Functional health literacy in adults in a rural community health center.

At a rural community health center, 183 adult patients were invited to participate in an unspecified study. In a closed-door session, interested invitees were told the study required taking the Test of Functional Health Literacy in Adults (TOFHLA). After the purpose of the study was privately disclosed, 70 patients agreed to enroll (38.25 percent acceptance rate). Approximately 15 percent demonstrated literacy/numeracy deficits, scoring in the Inadequate and Marginal Functional Health Literacy ranges. Student's t-test comparison of mean scores suggested patients with literacy/numeracy deficits tended to have higher mean ages and completed fewer mean years of school than those scoring in the Adequate range, p = 0.0007 and p = 0.0005, respectively. Pearson's Product Moment Correlations demonstrated a negative correlation between age and TOFHLA score, r = -0.52, a positive correlation between highest year of schooling and TOFHLA score, r = 0.51, and a negative correlation between age and highest grade of schooling, r = 0.39. Regression analysis suggested 27 percent of the variability in TOFHLA score was attributable to age, p = 0.0001, supporting the role of age in cognitive decline. Upon review of these patients' medical records, no information on their literacy/numeracy problems or deficits was identified.

Effectiveness and costs of omeprazole vs ranitidine for treatment of symptomatic gastroesophageal reflux disease in primary care clinics in West Virginia.

OBJECTIVE: To compare clinical, health-related quality of life (HRQL), and medical cost outcomes in patients with symptomatic gastroesophageal reflux disease (GERD) receiving omeprazole sodium or ranitidine hydrochloride treatment. METHODS: A multicenter, randomized, open-label, medical effectiveness trial conducted in 5 university-based family medicine clinics. Two hundred sixty-eight patients with GERD were recruited and randomly assigned to omeprazole sodium, 20 mg once daily, or ranitidine hydrochloride, 150 mg twice daily, for up to 6 months. Main outcome assessments included the Gastrointestinal Symptom Rating Scale (GSRS) Reflux score, Psychological General Well-Being Index, and Short-Form-36 Health Survey administered at baseline and 2, 4, 12, and 24 weeks. Medical resource use and cost data were collected. RESULTS: More omeprazole-treated patients reported improved heartburn resolution at 2 weeks (49.0% vs 33.3%; P=.007) and 4 weeks (58.6% vs 35.0%; P<.001) compared with ranitidine-treated patients. The GSRS Reflux scores across 3 months showed overall differences between omeprazole (mean, 2.67) and ranitidine (mean, 2.95) groups (P=.04). Mean total 6-month medical costs were $915 lower ($8371 vs $9286; P=.64), and no difference in mean outpatient medical costs ($1198 vs $1158; P=.76) were observed in the omeprazole group compared with the ranitidine group. A post hoc secondary analysis showed that, at 12 and 24 weeks, patients treated with omeprazole for 8 weeks or more reported greater heartburn resolution (ie, 24 [43%] of 56 patients at both intervals) than patients treated with ranitidine for 8 weeks or more (12 [24%] and 13 [26%] of 50 patients, respectively; P=.001). CONCLUSIONS: Ranitidine and omeprazole were both effective at improving heartburn symptoms; however, omeprazole provided greater resolution of heartburn symptoms at 2 and 4 weeks. Despite omeprazole's higher acquisition cost, there were no significant differences in total or outpatient costs between groups.

Health-related quality of life in primary care patients with gastroesophageal reflux disease.

OBJECTIVE: To describe the clinical characteristics and health-related quality of life of family medicine patients with clinically diagnosed gastroesophageal reflux disease (GERD). METHODS: The study involved the baseline assessment of 268 patients enrolled in a randomized clinical trial comparing treatments for GERD. The study was conducted in a five-center, university-based family practice in southeastern West Virginia. Patients with a clinical diagnosis of GERD and who had not received treatment in the past 30 days were eligible; pregnant and lactating women and patients with severe renal or hepatic insufficiency were excluded. RESULTS: Two hundred sixty-eight patients were included in the analysis. Mean +/- SD age was 44.9 +/- 14.1 years; 61.2% were women and 91.4% were white. Mean +/- SD body mass index was 30.3 +/- 6 kg/m2, and >15.3% of patients had no insurance. One hundred seventy-four (64.9%) patients were enrolled from nonurban primary care clinics. One hundred sixty-four patients (61.2%) were prescribed at least one medication prior to study enrollment (mean +/- SD 2.88 +/- 1.71; range 1-9). When adjusted for age, gender, comorbidity status, and rural status, severity of GERD was associated with decreased health-related quality of life. GERD patients without comorbidity demonstrated decrements in health-related quality of life when compared with the US general population. When compared with another GERD population, the study patients reported fairly consistent GERD symptomatology and health-related quality of life. CONCLUSIONS: GERD symptom severity was associated with impaired health-related quality of life in a predominantly rural primary care population.