Impact of a Health Literacy Intervention on Pediatric Emergency Department Use

Herman, Ariella; Young, Kelly D.; Espitia, Dennis; Fu, Nancy; Farshidi, Arta

doi:10.1097/pec.0b013e3181ab78c7

Cited by 40 publications

(54 citation statements)

References 10 publications

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“…We identified nine studies of eight interventions which aimed to change the number or rate of parental consultations for paediatric RTIs, involving a total of 1488 parents, 1580 families, and 558 children [19], [20], [21], [22], [23], [24], [25], [26], [27]. Interventions were delivered at home in four studies [22], [24], [26], [27], and at GP surgeries or emergency departments in the remainder.…”

Section: Resultsmentioning

confidence: 99%

Interventions to Influence Consulting and Antibiotic Use for Acute Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

et al. 2012

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BackgroundRespiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes.Methodology/Principal FindingsWe conducted a systematic review and meta-analysis to assess the effectiveness of interventions directed towards parents or caregivers which were designed to influence consulting and antibiotic use for respiratory tract infections (RTIs) in children in primary care. Main outcomes were parental consulting rate, parental knowledge, and proportion of children subsequently consuming antibiotics. Of 5,714 references, 23 studies (representing 20 interventions) met inclusion criteria. Materials designed to engage children in addition to parents were effective in modifying parental knowledge and behaviour, resulting in reductions in consulting rates ranging from 13 to 40%. Providing parents with delayed prescriptions significantly decreased reported antibiotic use (Risk Ratio (RR) 0.46 (0.40, 0.54); moreover, a delayed or no prescribing approach did not diminish parental satisfaction.ConclusionsIn order to be most effective, interventions to influence parental consulting and antibiotic use should: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms. These results support the wider implementation of interventions to reduce inappropriate antibiotic use in children.

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Section: Resultsmentioning

confidence: 99%

Interventions to Influence Consulting and Antibiotic Use for Acute Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

et al. 2012

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“…(13,23) Thus, it is essential to improve the knowledge of caregivers on child health matters; this will help to optimise the caregivers' navigation of the healthcare system. (24) Caregivers also attended paediatric EDs due to their need for assurance and the perceived advantage of paediatric EDs over primary care providers. However, some of these paediatric conditions can be well-managed by primary care providers or the caregivers themselves in the comfort of their own homes.…”

Section: Discussionmentioning

confidence: 99%

“…A health aid book for caregivers to use at home also has the potential to help reduce nonurgent ED attendance. (24) KKH's ED currently has patient information pamphlets on how to manage conditions such as fever, nosebleed and minor head injury at home, as well as recognition of symptoms that necessitate an ED visit. These pamphlets or booklets could be distributed at primary care provider clinics to preemptively educate caregivers who would otherwise choose to attend the ED at a later date for perceived emergencies.…”

Section: Discussionmentioning

confidence: 99%

Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers’ perspectives

Kua

Ong

et al. 2016

smedj

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INTRODUCTIONThe use of the emergency department (ED) for nonurgent care is a worldwide concern.(1-5) Singapore, the most economically developed country in Southeast Asia, is no exception. In 2013, approximately 60% of visits to the paediatric ED of KK Women's and Children's Hospital (KKH), Singapore, were for nonurgent conditions. Nonurgent use of the ED leads to overcrowding, long waiting periods, increased costs, high staff burden, caregiver dissatisfaction and lower quality of care for patients requiring urgent care.(6-8) Therefore, understanding the factors related to nonurgent ED use is paramount and may have far-reaching impact.A constellation of variables influences caregivers' decision to attend paediatric EDs. Previous studies on caregivers' perspectives revealed perceived need as a common reason; this perceived need is related to the perceived severity of the child's illness, (7,(9)(10)(11)(12)(13) the need to seek assurance on the course of the illness (7) and the expectation that medical tests, such as radiography, will be needed. (7,10,13) Caregivers' perceptions of primary healthcare providers are also a key contributing factor to the nonurgent use of paediatric EDs. Several studies indicated that caregiver dissatisfaction with primary healthcare providers was due to accessibility and scheduling issues, (9)(10)(11) as well as the perception that the quality of care given by primary healthcare providers is lower than that given at the ED. (14) In addition, overseas studies have indicated that factors such as insurance coverage and welfare are related to nonurgent paediatric ED attendance. (9,15) In the Behavioural Model of Health Services Use, (16) Andersen suggested that the use of health services is shaped by the interaction between individual characteristics and contextual factors (e.g. health services and policies). Singapore has a network of primary healthcare providers consisting of 18 government polyclinics and approximately 1,500 private general practitioner (GP) clinics. (17) Primary care professionals are usually the first point of contact for patients, and if needed, can refer them to medical specialists and hospitals. The healthcare financing system in Singapore espouses the philosophies of individual responsibility and affordable healthcare for all. The government subsidises low-income families, citizens and permanent residents seeking care in the public sector. (18) While previous studies and theoretical frameworks provide some insight into the factors related to the nonurgent use of paediatric EDs, this issue has not been explored in a Southeast Asian population. Thus, the present study aimed to qualitatively explore questions on paediatric ED attendance from the perspective of caregivers who presented at KKH, a large public children's hospital. The findings of this study may be used to develop effective and targeted interventions to reduce unnecessary paediatric ED attendance.

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“…Other aspects of the ED environment such as ED overcrowding, longer waiting times, decreased ED staff productivity and increased ED staff frustration may also occur [2,14] . Although the measurement of health literacy may be relevant to all nursing settings, this paper explores the measurement of health literacy within the ED.…”

Section: Introductionmentioning

confidence: 99%

“…Health literacy, or how health consumers understand and act upon health information, has become a priority in the delivery of health care, as consumers with limited health literacy skills experience poorer health outcomes [1] and are often high users of health services [2,3] . Literacy and health literacy are associated concepts.…”

Section: Introductionmentioning

confidence: 99%

Measuring health literacy in emergency departments

Alqudah

Johnson

Cowin

et al. 2013

JNEP

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Background: Literacy and health literacy are important concepts that are related to how important health care messages are understood by patients. Emergency nurses are engaged in health promotion and require an understanding of the patient's health literacy. To assist emergency nurses in assessing a patient's level of health literacy a series of valid and reliable health literacy measurement tools have been presented. The aim of this paper is to nominate one of these tools to be used by emergency nurses in testing individual and group levels of health literacy. Methods:Databases searched included Scopus, Science direct, PubMed, PsycINFO and Educational Resources Information Center (ERIC). Included articles were published between 1990 and 2011, English language only, and articles that discussed word recognition tools and tools that take five minutes or less to administer resulting in sixteen articles. Results:The Rapid Estimate of Adult Literacy in Medicine-Short Format (REALM-SF) has been used successfully within an emergency setting to identify patients' level of health literacy and to supply appropriate health information. This tool was found by nursing staff to be easily administered, and more acceptable when used in private areas. However, further research within varying age groups is recommended. Conclusion:Most of the available tools are related to each other and have the ability to measure varying levels of health literacy. The REALM-SF is a simple quick approach to measuring health literacy in busy clinical settings. Emergency nurses require training in administering these tests in a non-threatening and accurate manner.

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Impact of a Health Literacy Intervention on Pediatric Emergency Department Use

Abstract: Health literacy interventions may reduce nonurgent emergency department visits and help mitigate emergency department overcrowding and the rising costs of health care.

Cited by 40 publications

References 10 publications

Interventions to Influence Consulting and Antibiotic Use for Acute Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

Interventions to Influence Consulting and Antibiotic Use for Acute Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers’ perspectives

Measuring health literacy in emergency departments

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