Health literacy and primary care organization

Patients with chronic diseases must interpret health information regarding their symptoms, medications, and treatment goals. However, clear advice tailored to a single condition becomes difficult to apply when multiple conditions require attention. The World Health Organization recognizes that health literacy is influenced by the organization of services and resources available to people, as well as by their knowledge and skills [1]. Helping patients understand and use information must therefore be integrated into the core organizational structure of primary care.

Min et al. [2] examined the association between having a regular physician and health literacy among adults with and without chronic diseases using data from the 2021 Korea Health Panel Study. Among 4,627 participants with chronic diseases, those reporting a regular physician had greater odds of being in a higher health-literacy category (adjusted odds ratio, 1.94; 95% confidence interval, 1.42–2.63). No significant association was observed among participants without chronic diseases. Because this study used cross-sectional data, it cannot determine whether having a regular physician contributes to better health literacy or whether people with greater health literacy are more likely to maintain an ongoing relationship with a physician. In addition, self-reported measures of having a regular physician did not account for the duration or quality of the therapeutic relationship, nor was continuity of care directly quantified. Nevertheless, the association suggests that physician–patient relationships deserve attention when addressing health literacy in chronic disease care.

Repeated contact with the same physician is a possible explanation. A physician who knows a patient’s treatment history may be better placed to tailor advice to that patient’s circumstances [3]. Additionally, follow-ups offer an opportunity to revisit unanswered questions.

Regular follow-ups also depend on how the services are organized. A comparative review of primary care systems in South Korea and Japan discussed physician training, gatekeeping, and integration with community care [4]. If primary care physicians are expected to assist patients in interpreting advice from different sources, they require access to relevant clinical information and must have a defined role in follow-up. These functions deserve attention during service design, alongside factors such as appointment availability and the range of conditions treated.

Clinicians should ask what patients have read or heard, and which advice they find difficult to reconcile with their treatment. The explanations should address these questions in plain language. Asking patients to describe their agreed plan in their own words allows the clinician to verify whether the explanation was clear [5,6]. The Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit recommends ensuring all communications are accessible and easily understood, as challenges can arise even among patients who typically navigate health information effectively [6]. Written information can support this discussion, and unresolved questions should be recorded for follow-up.

After a visit, patients need a clear way to contact the practice. Practices should specify who is responsible for discussing the test results, scheduling appointments, and checking referrals [6]. At the health system level, payment and staffing arrangements should allow time for these activities.

Future studies should distinguish between having a regular physician and the continuity of care and communication experienced by patients. Repeated measures of health literacy together with assessments of self-management and clinical outcomes could help determine the most relevant aspects of care. Access to follow-up should also be considered when evaluating interventions. Primary care should provide patients with a clear explanation of their treatment and a reliable way to return when questions remain unanswered.