Health Literacy Screening May Be Helpful for Personalizing RA Care

Originally published by our sister publication Specialty Pharmacy Continuum

By Ethan Covey

Incorporating the use of the Brief Health Literacy Screening (BHLS) tool into the management of patients with rheumatoid arthritis (RA) may provide valuable insight into patient needs, allowing for personalized counseling approaches, according to a poster presented at the NASP 2024 Annual Meeting & Expo, in Nashville, Tenn.

“Health literacy is a significant barrier to medication adherence and disease management for patients with a wide array of chronic diseases, including RA,” Sam Good, MD, a rheumatology fellow at the University of California, Los Angeles, told Specialty Pharmacy Continuum. “This study helps identify a feasible tool for evaluating health literacy in a clinical setting.”

The prospective observational study took place from August 2023 through March 2024 and evaluated the relationship between health literacy and patient-reported RA disease activity following the initiation of treatment.

Twenty-seven adult patients with RA, who had been prescribed a new specialty therapy and were receiving clinical management from a health-system specialty pharmacy, were included in the analysis. BHLS, consisting of a four-item questionnaire, was used to assess health literacy at baseline. RA disease activity was measured with the Routine Assessment of Patient Index 3 (RAPID3) scores, both at baseline and at a follow-up period of three to four months.

Most patients had high RA disease activity at baseline (70%), and were classified as having an adequate level of health literacy (78%). The average change in RAPID3 score was −2.7 + 7.1, −8.3 + 13.3 and −0.9 + 4.4 for those in the adequate, marginal and limited health literacy categories, respectively. There was no statistically significant relationship between baseline BHLS and change in RAPID3 score.

“Although there was no statistically significant relationship between baseline BHLS and change in RAPID3 score, the follow-up period of three to four months was short,” Dr. Good said. “Therefore the investigators may have been unable to detect any change in RAPID3 score.

“It would be interesting to see what happens to patients at three-month intervals for longer periods of time in order to determine whether you eventually start to see a difference in disease activity at periods such as one or two years,” he added. “Future studies may be able to utilize BHLS to assess the effects of health literacy on patient-reported outcome measures in RA.”

Dr. Good noted that it would also be interesting for future studies to stratify patients by medication type. This, he said, could examine whether patients who receive injectable medications are more susceptible to the effects of lower health literacy than those who use oral medications.

And if the technique were implemented more broadly into a clinic workflow, he said it would be valuable to assess the uptake of the BHLS as a process measure.

“For example, what percentage of clinical encounters actually recorded a BHLS response out of the total available encounters with RA patients?” he said.