Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Antimicrob Resist Infect Control. 2023 Aug 10;12(1):77. doi: 10.1186/s13756-023-01277-1.
Contact investigation is an important tool to identify unrecognized patients who are colonized with antibiotic-resistant bacteria. Many Dutch hospitals include already discharged contact patients by sending them a self-sampling request at home, incl. an information letter and sampling materials. Each hospital composes these information letters on their own initiative, however, whether discharged patients comprehend and comply with these requests remains unclear. Therefore, the aim was to provide insight into patients' comprehension of and self-reported compliance with self-sampling requests post-discharge.
This mixed-methods study was performed in eight Dutch hospitals. First, the Common European Framework of Reference (CEFR) language level of self-sampling request letters was established. Second, a questionnaire about patients' comprehension of the letter, self-reported compliance, and reasons for compliance or non-compliance were sent to patients that received such a request in 2018/2019. Finally, a random selection of questionnaire respondents was interviewed between January and March 2020 to gain additional insights.
CEFR levels of 15 letters were established. Four letters were assigned level B1, four letters B1-B2, and seven letters B2. The majority of patients reported good comprehension of the letter they had received. Conversely, some respondents indicated that information about the bacterium (18.4%), the way in which results would be communicated (18.1%), and the self-sampling instructions (9.7%) were (partially) unclear. Furthermore, self-reported compliance was high (88.8%). Reasons to comply were personal health (84.3%), the health of others (71.9%), and general patient safety (96.1%). Compliant patients appeared to have a need for confirmation, wanted to protect family and/or friends, and felt they were providing the hospital the ability to control the transmission of antibiotic-resistant bacteria. Although a limited number of non-compliant patients responded to the questionnaire, it seemed that more patients did not comply with self-sampling requests when they received a letter in a higher CEFR-level (B2) compared to a lower CEFR-level (< B2) (9.8% vs. 2.5%, P = 0.049).
This study showed an overall good comprehension of and high self-reported compliance with self-sampling requests post-discharge. Providing balanced information in self-sampling request letters has the potential to reduce patient's ambiguity and concerns, and can cause increased compliance with self-sampling requests.
接触者调查是识别未被识别的定植有抗生素耐药菌患者的重要工具。许多荷兰医院通过向已出院的接触者在家中发送自我采样请求，包括信息函和采样材料，来包括这些已出院的接触者。每家医院都是自行编写这些信息函，但出院患者是否理解并遵守这些请求尚不清楚。因此，本研究旨在了解患者出院后对自我采样请求的理解和自我报告的依从性。
本混合方法研究在荷兰的 8 家医院进行。首先，根据《欧洲共同参考框架》（CEFR）确定自我采样请求函的语言级别。其次，在 2018/2019 年向收到此类请求的患者发送了一份关于他们对信函的理解、自我报告的依从性以及依从或不依从的原因的问卷。最后，在 2020 年 1 月至 3 月期间，随机选择问卷回答者进行访谈，以获得更多见解。
确定了 15 封信的 CEFR 级别。有 4 封信被评为 B1 级，4 封信为 B1-B2 级，7 封信为 B2 级。大多数患者报告说他们很好地理解了收到的信。相反，一些受访者表示，有关细菌的信息（18.4%）、结果沟通方式（18.1%）和自我采样说明（9.7%）部分不清楚。此外，自我报告的依从性很高（88.8%）。依从的原因是个人健康（84.3%）、他人健康（71.9%）和一般患者安全（96.1%）。依从的患者似乎需要得到确认，希望保护家人和/或朋友，并认为他们为医院控制抗生素耐药菌的传播提供了能力。尽管回答问卷的非依从患者人数有限，但似乎收到 CEFR 级别较高（B2）的信的患者比收到 CEFR 级别较低（<B2）的信的患者更不依从自我采样请求（9.8%比 2.5%，P=0.049）。
本研究显示，出院后患者对自我采样请求的总体理解良好，自我报告的依从性很高。在自我采样请求函中提供平衡的信息有可能减少患者的歧义和担忧，并提高对自我采样请求的依从性。
