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Seventy-two-hour antibiotic retrieval from the ED: a randomized controlled trial of discharge instructional modality

Published:February 18, 2016DOI:https://doi.org/10.1016/j.ajem.2016.02.046

      Abstract

      Background

      Limited health literacy is a risk factor for poor outcomes in numerous health care settings. Little is known about the impact of instructional modality and health literacy on adherence to emergency department (ED) discharge instructions.

      Purpose

      To examine the impact of instructional modality on 72-hour antibiotic retrieval among ED patients prescribed outpatient antibiotics for infections.

      Methods

      English-speaking ED patients diagnosed as having acute infections and prescribed outpatient antibiotics were randomized to standard discharge instructions, standard instructions plus text-messaged instructions, or standard instructions plus voicemailed instructions targeting ED prescriptions. Health literacy was determined by validated instrument. Seventy-two-hour antibiotic retrieval, 30-day report of prescription completion, and discharge instructional modality preference were assessed.

      Results

      Nearly one-quarter of the 2521 participants demonstrated low health literacy. Low health literacy predicted decreased 72-hour antibiotic retrieval (χ2 = 9.56, P = .008). No significant association with antibiotic retrieval was noted across the 3 treatment groups (χ2 = 5.112, P = .078). However, patients randomized to the text message group retrieved antibiotic prescriptions within 72 hours more frequently than did those randomized to the voicemail treatment group (χ2 = 4.345, P = .037), and patients with low health literacy randomized to voicemailed instructions retrieved their antibiotic prescriptions less frequently than did those randomized to standard of care instructions (χ2 = 5.526, P = .019). Reported instructional modality preferences were inconsistent with the primary findings of the study.

      Conclusions

      Discharge instructional modality impacts antibiotic retrieval in patients with low health literacy. Preference for discharge instructional modality varies by degree of health literacy, but does not predict which modality will optimize 72-hour antibiotic retrieval.
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      References

        • Nielsen-Bohlman L.
        • Panzer A.M.
        • Kindig D.A.
        Health literacy: a prescription to end confusion.
        The National Academies Press, 2004
        • Hardie N.A.
        • Kyanko K.
        • Busch S.
        • Losasso A.T.
        • Levin R.A.
        Health literacy and health care spending and utilization in a consumer-driven health plan.
        J Health Commun. 2011; 16: 308-321https://doi.org/10.1080/10810730.2011.604703
        • Herndon J.B.
        • Chaney M.
        • Carden D.
        Health literacy and emergency department outcomes: a systematic review.
        Ann Emerg Med. 2011; 57: 334-345https://doi.org/10.1016/j.annemergmed.2010.08.035
        • Murray M.D.
        • Tu W.
        • Wu J.
        • Morrow D.
        • Smith F.
        • Brater D.C.
        Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills.
        . 2010; 85: 651-658https://doi.org/10.1038/clpt.2009.7.Factors
        • Omachi T.A.
        • Sarkar U.
        • Yelin E.H.
        • Blanc P.D.
        • Katz P.P.
        Lower health literacy is associated with poorer health status and outcomes in chronic obstructive pulmonary disease.
        J Gen Intern Med. 2013; 28: 74-81https://doi.org/10.1007/s11606-012-2177-3
        • Schumacher J.R.
        • Hall A.G.
        • Davis T.C.
        • Arnold C.L.
        • Benneth R.D.
        • Wolf M.S.
        • et al.
        Potentially preventable use of emergency services: the role of low health literacy.
        Med Care. 2013; 51: 654-658https://doi.org/10.1097/MLR.0b013e3182992c5a
        • Gazmararian J.A.
        • Williams M.V.
        • Peel J.
        • Baker D.W.
        Health literacy and knowledge of chronic disease.
        Patient Educ Couns. 2003; 51 ([Available at: http://www.ncbi.nlm.nih.gov/pubmed/14630383]): 267-275
        • Persell S.D.
        • Osborn C.Y.
        • Richard R.
        • Skripkauskas S.
        • Wolf M.S.
        Limited health literacy is a barrier to medication reconciliation in ambulatory care.
        J Gen Intern Med. 2007; 22: 1523-1526https://doi.org/10.1007/s11606-007-0334-x
        • Kripalani S.
        • Gatti M.E.
        • Jacobson T.A.
        Association of age, health literacy, and medication management strategies with cardiovascular medication adherence.
        Patient Educ Couns. 2010; 81: 177-181https://doi.org/10.1016/j.pec.2010.04.030
        • Noureldin M.
        • Plake K.S.
        • Morrow D.G.
        • Tu W.
        • Wu J.
        • Murray M.D.
        Effect of health literacy in patients with heart failure.
        Pharmacotherapy. 2012; 32: 819-826
        • Davis T.C.
        • Wolf M.S.
        • Bass 3rd, P.F.
        • Thompson J.A.
        • Tilson H.H.
        • Neuberger M.
        • et al.
        Literacy and misunderstanding prescription drug labels.
        Ann Int Med. 2006; 145: 887-894
        • Dunn-Navarra A.M.
        • Stockwell M.S.
        • Meyer D.
        • Larson E.
        Parental health literacy, knowledge and beliefs regarding upper respiratory infections (URI) in an urban latino immigrant population.
        J Urban Heal. 2012; 89: 848-860https://doi.org/10.1007/s11524-012-9692-8
        • Rowlands G.
        • Protheroe J.
        • Winkley J.
        • Richardson M.
        • Seed P.T.
        • Rudd R.
        A mismatch between population health literacy and the complexity of health information: an observational study.
        Br J Gen Pract. 2015; 65: e379-e386https://doi.org/10.3399/bjgp15X685285
        • Chappuy H.
        • Taupin P.
        • Dimet J.
        • Claessens Y.E
        • Tréluyer J.M.
        • Chéron G.
        • Groupe Francophone de Réanimation & Urgences Pédiatriques
        Do parents understand the medical information provided in paediatric emergency departments? A prospective multicenter study.
        Acta Paediatr. 2012; 101: 1089-1094https://doi.org/10.1111/j.1651-2227.2012.02763.x
        • Engel K.G.
        • Heisler M.
        • Smith D.M.
        • Robinson C.H.
        • Forman J.H.
        • Ubel P.A.
        Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?.
        Ann Emerg Med. 2009; 53 ([e15]): 454-461https://doi.org/10.1016/j.annemergmed.2008.05.016
        • Gignon M.
        • Ammirati C.
        • Mercier R.
        • Detave M.
        Compliance with emergency department discharge instructions.
        J Emerg Nurs. 2014; 40: 51-55https://doi.org/10.1016/j.jen.2012.10.004
        • Lieberman P.
        • Decker W.
        • Camargo C.A. Jr
        • Oconnor R.
        • Oppenheimer J.
        • Simons F.E.
        SAFE: a multidisciplinary approach to anaphylaxis education in the emergency department.
        Ann Allergy Asthma Immunol. 2007; 98: 519-523https://doi.org/10.1016/S1081-1206(10)60729-6
        • Ginde A.A.
        • Clark S.
        • Goldstein J.N.
        • Camargo C.A. Jr
        Demographic disparities in numeracy among emergency department patients: evidence from two multicenter studies.
        Patient Educ Couns. 2008; 72: 350-356https://doi.org/10.1016/j.pec.2008.03.012
        • Ginde A.A.
        • Pallin D.J.
        • Camargo C.A.
        Hospitalization and discharge education of emergency department patients with hypoglycemia.
        Diabetes Educ. 2014; 34: 683-691https://doi.org/10.1177/0145721708321022
        • Heng K.W.J.
        • Tham K.Y.
        • How K.Y.
        • Foo J.S.
        • Lau Y.H.
        • Li A.Y.
        Recall of discharge advice given to patients with minor head injury presenting to a Singapore emergency department.
        Singapore Med J. 2007; 48 ([Available at: http://www.ncbi.nlm.nih.gov/pubmed/18043837]): 1107-1110
        • Wolf M.S.
        • Bailey S.C.
        • Serper M.
        • Smith M.
        • Davis T.C.
        • Russell A.L.
        • et al.
        Comparative effectiveness of patient-centered strategies to improve FDA medication guides.
        Med Care. 2014; 52: 781-789https://doi.org/10.1097/MLR.0000000000000182
        • Wolf M.S.
        • Davis T.C.
        • Curtis L.M.
        • Webb J.A.
        • Bailey S.C.
        • Shrank W.H.
        • et al.
        Effect of standardized, Patient-centered label instructions to improve comprehension of prescription drug use methods.
        . 2011; 49: 96-100
        • Powers R.D.
        Emergency department patient literacy and the readability of patient-directed materials.
        Ann Emerg Med. 1988; 17 ([Available at: http://www.ncbi.nlm.nih.gov/pubmed/3337429]): 124-126
        • Olives T.
        • Patel R.
        • Patel S.
        • Hottinger J.
        • Miner J.R.
        Health literacy of adults presenting to an urban ED.
        Am J Emerg Med. 2011; 29: 875-882https://doi.org/10.1016/j.ajem.2010.03.031
        • Karras D.J.
        • Kruus L.K.
        • Cienki J.J.
        • Wald M.M.
        • Chiang W.K.
        • Shayne P.
        • et al.
        Evaluation and treatment of patients with severely elevated blood pressure in academic emergency departments: a multicenter study.
        Ann Emerg Med. 2006; 47: 230-236https://doi.org/10.1016/j.annemergmed.2005.11.001
        • Lawrence L.M.
        • Jenkins C.A.
        • Zhou C.
        • Givens T.G.
        The effect of diagnosis-specific computerized discharge instructions on 72-hour return visits to the pediatric emergency department.
        Pediatr Emerg Care. 2009; 25: 733-738https://doi.org/10.1097/PEC.0b013e3181bec817
        • Johnson a
        • Sandford J.
        Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home: systematic review.
        Health Educ Res. 2005; 20: 423-429https://doi.org/10.1093/her/cyg141
        • Giuse N.B.
        • Koonce T.Y.
        • Storrow A.B.
        • Kusnoor S.V.
        • Ye F.
        Using health literacy and learning style preferences to optimize the delivery of health information.
        J Health Commun. 2012; 17: 122-140https://doi.org/10.1080/10810730.2012.712610
        • Stockwell M.S.
        • Hofstetter A.M.
        • DuRivage N.
        • Barrett A.
        • Fernandes N.
        • Vargas C.Y.
        • et al.
        Text message reminders for second dose of influenza vaccine: a randomized controlled trial.
        Pediatrics. 2015; 135: e83-e91https://doi.org/10.1542/peds.2014-2475
        • Paul A.
        • Cho E.
        • Sarohia M.
        Text messaging in the emergency department: a novel and more efficient way to inform patients about test results.
        Ann Emerg Med. 2010; 56: S122https://doi.org/10.1016/j.annemergmed.2010.06.432
        • Cole-Lewis H.
        • Kershaw T.
        Text messaging as a tool for behavior change in disease prevention and management.
        Epidemiol Rev. 2010; 32: 56-69https://doi.org/10.1093/epirev/mxq004.Text
        • Diez-Canseco F.
        • Zavala-Loayza J.A.
        • Beratarrechea A.
        • Kanter R.
        • Ramirez-Zea M.
        • Rubinstein A.
        • et al.
        Design and multi-country validation of text messages for an mHealth Intervention for Primary Prevention of Progression to Hypertension in Latin America.
        JMIR Mhealth Uhealth. 2015; 3e19https://doi.org/10.2196/mhealth.3874
        • Albino S.
        • Tabb K.M.
        • Requena D.
        • Egoavil M.
        • Pineros-Leano M.F.
        • Zunt J.R.
        • et al.
        Perceptions and acceptability of short message services technology to improve treatment adherence amongst tuberculosis patients in Peru: A focus group study.
        PLoS One. 2014; 9: 1-6https://doi.org/10.1371/journal.pone.0095770
        • Kumar D.
        • Arya M.
        mHealth is an innovative approach to address health literacy and improve patient-physician communication—an HIV testing exemplar.
        J Mob Technol Med. 2015; 4: 25-30https://doi.org/10.7309/jmtm.4.1.6.mHealth
        • Suffoletto B.
        • Calabria J.
        • Ross A.
        • Callaway C.
        • Yealy D.M.
        A mobile phone text message program to measure oral antibiotic use and provide feedback on adherence to patients discharged from the emergency department.
        Acad Emerg Med. 2012; 19: 949-958https://doi.org/10.1111/j.1553-2712.2012.01411.x
        • Powers B.J.
        • Trinh J.V.
        • Bosworth H.B.
        Can this patient read and understand written health information?.
        JAMA. 2010; 304: 76-84https://doi.org/10.1001/jama.2010.896
        • Weiss B.
        • Mays M.Z.
        • Martz W.
        • Castro K.M.
        • DeWalt D.A.
        • Pignone M.P.
        • et al.
        Quick assessment of literacy in primary care : the Newest Vital Sign.
        . 2005; 514–522https://doi.org/10.1370/afm.405.College
        • Dumenci L.
        • Matsuyama R.K.
        • Kuhn L.
        • Perera R.A.
        • Siminoff L.A.
        On the validity of the Rapid Estimate of Adult Literacy in Medicine (REALM) scale as a measure of health literacy.
        Commun Methods Meas. 2013; 7: 134-143https://doi.org/10.1080/19312458.2013.789839
        • Lam F.
        • Stevenson F.A.
        • Britten N.
        • Stell I.M.
        Adherence to antibiotics prescribed in an accident and emergency department: the influence of consultation factors.
        Eur J Emerg Med. 2001; 8: 181-188https://doi.org/10.1097/00063110-200109000-00004
        • El-Shinnawy M.M.
        • Markus M.L.
        Media richness theory and new electronic communication media: A study of voicemail and electronic mail.
        in: International Conference on Information Systems. 1992 ([Paper 36 http://aisel.aisnet.org/icis1992/36])