Olives Travis D, Patel Roma G, Thompson Hannah M, Joing Scott, Miner James R
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; University of Minnesota-Twin Cities, Minneapolis, MN.
Am J Emerg Med. 2016 Jun;34(6):999-1005. doi: 10.1016/j.ajem.2016.02.046. Epub 2016 Feb 19.
Limited health literacy is a risk factor for poor outcomes in numerous health care settings. Little is known about the impact of instructional modality and health literacy on adherence to emergency department (ED) discharge instructions.
To examine the impact of instructional modality on 72-hour antibiotic retrieval among ED patients prescribed outpatient antibiotics for infections.
English-speaking ED patients diagnosed as having acute infections and prescribed outpatient antibiotics were randomized to standard discharge instructions, standard instructions plus text-messaged instructions, or standard instructions plus voicemailed instructions targeting ED prescriptions. Health literacy was determined by validated instrument. Seventy-two-hour antibiotic retrieval, 30-day report of prescription completion, and discharge instructional modality preference were assessed.
Nearly one-quarter of the 2521 participants demonstrated low health literacy. Low health literacy predicted decreased 72-hour antibiotic retrieval (χ(2) = 9.56, P=.008). No significant association with antibiotic retrieval was noted across the 3 treatment groups (χ(2) = 5.112, P=.078). However, patients randomized to the text message group retrieved antibiotic prescriptions within 72 hours more frequently than did those randomized to the voicemail treatment group (χ(2) = 4.345, P=.037), and patients with low health literacy randomized to voicemailed instructions retrieved their antibiotic prescriptions less frequently than did those randomized to standard of care instructions (χ(2) = 5.526, P=.019). Reported instructional modality preferences were inconsistent with the primary findings of the study.
Discharge instructional modality impacts antibiotic retrieval in patients with low health literacy. Preference for discharge instructional modality varies by degree of health literacy, but does not predict which modality will optimize 72-hour antibiotic retrieval.
健康素养有限是众多医疗环境中不良预后的一个风险因素。关于教育方式和健康素养对急诊科（ED）出院指导依从性的影响，人们了解甚少。
探讨教育方式对因感染而开具门诊抗生素处方的急诊科患者72小时内抗生素获取情况的影响。
将诊断为急性感染并开具门诊抗生素处方的英语流利的急诊科患者随机分为接受标准出院指导、标准指导加短信指导或标准指导加语音邮件指导（针对急诊科处方）。通过经过验证的工具确定健康素养。评估72小时抗生素获取情况、30天处方完成报告以及出院指导方式偏好。
2521名参与者中近四分之一表现出低健康素养。低健康素养预示着72小时抗生素获取率降低（χ² = 9.56，P = 0.008）。在3个治疗组中，未发现与抗生素获取有显著关联（χ² = 5.112，P = 0.078）。然而，随机分配到短信组的患者在72小时内获取抗生素处方的频率高于随机分配到语音邮件治疗组的患者（χ² = 4.345，P = 0.037），随机分配到语音邮件指导的低健康素养患者获取抗生素处方的频率低于随机分配到标准护理指导的患者（χ² = 5.526，P = 0.019）。报告的指导方式偏好与该研究的主要结果不一致。
出院指导方式影响低健康素养患者的抗生素获取。出院指导方式的偏好因健康素养程度而异，但无法预测哪种方式能优化72小时抗生素获取情况。
