患者英语水平有限时的住院准备情况:床边口译电话的混合方法研究。
Hospital discharge preparedness for patients with limited English proficiency: A mixed methods study of bedside interpreter-phones.
机构信息
Division of General Internal Medicine, University of California San Francisco, CA, USA.
Division of General Internal Medicine, University of California San Francisco, CA, USA; Multiethnic Health Equity Research Center, University of California San Francisco, CA, USA.
出版信息
Patient Educ Couns. 2018 Jan;101(1):25-32. doi: 10.1016/j.pec.2017.07.026. Epub 2017 Jul 24.
OBJECTIVE
Assess effects of a bedside interpreter-phone intervention on hospital discharge preparedness among patients with limited English proficiency (LEP).
METHODS
Mixed-methods study compared patient-reported discharge preparedness and knowledge of medications and follow-up appointments among 189 Chinese- and Spanish-speakers before (n=94) and after (n=95) bedside interpreter-phone implementation, and examined nurse and resident-physician interpreter-phone utilization through focus groups.
RESULTS
Pre-post discharge preparedness (Care Transitions Measure mean 77.2 vs. 78.5; p=0.62) and patient-reported knowledge of follow-up appointments, discharge medication administration and side effects did not differ significantly. Pre-post knowledge of medication purpose increased in bivariate (88% vs. 97%, p=0.02) and propensity score adjusted analyses [aOR (adjusted odds ratio), 4.49; 95% CI, 1.09-18.4]. Nurses and physicians reported using interpreter-phones infrequently for discharge communication, preferring in-person interpreters for complex discharges and direct communication with family for routine discharges. Post-implementation patients reported continued use of ad-hoc family interpreters (43%) or no interpretation at all (22%).
CONCLUSION
Implementation of a bedside interpreter-phone systems intervention did not consistently improve patient-reported measures of discharge preparedness, possibly due to limited uptake during discharges.
PRACTICE IMPLICATIONS
Hospital systems must better understand clinician preferences for discharge communication to successfully increase professional interpretation and shift culture away from using family members as interpreters.
目的
评估床边口译员-电话干预对英语水平有限的患者出院准备情况的影响。
方法
混合方法研究比较了 189 名讲中文和西班牙语的患者在床边口译员-电话实施前后(n=94 和 n=95)的患者报告的出院准备情况和对药物及随访预约的了解程度,并通过焦点小组检查了护士和住院医师-口译员-电话的使用情况。
结果
出院准备情况(转归过渡测量平均得分 77.2 与 78.5;p=0.62)和患者报告的随访预约、出院药物管理和副作用的了解程度无显著差异。药物用途的知识在单变量(88%与 97%,p=0.02)和倾向评分调整分析中有所增加[调整后的优势比(aOR),4.49;95%置信区间,1.09-18.4]。护士和医师报告说,他们很少使用口译员-电话进行出院沟通,更倾向于在复杂情况下使用现场口译员,并在常规情况下与家属进行直接沟通。实施后,患者报告继续使用临时家庭口译员(43%)或根本不使用口译员(22%)。
结论
床边口译员-电话系统干预的实施并没有始终如一地改善患者报告的出院准备情况,这可能是由于在出院过程中使用率有限。
实践意义
医院系统必须更好地了解临床医生对出院沟通的偏好,以成功增加专业口译,并将文化从使用家庭成员作为口译员转变。