Feinberg Iris, Ogrodnick Michelle M, Hendrick Robert C, Bates Kimberly, Johnson Kevin, Wang Bingyan
Health Lit Res Pract. 2019 Jul 1;3(2):e117-e126. doi: 10.3928/24748307-20190501-01. eCollection 2019 Apr.
Health care providers (HCPs) may ask patients if they understand their diagnosis or instructions during clinic visits; patients often simply say yes. However, many patients leave with little idea of their medication and discharge instructions. Teach Back (TB) is a patient-centered health-literate technique that allows HCPs to confirm patient understanding during clinic visits.
The purpose of this pilot study was to determine a relationship between perception and actual use of TB by medical residents in primary care outpatient clinics (providers, = 16; clinic visits, = 80) and, if the observed rate of TB was discordant with perception, did a TB skills training intervention have any impact on use of TB (clinic visit, = 78). We were also interested in language used during TB and if use of TB was related to patient demographics or health literacy level.
Medical residents' perception was measured using the "Always Use Teach-Back Confidence and Conviction Scale" ( = 16). Clinic visits were audiotaped and scored for use of TB (pre-intervention, = 80; post-intervention, =78). The intervention was a 1-hour TB skills training course. Content analysis was performed to understand the use of TB language.
Despite the high level of confidence/conviction about TB ([16] = .669, <. 05) TB was only used twice out of 80 visits during pre-intervention clinic visits. During post-intervention, use of TB increased to 41 times by 10 residents (c2[1, = 16] = 6.533, <. 05). TB language after the intervention was more collaborative; there was a relationship between gender and use of TB.
Results from our pilot study identified three important observations that may be critical to improving health-literate physician communication: residents believe they are using TB in the clinic for many patients; use of TB was discordantly low at 2.5%; and a single 1-hour skills training intervention dramatically increased TB use to 53%. Residents used patient-centered TB language after the training intervention. .
Medical residents believe they are using Teach Back to confirm patient understanding in the clinic 60% of the time when they actually used Teach Back only 2.5% of the time. After an educational intervention, they used Teach Back 53% of the time; Teach-Back language was collaborative and patient-centered, and all but two patients confirmed their medication and discharge plan.
医疗服务提供者（HCPs）在门诊就诊时可能会询问患者是否理解自己的诊断或医嘱；患者通常只是简单地回答“是”。然而，许多患者离开时对自己的用药和出院医嘱却知之甚少。反馈教学法（TB）是一种以患者为中心的健康素养技巧，可让医疗服务提供者在门诊就诊时确认患者是否理解。
这项试点研究的目的是确定初级保健门诊的住院医师对反馈教学法的认知与实际使用之间的关系（提供者，n = 16；门诊就诊次数，n = 80），如果观察到的反馈教学法使用率与认知不一致，那么反馈教学法技能培训干预对其使用是否有任何影响（门诊就诊次数，n = 78）。我们还对反馈教学法中使用的语言以及反馈教学法的使用是否与患者人口统计学特征或健康素养水平相关感兴趣。
使用“始终使用反馈教学法的信心和信念量表”（n = 16）来衡量住院医师的认知。对门诊就诊进行录音，并对反馈教学法的使用进行评分（干预前，n = 80；干预后，n = 78）。干预措施是一个为期1小时的反馈教学法技能培训课程。进行内容分析以了解反馈教学法语言的使用情况。
尽管对反馈教学法有很高的信心/信念（[16] = 0.669，P < 0.05），但在干预前的80次门诊就诊中，反馈教学法仅使用了两次。在干预后，10名住院医师使用反馈教学法的次数增加到了41次（χ2[1, n = 16] = 6.533，P < 0.05）。干预后的反馈教学法语言更具协作性；反馈教学法的使用与性别之间存在关系。
我们试点研究的结果确定了三个重要观察结果，这可能对改善具有健康素养的医生沟通至关重要：住院医师认为他们在诊所中对许多患者使用了反馈教学法；反馈教学法的使用率低至2.5%，存在不一致；单次1小时的技能培训干预显著将反馈教学法的使用率提高到了53%。培训干预后，住院医师使用了以患者为中心的反馈教学法语言。
住院医师认为他们在诊所中60%的时间使用反馈教学法来确认患者的理解，而实际上他们仅在2.5%的时间使用了反馈教学法。经过教育干预后，他们在53%的时间使用了反馈教学法；反馈教学法语言具有协作性且以患者为中心，除两名患者外，所有患者都确认了他们的用药和出院计划。
