Proposal for a Global Adherence Scale for Acute Conditions (GASAC): A prospective cohort study in two emergency departments.

BACKGROUND: Adherence in the context of patients with acute conditions is a major public health issue. It is neglected by the research community and no clinically validated generic scale exists to measure it. OBJECTIVE: To construct and validate a Global Adherence Scale usable in the context of Acute Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions that the doctor may give. To measure adherence and to study its determinants. MATERIALS AND METHOD: We based the construction of the GASAC questionnaire on a theoretical model and a literature search. Then, between 2013 and 2014, we validated it in a prospective observational study in two hospital emergency departments. Patients were contacted by phone about one week after their consultation to answer several questionnaires, including GASAC and the Girerd self-administered questionnaire about medication adherence as a control. RESULTS: GASAC consists of four adherence subscales: drug prescriptions; blood tests/ radiography prescriptions; lifestyle advice and follow-up instructions. An analysis of the 154 sets of answers from patients showed that the GASAC drug subscale had satisfactory internal coherence (Cronbach's alpha = 0.78) and was correlated with the Girerd score, as was GASAC as a whole (p<0.01). The median score was 0.93 IQR [0.78-1] for a maximum value of 1 (n = 154). In multivariaable analysis, infection was more conducive of good adherence (cut off at ≥ 0.8; n = 115/154; 74.7% [67.0-81.3]) than trauma (OR 3.69; CI [1.60-8.52]). The Doctor-Patient Communication score (OR 1.06 by score point, CI [1.02-1.10]) also influenced adherence. CONCLUSIONS: GASAC is a generic score to measure all dimensions of patient adherence following emergency departments visits, for use in clinical research and the evaluation of clinical practice. The level of adherence was high for acute conditions and Doctor-Patient Communication was a major determinant of adherence.

[Patient information leaflets - favoring the sustainability of messages provided to patients following an emergency consultation]. / Fiches d'information aux patients - Pour une compréhension durable des messages transmis au patient lors d'une consultation en urgence.

Delivering usable and sustainable information is a complex process in primary care, especially in the emergency context. A multimodal communication process combining verbal and written information promotes a better recall of the information and favors patient satisfaction. Patient information leaflets (PILs) are an effective and simple form of written documentation, adapted to patients with low health literacy levels. PILs given by doctors have a favorable impact on patients' knowledge and autonomy, as well as on adherence to the management plan. They also favor a reduction in the rate of re-consultations.

Transmettre une information durable et exploitable par son patient est un processus complexe, tout particulièrement dans le contexte d'urgence en médecine de premier recours. Une communication multimodale alliant le verbal et l'écrit favorise la remémoration de l'information et la satisfaction du patient. La fiche d'information patient (FIP) est une forme efficace et facile d'usage de documentation écrite, adaptée au niveau moyen de littératie en santé du patient et qui a démontré un impact favorable sur les connaissances et l'autonomie du patient, tout comme sur l'adhésion dans la prise en charge et la diminution de la reconsultation.

Impact of patient information leaflets on doctor-patient communication in the context of acute conditions: a prospective, controlled, before-after study in two French emergency departments.

OBJECTIVE: In the context of acute conditions seen in an emergency department, where communication may be difficult, patient information leaflets (PILs) could improve doctor-patient communication (DPC) and may have an impact on other outcomes of the consultation. Our objective was to assess the impact of PILs on DPC, patient satisfaction and adherence, and on patient and doctor behaviours. DESIGN: Prospective, controlled, before-after trial between November 2013 and June 2015. SETTING: Two French emergency departments. PARTICIPANTS: Adults and adolescents >15 years diagnosed with ankle sprain or an infection (diverticulitis, infectious colitis, pyelonephritis, pneumonia or prostatitis). INTERVENTION: Physicians in the intervention group gave patients a PIL about their condition along with an oral explanation. MAIN OUTCOME MEASURES: 7-10 days later, patients were contacted by phone to answer questionnaires. Results were derived from questions scored using a 4-point Likert scale. MAIN FINDINGS: Analysis of the 324 patients showed that PILs improved the mean DPC score (range: 13-52), with 46 (42-49) for 168 patients with PILs vs 44 (38-48) for 156 patients without PILs (p<0.01). The adjusted OR for good communication (having a score >35/52) was 2.54 (1.27 to 5.06). The overall satisfaction and adherence scores did not show significant differences. In contrast, satisfaction with healthcare professionals and timing of medication intake were improved with PILs. The overall satisfaction score improved significantly on per-protocol analysis. When using PILs, doctors prescribed fewer drugs and more examinations (radiology, biology, appointment with a specialist); the need for a new medical consultation for the same pathology was reduced from 32.1% to 17.9% (OR 0.46 [0.27 to 0.77]), particularly revisiting the emergency department. CONCLUSION: In emergency departments, PILs given by doctors improve DPC, increase patients' satisfaction with healthcare professionals, reduce the number of emergency reconsultations for the same pathology and modify the doctor's behaviour. TRIAL REGISTRATION NUMBER: NCT02246361.

A scale assessing doctor-patient communication in a context of acute conditions based on a systematic review.

BACKGROUND: There is no validated generic tool to measure Doctor-Patient-Communication (DPC) in a context of acute conditions. OBJECTIVE: To create and validate such a scale in a real population. MATERIALS AND METHOD: We performed a systematic review of validated DPC scales available in English. From these, using a theoretical model based on a multidisciplinary approach, we selected pertinent items that met the inclusion criteria and included them in a simple questionnaire. This tool based on a synthesis of the literature was then validated in a prospective study in two hospital emergency departments. RESULTS: We found 22 pertinent questionnaires and scoring systems. From these, we extracted items and built a scale based on 15 questions with graded responses (Likert from 1 to 4). The mean time for questionnaire completion was 3 minutes. We included 189 adults and adolescents in the study and analyzed complete responses to the questionnaire by 149 patients, gathered over the phone one week after their consultation. The scale had high internal consistency (Cronbach's alpha = 0.89) and good external validity. Two questions were removed due to redundancy giving a scale based on 13 questions. CONCLUSIONS: We have created an easy-to-use and validated generic questionnaire to assess DPC in a context of acute conditions, usable both in clinical research and in routine practice.

How best to use and evaluate Patient Information Leaflets given during a consultation: a systematic review of literature reviews.

BACKGROUND: In the past, several authors have attempted to review randomized clinical trials (RCT) evaluating the impact of Patient Information Leaflets (PILs) used during a consultation and draw some general conclusions. However, this proved difficult because the clinical situations, size and quality of RCTs were too heterogeneous to pool relevant data. OBJECTIVE: To overcome this 30-year stalemate, we performed a review of reviews and propose general recommendations and suggestions for improving the quality of PILs, how to use them and methods for evaluating them. METHODOLOGY: We searched five databases for reviews, systematic reviews and meta-analyses describing PILs. We drew general and condition-linked conclusions concerning the impact of PILs. Checklists summarize criteria for quality PILs, and ways of using and evaluating them. RESULTS: Of 986 articles found, 24 reviews were pertinent; the five oldest considered the impact of PILs irrespective of the condition the patient consulted for; the 19 more recent ones mostly addressed precise clinical situations. DISCUSSION: Whatever the clinical situation, PILs improve patients' knowledge and satisfaction. For acute conditions, in the short-term PILs also improve adherence to treatment. For chronic diseases, invasive procedures or screening situations, their impact on adherence varies depending on the context, how the PILs are given and the invasiveness of the intervention. CONCLUSION: PILs are considered to be very useful, especially for acute conditions where the patient is the first to suffer from lack of information. We propose checklists for writing, designing, using and evaluating PILs in RCTs to enable comparisons between different studies.

Impact of information leaflets on behavior of patients with gastroenteritis or tonsillitis: a cluster randomized trial in French primary care.

OBJECTIVE: To assess the impact of four patient information leaflets on patients' behavior in primary care. DESIGN: Cluster randomized multicenter controlled trial between November 2009 and January 2011. PARTICIPANTS: French adults and children consulting a participating primary care physician and diagnosed with gastroenteritis or tonsillitis. Patients were randomized to receive patient information leaflets or not, according to the cluster randomization of their primary care physician. INTERVENTION: Adult patients or adults accompanying a child diagnosed with gastroenteritis or tonsillitis were informed of the study. Physicians in the intervention group gave patients an information leaflet about their condition. Two weeks after the consultation patients (or their accompanying adult) answered a telephone questionnaire on their behavior and knowledge about the condition. MAIN MEASURES: The main and secondary outcomes, mean behavior and knowledge scores respectively, were calculated from the replies to this questionnaire. RESULTS: Twenty-four physicians included 400 patients. Twelve patients were lost to follow-up (3 %). In the group that received the patient information leaflet, patient behavior was closer to that recommended by the guidelines than in the control group (mean behavior score 4.9 versus 4.2, p < 0.01). Knowledge was better for adults receiving the leaflet than in the control group (mean knowledge score 4.2 versus 3.6, p < 0.01). There were fewer visits for the same symptoms by household members of patients given leaflets (23.4 % vs. 56.2 %, p < 0.01). CONCLUSION: Patient information leaflets given by the physician during the consultation significantly modify the patient's behavior and knowledge of the disease, compared with patients not receiving the leaflets, for the conditions studied.

[Developing patient information sheets in general practice. Proposal for a methodology]. / Elaboration de fiches d'information pour les patients en médecine générale. Proposition d'une méthodologie.

BACKGROUND: Health information is patients' wish and right. For general practitioners, it is a duty, a legal obligation and a pre-requisite in any preventive approach. Written information must complete oral information since it improves health care quality. However, in general practice, there are no patient documents which are scientifically valid, understandable and efficient in terms of communication. OBJECTIVE: To develop a method for creating patient information sheets and to experiment its feasibility through the development of 125 sheets focused on the most common clinical conditions in general practice. METHOD: Research and literature review pour the development of specifications, and creation of 125 sheets following these specifications. RESULTS: The specifications developed consist of the 10 following steps: selection of the topic and the objectives, literature review, selection of the sections, drafting, validation of the scientific contents, assessment among patients, validation of the layout, selection of the media, delivery to patients and update. Following these specifications, we developed 125 information sheets. Each of these was reviewed by several physicians and assessed with R. Flesh readability test (the established acceptable threshold value was 40). The 30 sheets associated with the lowest scores were selected and reviewed to improve their overall readability. CONCLUSION: Even though some difficulties cannot be avoided when developing patient information sheets, each physician or physician association can create its own documents following the proposed specifications and thus deliver a customized message.