Can This Patient Read and Understand Written Health Information?
Can This Patient Read and Understand Written Health Information?
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DOI：
10.1001/jama.2010.896
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发表时间：
2010-07-07
影响因子：
120.7
通讯作者：
Bosworth, Hayden B.
中科院分区：
文献类型：
--
作者：
Powers, Benjamin J.;Trinh, Jane V.;Bosworth, Hayden B.
读写能力有限的患者健康状况不佳的风险更高;然而，医生的看法是不准确的识别这些病人。目的系统地审查的准确性，简短的文书，以确定患者的识字能力有限。数据来源搜索的英文文献，从1969年至2010年2月使用PubMed，Psychinfo，以及关于健康素养、算术、阅读能力、研究选择前瞻性研究，包括18岁或以上的成年患者，评估了一个简短的工具，用于识别有限的识字在卫生保健环境相比，接受数据提取研究由2名评审员独立评估，他们各自提取信息并分配总体质量评级。数据综合10个研究使用6种不同的仪器符合纳入标准。在多项措施中，最新的生命体征（英语）在3项研究的基础上，在识别有限的识字能力方面表现良好。在单项问题中，询问患者使用替代阅读器的情况、填写医疗表格的信心和自我评价的阅读能力在识别识字不足或边缘识字的患者方面表现良好。问病人：“你对自己填写医疗表格有多大信心？“与5.0的有限识字率的概括似然比（LR）相关（95%置信区间[CI]，3.8-6.4）回答“有点信心”或“完全不信心”;总结LR为2.2（95% CI，1.5-3.3）表示“有点自信”;总结LR为0.44（95% CI，0.24-0.82）表示“相当自信”或“非常自信”。“结论几个单项问题，包括使用替代阅读器和对医疗表格的信心，对于快速识别识字有限的患者是中等有效的。JAMA. 2010;304（1）：76-84 www.jama.com
Context Patients with limited literacy are at higher risk for poor health outcomes; however, physicians' perceptions are inaccurate for identifying these patients.Objective To systematically review the accuracy of brief instruments for identifying patients with limited literacy.Data Sources Search of the English-language literature from 1969 through February 2010 using PubMed, Psychinfo, and bibliographies of selected manuscripts for articles on health literacy, numeracy, reading ability, and reading skill.Study Selection Prospective studies including adult patients 18 years or older that evaluated a brief instrument for identifying limited literacy in a health care setting compared with an accepted literacy reference standard.Data Extraction Studies were evaluated independently by 2 reviewers who each abstracted information and assigned an overall quality rating. Disagreements were adjudicated by a third reviewer.Data Synthesis Ten studies using 6 different instruments met inclusion criteria. Among multi-item measures, the Newest Vital Sign (English) performed moderately well for identifying limited literacy based on 3 studies. Among the single-item questions, asking about a patient's use of a surrogate reader, confidence filling out medical forms, and self-rated reading ability performed moderately well in identifying patients with inadequate or marginal literacy. Asking a patient, "How confident are you in filling out medical forms by yourself?" is associated with a summary likelihood ratio (LR) for limited literacy of 5.0 (95% confidence interval [CI], 3.8-6.4) for an answer of "a little confident" or "not at all confident"; a summary LR of 2.2 (95% CI, 1.5-3.3) for "somewhat confident"; and a summary LR of 0.44 (95% CI, 0.24-0.82) for "quite a bit" or "extremely confident."Conclusion Several single-item questions, including use of a surrogate reader and confidence with medical forms, were moderately effective for quickly identifying patients with limited literacy. JAMA. 2010;304(1):76-84 www.jama.com