Improving care transitions: the patient perspective.

After hospital discharge, patients commonly suffer potentially avoidable adverse events and hospital readmissions. As hospitals implement interventions to improve discharge transitions, it is important to understand patients' perspectives on which intervention components are most beneficial. This study examined a sample of 125 patients randomized to the intervention arm of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease study who completed a telephone survey about the helpfulness of different components of the intervention, which included medication reconciliation, inpatient counseling, simple adherence aids, and telephone follow-up. The majority of patients indicated that it was "very helpful" to speak with a pharmacist about their medications before discharge (72.8%), particularly about how to take the medications and how to prevent and manage side effects. Receiving an illustrated medication list (69.6%) and a follow-up phone call after discharge (68.0%) were also considered very helpful. Patients with limited health literacy indicated the greatest benefit. Patients also reported feeling more comfortable speaking with their outpatient providers about their medications after receiving the intervention. In conclusion, patients--particularly those with limited health literacy--found a hospital pharmacist-based intervention to be very helpful and empowering.

Neurovascular Compression at the Root Entry Zone Correlates with Trigeminal Neuralgia and Early Microvascular Decompression Outcome.

BACKGROUND: Trigeminal neurovascular contact (NVC) is hypothesized to be the etiology of classical trigeminal neuralgia (TGN). We aimed to seek a correlation between types of NVCs and the presence of TGN as well as early surgical outcome in patients with TGN treated with trigeminal microvascular decompression (MVD). METHODS: We blindly analyzed preoperative high-resolution magnetic resonance images with respect to the degree (none, "touch," or compression) and location of bilateral NVC in 57 retrospectively identified Burchiel Type 1 TGN patients treated by MVD. Location of NVC was noted as either at the root entry zone or distal to it. Using a logistic regression model, we assessed the degree and location of trigeminal NVC for correlation with the symptomatic side. Furthermore, the NVC characteristics on the symptomatic side were correlated with early postoperative pain relief. RESULTS: Although the degree and location of NVC were not statistically correlative independently, a combined interaction analysis of both statistically correlated with the symptomatic side and with early postoperative pain relief. CONCLUSIONS: We conclude that in TGN patients treated with MVD, magnetic resonance imaging identified neurovascular compression at the root entry zone (correlates with the affected side and early postoperative pain relief.

Health literacy and the quality of physician-patient communication during hospitalization.

BACKGROUND: Overall, poor physician-patient communication is related to post-discharge adverse events and readmission. We analyzed patients' ratings of the quality of physician-patient communication during hospitalization and how this varies by health literacy. METHODS: Medical patients were interviewed during their hospitalization to assess personal characteristics and health literacy. After discharge, patients completed by telephone the 27-item Interpersonal Processes of Care in Diverse Populations Questionnaire (IPC). Using the IPC, patients rated the clarity and quality of physicians' communication during the hospitalization along the following 8 domains: General clarity, Responsiveness to patient concerns, Explanation of patients' problems, Explanation of processes of care, Explanation of self-care after discharge, Empowerment, Decision making, and Consideration of patients' desire and ability to comply with recommendations. RESULTS: A total of 84 patients completed both the in-hospital and telephone interviews. Subjects had a mean age of 55, and 44% had inadequate health literacy. Overall, patients gave the poorest ratings to communication that related to Consideration of patients' desire and ability to comply with recommendations. Patients with inadequate health literacy gave significantly worse ratings on the domains of General clarity, Responsiveness to patient concerns, and Explanation of processes of care (P < 0.05 for each). In multivariable analyses, the relationship with General clarity did not persist. CONCLUSIONS: Physicians received relatively poor ratings on their Consideration of patients' desire and ability to comply with recommendations. Patients with inadequate health literacy experienced lower quality and clarity of hospital communication along multiple domains. More attention to effective health communication is warranted in the hospital setting.