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Editor's Correspondence |

Who Actually Has the "Low Health Literacy"?—Reply

Dean Schillinger, MD; Clifford Wilson, BA; Andrew Bindman, MD
Arch Intern Med. 2003;163(14):1745-1746. doi:10.1001/archinte.163.14.1745-a.
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McCormick and Jain suggest that one reason that physicians do not meet ADA guidelines is that they are poorly informed about these guidelines. Whether variation in the extent to which patients receive guideline-based care is a consequence of physicians' knowledge, beliefs, and attitudes about the guidelines vs patients' interest in adhering to the recommendations in the guidelines is an empirical question. Our study1 suggests that some of this variation can be explained by the extent to which physicians and patients are truly engaging in a partnership that allows for a mutual exchange of opinions, ideas, and solutions. We also suspect that a frequently unmeasured determinant of quality of care, the system of care itself, may influence the degree to which guideline-based care is delivered. Multidisciplinary care teams, computerized reminder systems, and other disease management interventions have the potential to lower barriers to both physician and patient "adherence" by identifying those in need, enabling timely interventions, addressing comorbidities, supporting decision making, and promoting interactive communication. Only a minority of clinical practices use such strategies2 and these tend not to serve patients most likely to have inadequate functional health literacy. We believe that for significant gains to be made in diabetes care, the chronic care model needs to expand both in its scope and in the extent to which it engages patients with inadequate functional health literacy.3

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