Closing the loop - Physician communication with diabetic patients who have low health literacy
Closing the loop - Physician communication with diabetic patients who have low health literacy
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DOI：
10.1001/archinte.163.1.83
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发表时间：
2003-01-13
影响因子：
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通讯作者：
Bindman, AB
中科院分区：
文献类型：
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作者：
Schillinger, D;Piette, J;Bindman, AB
背景：患者在门诊就诊时仅能回忆或理解医生传达的内容的一半。为了提高回忆，理解和遵守，建议医生引起患者对新概念的理解，并定制后续信息，特别是对于功能性健康素养低的患者。目前尚不清楚医生应用这种互动教育策略的频率，也不清楚它是否与改善健康结果有关。方法：我们使用直接观察来测量在公立医院工作的初级保健医生在门诊就诊期间评估患者回忆和理解新概念的程度，使用38名医生和74名讲英语的糖尿病患者和低功能健康素养之间的访问录音带。然后，我们研究是否有一个协会之间的医生的应用程序，这种互动的沟通策略和患者的血糖控制使用的信息，从临床和行政databases.Results：医生评估的回忆和理解的任何新的概念，在12（20%）的61次访问和15（12%）的124个新的概念。医生评估患者的回忆或理解能力的患者与医生没有评估的患者相比，血红蛋白A1水平更可能低于平均值（小于或等于58.6%）（比值比，8.96; 95%置信区间，1.1-74.9）（P = 0.02）。多因素Logistic回归分析显示，与血糖控制良好独立相关的2个变量是较高的健康素养水平（比值比，3.97; 95%可信区间，1.09-14.47）（P=.04）和医生应用互动沟通策略（比值比，15.15; 95%可信区间，2.07-110.78）（P
Background: Patients recall or comprehend as little as half of what physicians convey during an outpatient encounter. To enhance recall, comprehension, and adherence, it is recommended that physicians elicit patients' comprehension of new concepts and tailor subsequent information, particularly for patients with low functional health literacy. It is not known how frequently physicians apply this interactive educational strategy, or whether it is associated with improved health outcomes.Methods: We used direct observation to measure the extent to which primary care physicians working in a public hospital assess patient recall and comprehension of new concepts during outpatient encounters, using audiotapes of visits between 38 physicians and 74 English-speaking patients with diabetes mellitus and low functional health literacy. We then examined whether there was an association between physicians' application of this interactive communication strategy and patients' glycemic control using information from clinical and administrative databases.Results: Physicians assessed recall and comprehension of any new concept in 12 (20%) of 61 visits and for 15 (12%) of 124 new concepts. Patients whose physicians assessed recall or comprehension were more likely to have hemoglobin A,, levels below the mean (less than or equal to58.6%) vs patients whose physicians did not (odds ratio, 8.96; 95% confidence interval, 1.1-74.9) (P =.02). After multivariate logistic regression, the 2 variables independently associated with good glycemic control were higher health literacy levels (odds ratio, 3.97; 95% confidence interval, 1.09-14.47) (P=.04) and physicians' application of the interactive communication strategy (odds ratio, 15.15; 95% confidence interval, 2.07-110.78) (P