急诊科患者对出院指导的理解：不同患者是否需要不同的方法？
Patient understanding of discharge instructions in the emergency department: do different patients need different approaches?
作者信息
Sheikh Hasan, Brezar Aleksandar, Dzwonek Agata, Yau Lawrence, Calder Lisa A
机构信息
Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
出版信息
Int J Emerg Med. 2018 Feb 8;11(1):5. doi: 10.1186/s12245-018-0164-0.
BACKGROUND
Previous studies have demonstrated that patients have poor understanding of the discharge instructions provided from the emergency department (ED). The aims of this study are to determine if patient factors, such as income and level of education, correlate with patient understanding of discharge instructions and to explore if different patient populations prefer different resources for receiving discharge instructions.
METHODS
We conducted live observations of physicians providing discharge instructions in the ED to 100 patients followed by a patient survey to determine their understanding in four domains (diagnosis, treatment plan, follow-up instructions, and return to ED (RTED) instructions) and collect patient demographics. We enrolled patients over the age of 18 being discharged home. We excluded non-English- or French-speaking patients and those with significant psychiatric history or cognitive impairment. We performed a two-way ANOVA analysis of patient factors and patient understanding.
RESULTS
We found that patients had poor understanding of discharge instructions, ranging from 24.0% having poor understanding of their follow-up plan to 64.0% for RTED instructions. Almost half (42%) of patients did not receive complete discharge instructions. Lower income was correlated with a significant decrease in patient understanding of discharge diagnosis (p = 0.01) and RTED instructions (p = 0.04). Patients who did not complete high school trended towards lower levels of understanding of their diagnosis and treatment plan (p = 0.06). Lower income patients had a preference for receiving a follow-up phone call by a nurse, while higher income patients preferred online resources.
CONCLUSIONS
Lower income patients and those who have not completed high school are at a higher risk of poor understanding discharge instructions. As new technological solutions emerge to aid patient understanding of discharge instructions, our study suggests they may not aid those who are at the highest risk of failing to understand their instructions.
背景
先前的研究表明，患者对急诊科提供的出院指导理解不佳。本研究的目的是确定患者因素，如收入和教育水平，是否与患者对出院指导的理解相关，并探讨不同患者群体是否更喜欢通过不同资源来接收出院指导。
方法
我们对急诊科医生向100名患者提供出院指导的过程进行了现场观察，随后进行了患者调查，以确定他们在四个领域（诊断、治疗计划、随访指导和返回急诊科（RTED）指导）的理解情况，并收集患者的人口统计学信息。我们纳入了18岁以上出院回家的患者。我们排除了不会说英语或法语的患者以及有严重精神病史或认知障碍的患者。我们对患者因素和患者理解情况进行了双向方差分析。
结果
我们发现患者对出院指导的理解不佳，对随访计划理解不佳的比例为24.0%，对RTED指导理解不佳的比例为64.0%。几乎一半（42%）的患者没有收到完整的出院指导。低收入与患者对出院诊断（p = 0.01）和RTED指导（p = 0.04）的理解显著下降相关。未完成高中学业的患者对其诊断和治疗计划的理解水平有降低的趋势（p = 0.06）。低收入患者更喜欢护士进行随访电话，而高收入患者更喜欢在线资源。
结论
低收入患者和未完成高中学业的患者对出院指导理解不佳的风险更高。随着有助于患者理解出院指导的新技术解决方案的出现，我们的研究表明，这些解决方案可能对那些最有可能无法理解出院指导的患者没有帮助。
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