Discharge Instruction Comprehension and Adherence Errors: Interrelationship Between Plan Complexity and Parent Health Literacy - 23/10/19
, Jonathan S. Farkas, MD 1, 2, Alan L. Mendelsohn, MD 1, 2, Arthur H. Fierman, MD 1, 2, Suzy Tomopoulos, MD 1, 2, Rebecca E. Rosenberg, MD, MPH 1, 2, Benard P. Dreyer, MD 1, 2, Jennifer Melgar, BA 1, 2, John Varriano, BA 1, 2, H. Shonna Yin, MD, MS 1, 2Abstract |
Objective |
To examine associations between parent health literacy, discharge plan complexity, and parent comprehension of and adherence to inpatient discharge instructions.
Study design |
This was a prospective cohort study of English/Spanish-speaking parents (n = 165) of children ≤12 years discharged on ≥1 daily medication from an urban, public hospital. Outcome variables were parent comprehension (survey) of and adherence (survey, in-person dosing assessment, chart review) to discharge instructions. Predictor variables included low parent health literacy (Newest Vital Sign score 0-3) and plan complexity. Generalized estimating equations were used to account for the assessment of multiple types of comprehension and adherence errors for each subject, adjusting for ethnicity, language, child age, length of stay, and chronic disease status. Similar analyses were performed to assess for mediation and moderation.
Results |
Error rates were highest for comprehension of medication side effects (50%), adherence to medication dose (34%), and return precaution (78%) instructions. Comprehension errors were associated with adherence errors (aOR, 8.7; 95% CI, 5.9-12.9). Discharge plan complexity was associated with comprehension (aOR, 7.0; 95% CI, 5.4-9.1) and adherence (aOR, 5.5; 95% CI, 4.0-7.6) errors. Low health literacy was indirectly associated with adherence errors through comprehension errors. The association between plan complexity and comprehension errors was greater in parents with low (aOR, 8.3; 95% CI, 6.2-11.2) compared with adequate (aOR, 3.8; 95% CI, 2.2-6.5) health literacy (interaction term P = .004).
Conclusions |
Parent health literacy and discharge plan complexity play key roles in comprehension and adherence errors. Future work will focus on the development of health literacy-informed interventions to promote discharge plan comprehension.
Il testo completo di questo articolo è disponibile in PDF.Keywords : medication errors, hospital medicine, inpatient setting, pediatrics, communication
Abbreviations : EHR, RA
Mappa
| Supported by DHHS/HRSA (T32HP22238 [to A.F.]); National Center for Advancing Translational Sciences/National Institutes of Health (NYU CTSA UL1 TR001445 [to NYU School of Medicine]); Academic Pediatric Association, McClean, VA (to A.G.); the Committee of Interns and Residents/Service Employees International Union, New York, NY (to A.G.); and KiDS of NYU, New York, NY (to A.G.). The study sponsors had no role in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; or (4) the decision to submit the paper for publication. The authors declare no conflicts of interest. |
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| Portions of this study were presented as a platform presentation at the Pediatric Academic Societies Meeting, May 6-9, 2017, San Francisco, California. |
Vol 214
P. 193 - novembre 2019 Ritorno al numero
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