Literacy and numeracy skills and anticoagulation control
Literacy and numeracy skills and anticoagulation control
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DOI：
10.1097/00000441-200408000-00004
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发表时间：
2004-08-01
影响因子：
3.1
通讯作者：
Byrd, JC
中科院分区：
文献类型：
--
作者：
Estrada, CA;Martin-Hryniewicz, M;Byrd, JC
背景：使用印刷材料在社会中发挥作用的能力(识字)和处理基本数字概念(算术)的能力可能会影响患者遵循剂量计划的能力。我们检查了服用华法林的患者的识字和算术技能，并探索了它们与抗凝控制的关系。方法和结果：在两个抗凝治疗单元就诊的50岁以上的患者被纳入前瞻性研究。我们测量了识字率、算术能力和国际标准化比率(INR)。在3个月的随访期间，我们计算了INR的变异性和患者的INR在他或她的治疗范围内的时间，与出血和有效性相关的变量。在143名患者中，只有75名(52.4%)的人能够阅读八年级或以下的健康相关词汇。患者完成的自我报告等级高于测量的识字等级(kappa=0.21)。虽然79.0%的学生至少完成了八个年级，但只有47.6%的学生在那个年级获得了分数。69名患者没有回答或正确回答了六个算术问题中的不到两个(48.3%)。识字率低(P=0.009)和算术能力低(P=0.004)的患者INR变异性较高。不同文化程度的患者在范围内的时间相似(P=0.9)。算术水平低的患者在治疗范围外花费的时间较多(P=0.04)，在范围内花费的时间有减少的趋势(P=0.10)。结论：低识字率在服用华法林的研究患者中普遍存在。识字和算术能力低与抗凝控制措施差有关。
Background: The ability to use printed material to function in society (literacy) and to handle basic numerical concepts (numeracy) may have implications in patients' ability to follow dosing schedules. We examined literacy and numeracy skills among patients on warfarin and explored their association with anticoagulation control. Methods and Results: Patients older than 50 years attending two anticoagulation management units were prospectively enrolled. We measured literacy, numeracy, and international normalized ratio (INR). During a 3-month follow-up period, we calculated the variability of the INR and the amount of time a patient's INR was within his or her therapeutic range, variables associated with bleeding and effectiveness. Among 143 patients, only 75 (52.4%) were able to read health-related words at the eighth grade level or less. Patients' self-reported grade completed was higher than the measured literacy grade level (kappa = 0.21). While 79.0% had completed at least eight grades, only 47.6% had a score at that grade level. Sixty-nine patients answered none or correctly answered fewer than two of the six numeracy questions (48.3%). The INR variability was higher among patients with lower literacy (P = 0.009) and lower numeracy skills (P = 0.004). The time in range was similar among patients at different literacy levels (P = 0.9). Patients with lower numeracy level spent more time above their therapeutic range (P = 0.04) and had a trend of less time spent in range (P = 0.10). Conclusions: Low literacy was prevalent among study patients taking warfarin. Low literacy and numeracy were associated with measures of poor anticoagulation control.