Emergency department discharge instructions comprehension and compliance study.

OBJECTIVES To assess patient comprehension of emergency department discharge instructions and to describe other predictors of patient compliance with discharge instructions. METHODS Patients departing from the emergency department of an inner-city teaching hospital were invited to undergo a structured interview and reading test, and to participate in a follow-up telephone interview 2 weeks later. Two physicians, blinded to the other's data, scored patient comprehension of discharge information and compliance with discharge instructions. Inter-rater reliability was assessed using a kappa-weighted statistic, and correlations were assessed using Spearman's rank correlation coefficient and Fisher's exact test. RESULTS Of 106 patients approached, 88 (83%) were enrolled. The inter-rater reliability of physician rating scores was high (kappa = 0.66). Approximately 60% of subjects demonstrated reading ability at or below a Grade 7 level. Comprehension was positively associated with reading ability (r = 0.29, p = 0.01) and English as first language (r = 0.27, p = 0.01). Reading ability was positively associated with years of education (r = 0.43, p < 0.0001) and first language (r = 0.24, p = 0.03), and inversely associated with age (r = -0.21, p = 0.05). Non-English first language and need for translator were associated with poorer comprehension of discharge instructions but not related to compliance. Compliance with discharge instructions was correlated with comprehension (r = 0.31, p = 0.01) but not associated with age, language, education, years in anglophone country, reading ability, format of discharge instructions, follow-up modality or association with a family physician. CONCLUSIONS Emergency department patients demonstrated poor reading skills. Comprehension was the only factor significantly related to compliance; therefore, future interventions to improve compliance with emergency department instructions will be most effective if they focus on improving comprehension.

[1]  J. Hedges,et al.  Follow-up compliance after emergency department evaluation. , 1993, Annals of emergency medicine.

[2]  Jack A. Brizius,et al.  Enhancing Adult Literacy. A Policy Guide. , 1987 .

[3]  J. Kirscht,et al.  Understanding and improving patient compliance. , 1984, Annals of internal medicine.

[4]  J. Menegazzi,et al.  Compliance with emergency department referral: the effect of computerized discharge instructions. , 1993, Annals of emergency medicine.

[5]  E. Enguidanos,et al.  Language as a factor affecting follow-up compliance from the emergency department. , 1997, The Journal of emergency medicine.

[6]  C. Feied,et al.  Functional illiteracy among emergency department patients: a preliminary study. , 1993, Annals of emergency medicine.

[7]  B. Harrison,et al.  Effect of a preprinted form on the management of acute asthma in an accident and emergency department. , 1996, Journal of accident & emergency medicine.

[8]  L. G. Doak,et al.  Teaching Patients With Low Literacy Skills , 1985 .

[9]  T. Davis,et al.  The gap between patient reading comprehension and the readability of patient education materials. , 1990, The Journal of family practice.

[10]  E. J. Mayeaux,et al.  Improving patient education for patients with low literacy skills. , 1996, American family physician.

[11]  C. Graham,et al.  A comparison of interventions to improve clinic follow-up compliance after a pediatric emergency department visit , 1996, Pediatric emergency care.

[12]  R D Powers,et al.  Emergency department patient literacy and the readability of patient-directed materials. , 1988, Annals of emergency medicine.

[13]  D. Karras,et al.  Comprehension of discharge instructions by patients in an urban emergency department. , 1995, Annals of emergency medicine.

[14]  J. Menegazzi,et al.  Compliance with emergency department patient referral. , 1992, The American journal of emergency medicine.

[15]  C. Leblanc,et al.  Clinic follow-up from the emergency department: do patients show up? , 1996, Annals of emergency medicine.

[16]  T. Davis,et al.  Patient Reading Ability: An Overlooked Problem in Health Care , 1991, Southern medical journal.

[17]  T. Brennan,et al.  Patient noncompliance with medical advice after the emergency department visit. , 1996, Annals of emergency medicine.

[18]  J A Crane,et al.  Patient comprehension of doctor-patient communication on discharge from the emergency department. , 1997, The Journal of emergency medicine.

[19]  D. M. Williams,et al.  Emergency department discharge instructions and patient literacy: a problem of disparity. , 1996, The American journal of emergency medicine.