Caregiver Low Health Literacy and Nonurgent Use of the Pediatric Emergency Department for Febrile Illness

Morrison, Andrea K.; Chanmugathas, Ruben; Schapira, Marilyn M.; Gorelick, Marc H.; Hoffmann, Raymond G.; Brousseau, David C.

doi:10.1016/j.acap.2014.05.001

Cited by 51 publications

(51 citation statements)

References 25 publications

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“…Terms used to describe NUP include low‐acuity, low‐urgency, inappropriate, non‐acute and primary care cases. Eleven studies defined NUPs using ED resources used during visit, while nine studies defined and categorised NUP using triage evaluation . In five studies, NUPs were defined as illnesses that could be seen in the primary care or outpatient setting within 24 h .…”

Section: Resultsmentioning

confidence: 99%

Non‐urgent paediatric emergency department presentation: A systematic review

Alele

Emeto

Callander

et al. 2018

J Paediatrics Child Health

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There has been an increase in the use of the emergency department (ED) for non‐urgent presentations. The aim of this systematic review was to identify the proportion, criteria and predictors of non‐urgent ED presentations in paediatric populations. A search of multiple databases was conducted for articles published from inception of the databases to 20 August 2018, which reported the proportion, criteria and predictors of non‐urgent ED presentation in paediatric populations. Thirty‐one articles met the inclusion criteria. The mean proportion of non‐urgent paediatric ED presentations was 41.06 ± 15.16%. There appears to be a weak association between predisposing, enabling and needs factors and non‐urgent ED use in paediatric populations. The findings of this review suggest that non‐urgent ED use in paediatric populations is high. However, non‐urgent ED use and the reasons for the visits in paediatric populations remain understudied.

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Section: Resultsmentioning

confidence: 99%

Non‐urgent paediatric emergency department presentation: A systematic review

Alele

Emeto

Callander

et al. 2018

J Paediatrics Child Health

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“…Patient engagement is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care [9]. On the basis of available evidence in other settings of healthcare delivery [13,16,20,22,26,27,29,32,36,40,41], it is likely that patients with low health literacy presenting to a hand surgeon are at greater risk for poor treatment adherence, suboptimal outcomes, and misuse of resources; future studies should confirm these assumptions in this patient population. To the extent that asking more questions yields more information for patients, the observed difference in question-asking may reveal a source of health-literacy disparities in access to health information.…”

Section: Discussionmentioning

confidence: 99%

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Menendez

Hoorn

Mackert

et al. 2017

Clinical Orthopaedics &Amp; Related Research

110

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Background In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. Questions/purposes (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? Methods We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/ checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy as done by the tool's creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. Results Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, À4; 95% CI, À7 to À1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at

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“…The score was dichotomized into low (0–4 correct) or adequate health literacy (5–6 correct) as used by prior studies of health literacy in the pediatric ED. 11,18 Caregivers self-identified race which was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, and other in analysis. Those that chose more than one race were identified in as black, white, or Hispanic for analysis.…”

Section: Methodsmentioning

confidence: 99%

Health Literacy Affects Likelihood of Radiology Testing in the Pediatric Emergency Department

Morrison¹,

Brousseau²,

Brazauskas³

et al. 2015

The Journal of Pediatrics

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Objective To test the hypothesis that the effect of race/ethnicity on decreased radiologic testing in the pediatric emergency department (ED) varies by caregiver health literacy. Study design This was a secondary analysis of a cross-sectional study of caregivers accompanying children ≤12 years to a pediatric ED. Caregiver health literacy was measured using the Newest Vital Sign. A blinded chart review determined whether radiologic testing was utilized. Bivariate and multivariate analyses, adjusting for ED triage level, child insurance, and chronic illness were used to determine the relationship between race/ethnicity, health literacy, and radiologic testing. Stratified analyses by caregiver health literacy were conducted. Results 504 caregivers participated; the median age was 31 years, 47% were white, 37% black, 10% Hispanic, and 49% had low health literacy. Black race and low health literacy were associated with less radiologic testing (p <0.01). In stratified analysis, minority race was associated with less radiologic testing only if a caregiver had low health literacy (aOR 0.5; 95% CI 0.3–0.9) and no difference existed in those with adequate health literacy (aOR 0.7; 95% CI 0.4–1.3). Conclusion Caregiver low health literacy modifies whether minority race/ethnicity is associated with decreased radiologic testing, with only children of minority caregivers with low health literacy receiving fewer radiologic studies. Future interventions to eliminate disparities in healthcare resource utilization should consider health literacy as a mutable factor.

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Caregiver Low Health Literacy and Nonurgent Use of the Pediatric Emergency Department for Febrile Illness

Cited by 51 publications

References 25 publications

Non‐urgent paediatric emergency department presentation: A systematic review

Non‐urgent paediatric emergency department presentation: A systematic review

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Health Literacy Affects Likelihood of Radiology Testing in the Pediatric Emergency Department

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