Health literacy and the emergency room

A multicenter, cross-sectional study in last month's Academic Emergency Medicine administered a short health literacy assessment questionnaire to 300 patients in 3 Boston emergency rooms. In addition to examining raw scores, investigators also looked at correlations with other sociodemographic variables.

Older age, less education, and lower income were all associated with reduced functional health literacy. Associations with ethnicity, race, and language were not statistically significant in the multivariate analysis (i.e. after correcting for other variables).

The authors note "In this sample, one-quarter of ED patients would be expected to have difficulty understanding health materials and following prescribed treatment regimens. Advanced age and low socioeconomic status were independently associated with limited health literacy. The ability of a significant subgroup of ED patients to understand health information, especially during illness or injury, requires further study."

One potential limitation that comes to mind - a cross-sectional study gives just a snapshot, rather than a longitudinal assessment -- the questionnaire results reflect each individual's completion of a brief test during their stay in the ED setting, which is a fairly difficult environment given the complexity of this kind of healthcare encounter (stress of the health condition, urgency, family issues, financial considerations, etc.). The competing concerns of the environment may shift individual test results downward. If you tested the same person while they were going to a routine visit at their doctor, their results may be different.

On the other hand, the methods of the current study would seem to give an accurate picture of functional health literacy at the moment of crisis, which speaks more to how people may (or may not) be able to handle, process, and retain information in that particular setting.

So, having a librarian stationed in the ED might not, then, be a good idea, but do other strategies come to mind for aiding individuals with lower health literacy in this setting?

Reference: Ginde AA, Weiner SG, Pallin DJ, Camargo CA Jr. Multicenter study of limited health literacy in emergency department patients. Acad Emerg Med. 2008 Jun;15(6):577-80. PubMed abstract

Change in drugmaker swag

via WSJ's Health blog -- Drugmakers pulling plug on free pens, mugs, and pads -- talks about this revision to the PhRMA Code (voluntary guidelines for pharma marketing activities), authored by the pharmaceutical industry's trade group, which is calling for more responsible marketing by eliminating some of the freebie gifts. It doesn't, however, set explicit limits on spending for physician consulting and speaking engagements, but recommends internal limits and tracking procedures be put in place.

The full PhRMA marketing code is here; more in the WSJ and the New York Times.

Violence against nurses

It seems like we get a search request on this topic every couple of years or so and yesterday's New York Times has a great piece by David Tuller summarizing recent stats about violence against nurses and workplace prevention strategies -- "Nurses Step Up Efforts to Protect Against Attacks" (via The Pump Handle)

For more info, a quick PubMed search - nurse-patient relations[majr] AND violence[majr] (does include some false drops about screening for abuse, domestic violence, elder abuse, etc.)

PubMed as a verb

DrugMonkey ponders the changing role of PubMed with increasing focus on open access -- "I'll PubMed it and find out"

Most of the audience for this blog will be familiar with the use of "Google" as a verb to describe searching the World Wide Web for information on a given topic. "I googled a half-dozen mojito recipes which we tried out on the Fourth". "Did you google your blind date/new postdoc to make sure he isn't a psycho?". "You got dinner plans after the conference sessions end for the day? No? Lemme google up some restaurants."

...

Lagging well behind this transformation of our information-age lives, but assuredly steaming right along behind, is the verb-ification of PubMed. For some of us, it is here already. This is the area where I am sympathetic to the antics of the Open Access Acolytes™.

Search challenge 10

For this month's search challenge, a question from a primary care physician: A woman's maternal grandmother had breast cancer at the age of 36. As a result, her ob/gyn is recommending screening to begin at 31. What is the evidence for determining when to begin screening patients who have second degree relatives with breast cancer? Is imaging other than mammogram (e.g. MRI) preferred? Does the presence/absence of BRCA 1/2 mutations affect these recommendations?

Post your suggestions in the comments! I'll pull our thoughts together for a follow-up post on the first Monday of August.

Search challenge 9: strategies

Search challenge 9 was "Can you find literature that discusses physician/nurse collaboration and communication, and assessments of associated effects on nurse retention?"

One commenter posted a CINAHL strategy and found some dissertations that may be useful in aiding a literature review, also noting that a PubMed on the search might be more difficult since some of the most relevant indexing terms are unique to CINAHL.

From a few quick searches, the main term that seems to be useful in PubMed is the MeSH term "Physician-Nurse Relations" -- restricting to "major" and a few other things brings it down to about 500 hits, including ~180 in the last two years

"Physician-Nurse Relations"[Majr] AND eng[la] NOT (case reports[pt] OR letter[pt] OR comment[pt] OR editorial[pt] OR news[pt] OR newspaper article[pt])

ANDing a string like (job satisfaction[mh] OR personnel turnover[mh] OR retention[tiab] OR retaining[tiab] OR retain[tiab] OR retained[tiab] OR turnover[tiab]) was fairly effective in finding a few studies that looked at the retention/turnover issue. Other MeSH terms also seemed to pop up in the indexing of the more relevant items -- "communication," "attitudes of health personnel," "cooperative behavior," "burnout, professional," and the "psychology" subheading (attached to various MeSH terms).

EMRs in ambulatory care

Last week's NEJM has a large survey of opinion and usage of EMRs by ambulatory care physicians (n=2758):

DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, Kaushal R, Levy DE, Rosenbaum S, Shields AE, Blumenthal D. Electronic health records in ambulatory care--a national survey of physicians. N Engl J Med. 2008 Jul 3;359(1):50-60.

excerpt from the abstract:

Results: Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.

Conclusions: Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.