Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

Albrecht, Jennifer S.; Gruber‐Baldini, Ann L.; Hirshon, Jon Mark; Brown, Clayton H.; Goldberg, Richard W.; Rosenberg, Joseph; Comer, Angela C.; Furuno, Jon P.

doi:10.1007/s11606-014-2956-0

Cited by 66 publications

(53 citation statements)

References 34 publications

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“…For example, a discussion with a younger, relatively uncomplicated patient may focus on secondary prevention and reduction of risk factors such as smoking, while a discussion with an older patient may focus on a constellation of co-occurring conditions and polypharmacy rather than on the patient’s heart condition. Additionally, non-comprehension of discharge instructions has been reported among elderly patients less than a week post-discharge[32]. Although women hospitalized with ACS tend to be older[33], we found that men were more likely to perceive their heart condition to be cured, independent of age.…”

Section: Discussionmentioning

confidence: 51%

Perceiving one’s heart condition to be cured following hospitalization for acute coronary syndromes: Implications for patient-provider communication

Waring

McManus

Lemon

et al. 2016

Patient Education and Counseling

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Objective We examined the proportion of patients perceiving their heart condition to be cured following hospitalization for ACS and identified characteristics associated with these perceptions. Methods We conducted a prospective cohort study of adults hospitalized with ACS (N=396). Patient interviews during hospitalization and one week post-discharge provided demographic and psychosocial characteristics. Medical records provided clinical characteristics. At one week, patients who rated “My heart condition is cured” as “definitely true” or “mostly true” were considered to perceive their heart condition cured. Results Participants were aged 60.7 (SD:11.0) years, 26.5% female, and 89.0% non-Hispanic white; 16.7% had unstable angina, 59.6% NSTEMI, and 23.7% STEMI. One week post-discharge, 30.3% perceived their heart condition to be cured. Characteristics associated with cure perceptions were older age (OR=2.2; 95% CI: 1.2–4.0 for ≥65 years vs <55 years), male sex (OR=2.4; 95%CI: 1.3–4.2), history of hypertension (OR=1.8; 95%CI: 1.1–3.1), history of stroke (OR=4.2; 95%CI: 1.1–16.7), no history of CHD (OR=2.8; 95%CI: 1.6–4.9), and receipt of CABG during hospitalization (OR=4.8, 95%CI: 1.9–12.0 vs medical management). Conclusion One week post-discharge, 3 in 10 patients perceived their heart condition to be cured. Practice Implications Conversations with patients should frame ACS as a chronic disease and dispel cure perceptions.

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Section: Discussionmentioning

confidence: 51%

Perceiving one’s heart condition to be cured following hospitalization for acute coronary syndromes: Implications for patient-provider communication

Waring

McManus

Lemon

et al. 2016

Patient Education and Counseling

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“…Some patients do not understand some of the information conveyed during discharge, including information about their medications [47], particularly for older patients [48,49]. For hospitals that are or will soon begin to implement preemptive PGx testing, providers and patients may benefit from a section on PGx testing in the discharge summary or a separate handout of the results.…”

Section: Overcoming Challenges To Communicating Pgx Test Resultsmentioning

confidence: 99%

Nurses’ Communication of Pharmacogenetic Test Results as Part of Discharge Care

Haga

Mills

2015

Pharmacogenomics

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As pharmacogenetic (PGx) testing is becoming integrated into routine clinical procedures for admitted hospital patients, consideration is needed as to when test results will be communicated to patients and by whom. Given the implications of PGx test results for current and future care, we propose that if results are not promptly discussed with patients when testing is completed, results should be discussed with patients during discharge care when possible, included in the printed or electronic discharge summary and a copy of the results sent to their primary provider. Nurses play an important role in discharge planning and care by providing patients with the necessary information and support to transfer from the hospital setting to an outpatient setting or to return to home and work. To promote nurses’ ability to fulfill the role of communicating PGx test results, revised curricula and interprofessional and clinical decision support are needed.

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“…Within hospitals, Albrecht et al 3 report that more than 25 % of patients do not understand their discharge…”

mentioning

confidence: 99%

“…Within hospitals, Albrecht et al 3 report that more than 25 % of patients do not understand their discharge medication instructions and 50 % do not understand the dietary instructions. With so many patients uninformed, it is unsurprising that hospital readmission rates show few signs of decline.…”

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confidence: 99%

Physician Incomes in the Twenty-first Century: Time for a New Social Contract

Kravitz

2014

J GEN INTERN MED

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T homas Picketty's new opus, Capital in the 21st Century, has been acclaimed as the book most purchased (Amazon ran out of copies for a brief period in May), most talked about (The Guardian calls it a VIB-very important book), and least read in 2014. As a matter of editorial duty, I did read it (though admittedly not in full). The book contains huge amounts of historical data organized into a number of eyestrain-inducing tables and graphs. However, the basic idea is that over time, the return on capital investment will always exceed the rate of growth of the economy as a whole (which Picketty summarizes in the equation r>g). If this is true, then wealth will tend to concentrate over time, and with it political power. (Picketty views the period of rapid economic growth between World War II and the 1970s as an historical anomaly.) To avoid this plutocratic dystopia, Picketty suggests a solution that will never be implemented: a global, progressive tax on wealth. You have to admire his neo-Marxian audacity.While Picketty's policy prescription may be dubious, his diagnosis of a withering democracy seems frighteningly plausible. But what does this have to do with physicians and specifically physicians' incomes? In 2012, health care accounted for 17 % of the $16.4 trillion US economy. In that same year, physician and clinical services were estimated at $566 billion-or about $820,000 for each of 691,000 actively practicing physicians and surgeons. The Center for Medicare and Medicaid Services (CMS) estimates that growth in physician and clinical services will approach 6 % per year through 2022. Thus, in 2022 physician services will cost the country over $1 trillion (in 2012 dollars)-about $1.2 million for each member of the projected physician workforce of 815,000.Of course, reimbursements for clinical services do not accrue only to doctors, nor do these figures account for practice expenses. Nevertheless, as self-declared leaders of the health care system, physicians need to take some responsibility for managing their share of health care expenditures-what everyone else calls costs, and what we call income. This, I imagine, will require accepting both a ratcheting-down of physician incomes on average and a narrowing of the gap between the highest and lowest paid specialties. Depending on how this plays out, general internists, along with other specialists who trade in "evaluation and management," could end up making about the same or somewhat more, while many procedurally oriented specialists would make somewhat less.Based on 2007 OECD data, 1 I would suggest as a reasonable standard that physician incomes should average about five times the mean national wage-more than most lawyers, professors, engineers, and small business owners, less than many financial analysts and real estate developers. Physicians' time under this proposal would be reimbursed at roughly $125 per hour. To allow for differences in training duration and practice intensity, some specialists could be paid up to 25 % higher and others up to 25 % lowe...

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Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

Cited by 66 publications

References 34 publications

Perceiving one’s heart condition to be cured following hospitalization for acute coronary syndromes: Implications for patient-provider communication

Perceiving one’s heart condition to be cured following hospitalization for acute coronary syndromes: Implications for patient-provider communication

Nurses’ Communication of Pharmacogenetic Test Results as Part of Discharge Care

Physician Incomes in the Twenty-first Century: Time for a New Social Contract

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