHL (defined by National Assessment of Adult Literacy score <226) were the compared with those with high health literacy. Multivariable regression models were constructed to examine the association of LHL with number of outpatient glaucoma visits, prescription medications, polypharmacy (≥2 ocular hypotensive classes prescribed), and associated costs.

Results: Self-reported glaucoma diagnosis was associated with higher rates of LHL [23.9% vs. 9.7%, odds ratio (95% CI): 2.43 (2.25-2.62), P <0.0001]. Among those with glaucoma, LHL was associated with fewer glaucoma outpatient visits [risk ratio: 0.94 (0.89-0.99), P =0.02] and the use of a greater number of ocular hypotensive medications [1.06 (1.01-1.12), P =0.03]. Moreover, those with LHL had higher health care spending on prescription medications [mean: $556.40 vs. $471.87, β (95% CI): $57.05 ($30.22-$83.87)]. Adult glaucoma patients with LHL were also more likely to have polypharmacy [odds ratio (95% CI): 1.26 (1.01-1.59)].

Conclusion: LHL was more prevalent in patients with glaucoma, compared with those without. Glaucoma patients with LHL were prescribed more medications and had higher medication costs, however, they had fewer outpatient glaucoma visits. Improved glaucoma patient education to address LHL is needed, in addition to studies to understand the impact of these findings on treatment outcomes.