ABSTRACTS

Volume 11, Number 6
September 2006

Vol. 11, Number 6: Contents | Editorial | Abstracts

Approaches to Improving Health Literacy: Lessons From the Field
    Terry C. Davis A1, Julie Gazmararian A2, Estela M. Kennen A3

A1 Departments of Medicine and Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
A2 Emory Center on Health Outcomes and Quality, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
A3 Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA

This article does not have an abstract.

The Importance of Establishing Regimen Concordance in Preventing Medication Errors in Anticoagulant Care
    Dean Schillinger A1, Frances Wang A1, Maytrella Rodriguez A1, Andrew Bindman A1, Edward L. Machtinger A2

A1 University of California, San Francisco Division of General Internal Medicine, San Francisco, California, USA
A2 San Francisco General Hospital, San Francisco, California, USA

Miscommunication between patients and providers can have serious consequences, especially where medications are concerned. We examined whether regimen discordance between patient and provider, a possible result of miscommunication, contributes to unsafe medication management.

We studied 220 patients taking warfarin in an anticoagulation clinic to characterize two medication assessment methods. We measured (1) adherence by asking patients to report any missed doses and (2) concordance between patients' and providers' reports of warfarin regimens. We categorized patients as having regimen adherence if they missed no doses, and concordance if there was patient–provider agreement in weekly dosage. We characterized anticoagulant outcomes as unsafe if international normalized ratio (INR) values were <2.0 (at risk for thrombosis) or >4.0 (at risk for hemorrhage), and explored relationships among adherence, concordance, and anticoagulant outcomes.

One hundred fifty-five patients (71%) reported no missed doses during the prior 30 days. Poor adherence was associated with underanticoagulation (AOR 2.33, 1.56–3.45), but not overanticoagulation (AOR 1.36, 0.69–2.66). One hundred ten patients (50%) reported regimens discordant with clinicians' report. There was no relationship between patients' reports of adherence and concordance. Among adherent patients, discordance was associated with underanticoagulation (AOR 1.67, 1.00–2.78) and overanticoagulation (AOR 3.44, 1.32–9.09).

Discordance regarding warfarin regimens is common and places patients at risk for adverse events. To promote safe and effective care, clinicians should separately determine adherence and regimen concordance during routine medication assessments. Systems need to be developed to ensure concordance in medication regimens.

The Influence of Graphic Format on Breast Cancer Risk Communication
     Marilyn M. Schapira A1, Ann B. Nattinger A1, Timothy L. McAuliffe A2

A1 General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
A2 Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Graphic displays can enhance quantitative risk communication. However, empiric data regarding the effect of graphic format on risk perception is lacking. We evaluate the effect of graphic format elements on perceptions of risk magnitude and perceived truth of data. Preferences for format also were assessed. Participants (254 female primary care patients) viewed a series of hypothetical risk communications regarding the lifetime risk of breast cancer. Identical numeric risk information was presented using different graphic formats. Risk was perceived to be of lower magnitude when communicated with a bar graph as compared with a pictorial display (p < 0.0001), or with consecutively versus randomly highlighted symbols in a pictorial display (p = 0.0001). Data were perceived to be more true when presented with random versus consecutive highlights in a pictorial display (p < 0.01). A pictorial display was preferred to a bar graph format for the presentation of breast cancer risk estimates alone (p = 0.001). When considering breast cancer risk in comparison to heart disease, stroke, and osteoporosis, however, bar graphs were preferred pictorial displays (p < 0.001). In conclusion, elements of graphic format used to convey quantitative risk information effects key domains of risk perception. One must be cognizant of these effects when designing risk communication strategies.

Sex Education and the News: Lessons From How Journalists Framed Virginity Pledges
    Felicia E. Mebane A1, Eileen A. Yam A2, Barbara K. Rimer A3

A1 Department of Health Policy and Administration, School of Public Health, The University of North Carolina at Chapel Hill, North Carolina, USA
A2 The Population Council, Regional Office for Latin America and the Caribbean, Mexico City, Mexico
A3 Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill, North Carolina, USA

This analysis of newspaper articles about virginity pledges published from 1987 to 2001 describes prominent news frames on sex education. The articles focused on True Love Waits, a nationwide virginity pledge campaign encouraging abstinence, and results from Add Health (TLW), a longitudinal study that included questions to evaluate the effects of virginity pledges. Our results show how news frames and sources can vary for related events. Reporting on virginity pledges was often not grounded in science, and reporting on the science of pledges did not reflect a broader context. In this case, reporting may have encouraged support for abstinence-only programs.

Improving the Way We Die: A Coorientation Study Assessing Agreement/Disagreement in the Organization–Public Relationship of Hospices and Physicians
    Kathleen S. Kelly A1, Michael F. Thompson A2, Richard D. Waters A1

A1 Department of Public Relations, University of Florida, Gainesville, Florida, USA
A2 Legislative Aide, Senator Jon Kyl (AZ), Washington, DC, USA

The movement to reform dying in America promotes hospice as a model for change. Yet terminally ill patients increasingly are closer to death when they enter some 3,300 hospices. Hospice leaders blame physicians for delaying referrals and charge that delays cause hardships for their organizations and patients. Based on symmetrical theory and the coorientation model, a survey of one Southern hospice and its referring physicians was conducted to measure agreement, perceived agreement, and accuracy between the two sides on the issue of timely referral. Results showed that hospice leaders inaccurately perceive a high degree of disagreement when they and physicians generally agree on the issue.

Book Review

A Review of: “Paget, M. A. (2004). The Unity of Mistakes: A Phenomenological Interpretation of Medical Work.”: Philadelphia, PA: Temple University Press.
Heather J. Carmack