Rhodes K V, Lauderdale D S, Stocking C B, Howes D S, Roizen M F, Levinson W
Robert Wood Johnson Clinical Scholars Program, University of Chicago, IL 60637, USA.
Ann Emerg Med. 2001 Mar;37(3):284-91. doi: 10.1067/mem.2001.110818.
We evaluate a computer-based intervention for screening and health promotion in the emergency department and determine its effect on patient recall of health advice.
This controlled clinical trial, with alternating assignment of patients to a computer intervention (prevention group) or usual care, was conducted in a university hospital ED. The study group consisted of 542 adult patients with nonurgent conditions. The study intervention was a self-administered computer survey generating individualized health information. Outcome measures were (1) patient willingness to take a computerized health risk assessment, (2) disclosure of behavioral risk factors, (3) requests for health information, and (4) remembered health advice.
Eighty-nine percent (470/542) of eligible patients participated. Ninety percent were black. Eighty-five percent (210/248) of patients in the prevention group disclosed 1 or more major behavioral risk factors including current smoking (79/248; 32%), untreated hypertension (28/248; 13%), problem drinking (46/248; 19%), use of street drugs (33/248; 13%), major depression (87/248; 35%), unsafe sexual behavior (84/248; 33%), and several other injury-prone behaviors. Ninety-five percent of patients in the prevention group requested health information. On follow-up at 1 week, 62% (133/216) of the prevention group patients compared with 27% (48/180) of the control subjects remembered receiving advice on what they could do to improve their health (relative risk 2.3, 95% confidence interval 1.77 to 3.01).
Using a self-administered computer-based health risk assessment, the majority of patients in our urban ED disclosed important health risks and requested information. They were more likely than a control group to remember receiving advice on what they could do to improve their health. Computer methodology may enable physicians to use patient waiting time for health promotion and to target at-risk patients for specific interventions.
我们评估一种基于计算机的干预措施在急诊科进行筛查和健康促进的效果，并确定其对患者对健康建议的记忆情况的影响。
这项对照临床试验在一家大学医院的急诊科开展，患者交替分配至计算机干预组（预防组）或常规护理组。研究组由542例患有非紧急病症的成年患者组成。研究干预措施是一项可生成个性化健康信息的自我管理式计算机调查。结局指标包括：（1）患者接受计算机化健康风险评估的意愿；（2）行为危险因素的披露情况；（3）对健康信息的需求；（4）记住的健康建议。
89%（470/542）的符合条件患者参与了研究。90%为黑人。预防组中85%（210/248）的患者披露了1种或更多主要行为危险因素，包括当前吸烟（79/248；32%）、未治疗的高血压（28/248；13%）、问题饮酒（46/248；19%）、使用街头毒品（33/248；13%）、重度抑郁症（87/248；35%）、不安全的性行为（84/248；33%）以及其他几种易导致受伤的行为。预防组中95%的患者索要健康信息。在1周后的随访中，预防组62%（133/216）的患者记住了关于如何改善健康的建议，而对照组这一比例为27%（48/180）（相对风险2.3，95%置信区间1.77至3.01）。
通过自我管理式基于计算机的健康风险评估，我们城市急诊科的大多数患者披露了重要的健康风险并索要信息。他们比对照组更有可能记住关于如何改善健康的建议。计算机方法可能使医生能够利用患者的候诊时间进行健康促进，并针对高危患者进行特定干预。
