Nuernberger Matthias, Lehmann Thomas, Brodoehl Stefan, Huebner Jutta, Lewejohann Jan-Christoph
Department of Emergency Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
Department of Medical Statistics, Informatics and Data Science, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
Front Public Health. 2025 Aug 26;13:1656755. doi: 10.3389/fpubh.2025.1656755. eCollection 2025.
Most adults in the United States and Europe have low health literacy (HL), which also has an impact on emergency care. It is unclear, whether low HL impairs the patients' ability to evaluate the seriousness of their emergency and if it increases patient-clinician disagreement.
In this prospective cross-sectional study in a German tertiary-care emergency department (ED), 257 adults (median age = 55 y) self-assessed the severity of their condition on arrival; simultaneously, an ED nurse and physician provided independent assessments. Thirty days later, an expert panel reviewed each case and issued a specialist evaluation. HL was assessed with the 16-item European Health Literacy Survey (HLS-EU-Q16) and categorized as adequate ( = 95), problematic ( = 119), or inadequate ( = 43). Three discrepancy indices were computed from age-, gender-, and education-adjusted assessments. Spearman correlations and Kruskal-Wallis tests compared agreement across HL levels; linear and logistic regressions examined predictors of discrepancy and severe outcome.
Patients with adequate HL showed the strongest alignment with clinicians ( = 0.24), whereas correlations were weaker in the inadequate group (ρ = 0.18). Discrepancies decreased as HL improved ( = -0.12 to -0.19, < 0.05), but HL alone explained only up to 7% of variance. Concordant assessments increased with rising HL. Overestimation was most prevalent at inadequate HL level. In multivariable logistic modeling, each one-point increase in the Patient to Medical Team discrepancy raised the odds of a severe outcome by 27% (OR = 1.27, 95% CI [1.04, 1.55]), whereas each additional HL score point lowered the odds by 13% (OR = 0.87, 95% CI [0.77, 0.99]).
Lower HL modestly but consistently enlarges the gap between patients' and clinicians' emergency assessments and is associated to a higher likelihood of a severe outcome via this mismatch. Although adequate HL improves agreement, half of these patients still struggle to evaluate severity. Routine teach-back communication might be helpful to identify discrepancies. These findings underscore the need for healthcare professionals to assess patients without prejudice, regardless of presenting symptoms, to ensure optimal medical care.
Identifier, DRKS00032962.
美国和欧洲的大多数成年人健康素养较低，这也对急诊护理产生影响。目前尚不清楚低健康素养是否会损害患者评估自身急诊严重程度的能力，以及是否会增加患者与临床医生之间的分歧。
在德国一家三级护理急诊科进行的这项前瞻性横断面研究中，257名成年人（中位年龄 = 55岁）在到达时自行评估了病情的严重程度；同时，一名急诊科护士和医生进行了独立评估。30天后，一个专家小组审查了每个病例并给出了专业评估。使用16项欧洲健康素养调查问卷（HLS-EU-Q16）评估健康素养，并将其分为足够（ = 95）、有问题（ = 119）或不足（ = 43）三类。根据年龄、性别和教育程度调整后的评估计算了三个差异指数。采用Spearman相关性分析和Kruskal-Wallis检验比较不同健康素养水平之间的一致性；线性回归和逻辑回归分析了差异和严重结果的预测因素。
健康素养足够的患者与临床医生的一致性最强（ = 0.24），而健康素养不足组的相关性较弱（ρ = 0.18）。随着健康素养的提高，差异减小（ = -0.12至-0.19， < 0.05），但仅健康素养只能解释高达7%的方差。随着健康素养的提高，一致性评估增加。在健康素养不足水平时，高估最为普遍。在多变量逻辑模型中，患者与医疗团队之间的差异每增加1分，严重后果的几率就会增加27%（OR = 1.27，95%CI [1.04, 1.55]），而健康素养得分每增加1分，几率就会降低13%（OR = 0.87，95%CI [0.77, 0.99]）。
较低的健康素养适度但持续地扩大了患者与临床医生在急诊评估上的差距，并通过这种不匹配与严重后果更高的可能性相关。虽然足够的健康素养能提高一致性，但这些患者中有一半仍难以评估严重程度。常规的反馈沟通可能有助于识别差异。这些发现强调了医疗保健专业人员需要不带偏见地评估患者，无论其呈现何种症状，以确保最佳医疗护理。
标识符，DRKS00032962。
