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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Article Info
Publication History
Published online: February 18, 2016
Accepted:
February 15,
2016
Received:
December 17,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
