首页> 外文学位 >Effectiveness of a low literacy, pictographic tool in improving pediatric provider medication counseling and parent dosing accuracy.
【24h】

Effectiveness of a low literacy, pictographic tool in improving pediatric provider medication counseling and parent dosing accuracy.

机译:低识字率的象形文字工具在改善儿科医师的用药咨询和父母剂量准确性方面的有效性。

获取原文
获取原文并翻译 | 示例

摘要

Background: Parent medication errors are exceedingly common, with one child experiencing an outpatient medication error every 8 minutes. In a previous randomized controlled trial where the intervention was carried out under ideal conditions, we examined the efficacy of a pictographic, health literacy-informed medication instruction sheet-based intervention (HELPix) in reducing parent dosing errors. While our intervention was efficacious in reducing errors, reproducing these results in a real world setting, is necessary to examine the true effectiveness of HELPix.;Objectives: 1) To examine the impact of HELPix implementation on parent medication dosing errors. 2) To assess the effect of HELPix implementation on provider use of medication counseling strategies.;Design/Methods: A pre-implementation/post-implementation study design was used in 2 pediatric Emergency Departments (EDs) in New York City, one with planned implementation of the HELPix intervention (HELPix site) and the other a control site within the same hospital network. Subject inclusion criteria included: 1) English or Spanish-speaking parent, 2) child <9 years old, child prescribed a short course (?14 days) daily liquid medicine, and 3) parent present with the child in the emergency department and received medication counseling.;Parents were recruited over the phone; those who enrolled completed a phone interview along with a follow-up in-person assessment (median time to follow-up=15 days). ED providers (residents, fellows, attendings) were also recruited. The HELPix intervention consists of: 1) provider provision of patient- and medicine-specific pictographic instruction sheets, 2) provider use of pictures/drawings as part of counseling to reinforce dosing information, 3) provider demonstration of the dose using an oral syringe, 3) teachback of dose information, 4) parent showback of the dose they plan to give, and 5) provider provision of an oral syringe. At the HELPix site, ED providers were trained in the use of HELPix counseling strategies as well as how to use the electronic medical record (EMR) system to generate the instruction sheets while ordering a prescription. Outcomes assessed were: 1) provider provision of HELPix instruction sheets via web tracking, 2) dosing errors ≥ 20% deviation from prescribed dose, assessed from observation at follow-up visit, 3) provider counseling practices (i.e. use of pictures/drawings, demonstration, teachback, showback, provision of dosing tool) obtained by parent report.;Results: A total of 1493 parents were assessed by telephone for eligibility in the pre-/post-implementation phases. 561 parent-child dyads were recruited by phone (284 at HELPix site; 277 at control site). A total of 92% were mothers, 52% were Spanish speakers, 78% were Latino, 16% were Black, and 85% were of low socioeconomic status. Web tracking at the HELPix intervention site indicated that for 58% of the enrolled families in the post-implementation period, providers generated HELPix medication instruction sheets. Compared to the pre-implementation period at the intervention site, parent dosing errors rates were significantly reduced during the post-implementation period (37% versus 16%; AOR=0.3, p<0.001); with an overall Relative Risk Reduction (RRR)=57%, with greatest reductions in errors among those that received HELPix sheets (12% error rate, RRR=68%). Providers at the HELPix implementation site were significantly more likely to use recommended provider counseling strategies post-implementation compared to pre-implementation (pictures/drawings: 37% versus 1%; dosing demonstration: 59% versus 33%; teachback: 24% versus 8%; showback: 33% vs. 13%, and provision of oral syringe 79% versus 25%; p<0.0001 for all strategies). In the non-intervention site, there were no differences in parent dosing error rates, or in provider use of counseling strategies between the pre- and post-implementation periods. Conclusion: Implementation of the HELPix intervention resulted in increased provider use of recommended counseling strategies as well as decreased parent medication dosing errors in an urban public hospital setting serving low socioeconomic status families. Use of HELPix supports high quality provider medication counseling and appears to be feasible to incorporate as part of routine Emergency Department discharge practices.
机译:背景:父母用药错误非常普遍,一个孩子每8分钟经历一次门诊用药错误。在先前的一项在理想条件下进行干预的随机对照试验中,我们研究了一种象形的,基于健康素养知识的用药说明表干预(HELPix)在减少父母用药错误方面的功效。虽然我们的干预措施有效地减少了错误,但在现实环境中重现这些结果对于检查HELPix的真实有效性是必要的。目标:1)检查HELPix实施对母体药物剂量错误的影响。 2)评估HELPix实施对医疗服务提供者使用药物咨询策略的影响。设计/方法:纽约市的2个儿科急诊科(ED)使用了实施前/实施后研究设计,其中一个已计划在同一医院网络内实施HELPix干预(HELPix站点)和另一个控制站点。受试者纳入标准包括:1)会说英语或西班牙语的父母,2)9岁以下的孩子,开了短期课程(每天14天)的每日口服药,以及3)家长陪同孩子到急诊室就诊并接受了治疗药物咨询。通过电话招募家长;参加者完成了电话采访以及后续的亲自评估(随访的中位数时间为15天)。还招募了教育提供者(居民,研究员,参加者)。 HELPix干预措施包括:1)提供者提供患者和医学专用的象形文字说明书,2)提供者使用图片/图纸作为加强剂量信息的咨询的一部分,3)提供者使用口服注射器演示剂量, 3)讲授剂量信息,4)父母演示他们计划给予的剂量,以及5)提供者提供口服注射器。在HELPix网站上,对ED提供商进行了有关HELPix咨询策略使用以及如何在订购处方时如何使用电子病历(EMR)系统生成说明表的培训。评估的结果是:1)提供者通过网络跟踪提供的HELPix说明书,2)剂量误差与规定剂量的偏差≥20%,通过随访随访观察评估,3)提供者的咨询实践(即使用图片/图纸,结果:通过电话评估了总共1493名父母在实施前/实施后的资格。通过电话招募了561个亲子二元组(HELPix站点为284个,对照站点为277个)。共有92%为母亲,52%为讲西班牙语的人,78%为拉丁裔,16%为黑人,85%的社会经济地位低下。 HELPix干预站点的网络跟踪表明,实施后58%的已登记家庭中,提供者生成了HELPix药物使用说明书。与干预现场实施前相比,实施后阶段的父母用药错误率显着降低(37%比16%; AOR = 0.3,p <0.001)。总体相对风险降低(RRR)= 57%,在接受HELPix表格的受访者中,错误的减少最大(错误率12%,RRR = 68%)。与实施前相比,HELPix实施站点的提供者在实施后使用推荐的提供者咨询策略的可能性明显更高(图片/图纸:37%对1%;剂量演示:59%对33%;回授:24%对8 %;回扣率:33%和13%,以及提供口服注射器的比例分别为79%和25%;对于所有策略,p <0.0001)。在非干预场所,在实施前和实施后之间,父母的剂量错误率或提供者对咨询策略的使用没有差异。结论:HELPix干预措施的实施导致提供者更多使用推荐的咨询策略,并减少了为社会经济地位低下的家庭提供服务的城市公立医院的父母用药剂量错误。使用HELPix支持高质量的提供者药物咨询,并且似乎可以作为紧急部门常规出院实践的一部分。

著录项

  • 作者

    Sanchez, Dayana C.;

  • 作者单位

    Boston University.;

  • 授予单位 Boston University.;
  • 学科 Health sciences.;Higher education.
  • 学位 M.S.
  • 年度 2016
  • 页码 58 p.
  • 总页数 58
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

  • 入库时间 2022-08-17 11:48:49

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱:kefu@zhangqiaokeyan.com

京公网安备:11010802029741号 ICP备案号:京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有
  • 客服微信

  • 服务号