Relationship of Health Literacy to Intentional and Unintentional Non-Adherence of Hospital Discharge Medications
Relationship of Health Literacy to Intentional and Unintentional Non-Adherence of Hospital Discharge Medications
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DOI：
10.1007/s11606-011-1886-3
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发表时间：
2012-02-01
影响因子：
5.7
通讯作者：
Baker, David W.
中科院分区：
文献类型：
--
作者：
Lindquist, Lee A.;Go, Lise;Baker, David W.
老年人普遍缺乏卫生知识，这与健康状况不佳有关。出院时，经常更换药物，并通过出院说明告知患者这些变化。探讨健康素养与出院后48小时用药差异的关系，确定出院用药差异的原因。使用成人功能健康素养测试（sTOFHLA）的简写形式评估出院时健康素养的面对面调查。我们从书面出院说明中获得了药物清单。出院后48小时，我们打电话给受试者，评估他们目前的用药方案，任何用药差异，以及差异的原因。254名居住在社区的老年人，每千分之一的人，在一家城市医院接受24小时的急诊服务。254例老年人[平均年龄79.3岁，女性53.1%]中，142例（56%）出院后48小时的用药情况与出院说明不符。健康素养不足和边缘健康素养的受试者更容易出现非故意不依从性，即受试者不了解如何服药[健康素养不足47.7% vs边缘31.8% vs充足20.5% p = 0.002]。相反，那些健康素养足够的人明显更有可能故意不遵守，这意味着受试者理解了说明，但选择不遵守，这是导致药物差异的原因，与边缘和不充分的健康素养相比[充分73.3% vs.边缘11.1% vs.不充分15.6%,p < 0.001]。另一个常见的差异原因是出院指示不准确（39.3%）。有足够健康知识的老年人更倾向于故意不遵守他们的出院指示。健康知识不足的老年人更有可能因误解出院指示而出错。总之，这些结果可以解释为什么以前的研究表明健康素养和总体用药差异之间缺乏联系。
Inadequate health literacy is prevalent among seniors and is associated with poor health outcomes. At hospital discharge, medications are frequently changed and patients are informed of these changes via their discharge instructions.Explore the association between health literacy and medication discrepancies 48 hours after hospital discharge and determine the causes of discharge medication discrepancies.Face-to-face surveys assessing health literacy at hospital discharge using the short form of the Test of Functional Health Literacy in Adults (sTOFHLA). We obtained the medication lists from the written discharge instructions. At 48 hrs post-discharge, we phoned subjects to assess their current medication regimen, any medication discrepancies, and the causes of the discrepancies.Two hundred and fifty-four community-dwelling seniors a parts per thousand yen70 years, admitted to acute medicine services for > 24 hours at an urban hospital.Of 254 seniors [mean age 79.3 yrs, 53.1% female], 142 (56%) had a medication discrepancy between their discharge instructions and their actual home medication use 48 hrs after discharge. Subjects with inadequate and marginal health literacy were significantly more likely to have unintentional non-adherence-meaning the subject did not understand how to take the medication [inadequate health literacy 47.7% vs. marginal 31.8% vs. adequate 20.5% p = 0.002]. Conversely, those with adequate health literacy were significantly more likely to have intentional non-adherence-meaning the subject understood the instructions but chose not to follow them as a reason for the medications discrepancy compared with marginal and inadequate health literacy [adequate 73.3% vs. marginal 11.1% vs. inadequate 15.6%, p < 0.001]. Another common cause of discrepancies was inaccurate discharge instructions (39.3%).Seniors with adequate health literacy are more inclined to purposefully not adhere to their discharge instructions. Seniors with inadequate health literacy are more likely to err due to misunderstanding their discharge instructions. Together, these results may explain why previous studies have shown a lack of association between health literacy and overall medication discrepancies.