The post-hospital transition represents a vulnerable period for patients discharged on new medications. Evidence-based discharge education may improve follow-up adherence and lower readmission rates.1–3 Health literacy and health policy evidence should be considered when developing educational interventions.4–6 Low health literacy is strongly associated with higher mortality.5 We assessed the impact of a health education intervention on follow-up adherence and unplanned readmission among patients with osteoarticular infections discharged on outpatient parenteral antibiotic therapy (OPAT).7
This study used a quasi-experimental design. Preintervention patients received usual discharge teaching. Postintervention patients received an educational brochure written at a seventh-grade reading level. Combined teaching from Infectious Diseases (ID) providers emphasized post-hospital care. The brochure was developed using interdisciplinary clinical evidence and health literacy guidelines.
This study includes patients age >18 seen on the ID consultation service at Barnes Jewish Hospital between September 2010 and December 2011. Patients must have been discharged on IV antibiotics and have planned follow-up in the ID clinic. This study was approved by the institutional review board.
Statistical analysis was performed using SPSS version 18 (IBM SPSS, Chicago, IL). P values <.05 were considered statistically significant. The primary end points were adherence to ID clinic follow-up and readmission because of a defined set of conditions associated with OPAT (including Clostridium difficile and treatment failure).
Two hundred patients (100 preintervention and 100 postintervention) with similar demographics met criteria for analysis. There was a significant improvement in follow-up adherence in the postintervention group compared to the preintervention group (P = .02). Readmissions were similar in each group (P = .17). Treatment failure was the most common reason for readmission in both groups.
Our intervention demonstrated an improvement in post-hospital follow-up adherence for patients receiving OPAT. Previous studies have demonstrated that similar educational interventions resulted in improved post-hospital follow-up adherence.1 Discharge education combined with post-discharge support may improve readmissions significantly.1,2,8 This study was underpowered to analyze the multiple variables leading to treatment failure. Future studies should assess the factors that contribute to treatment failure and readmissions.
Acknowledgments
UMass Boston DNP committee: Janice Foust, Margaret McAllister (chair); Brochure development: Sally Adams, Hilary Babcock, Nancy Brames, Bernard Camins, Jessica Doiron, Victoria Fraser, Nigar Kirmani, Jonas Marschall, David Warren, and Lori Watkins; Technical assistance: Cherie Hill, Ling Shi, and Dottie Sinclair.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication was made possible by Grant Number UL1 RR024992 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Dr Lane was supported by the Washington University Institute of Clinical and Translational Sciences Grants UL1 TR000448 and KL2 TR000450 from the National Center for Advancing Translational Sciences and the KM1 Scholars Program Grant KM1CA156708 through the National Cancer Institute (NCI) at the NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.
Footnotes
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