Patricia Quinlan

The relationship among health literacy, health knowledge, and adherence to treatment in patients with rheumatoid arthritis.

BackgroundPatients with poor health literacy often lack the knowledge needed to manage their treatment.ObjectiveThe aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis.MethodThe study was completed in an urban, outpatient rheumatology setting. Health literacy was measured using the Test of Functional Health Literacy in Adults. The Arthritis Knowledge Questionnaire was modified to measure medication specific health knowledge, and the Morisky Medication Adherence scale was used to measure adherence. Researchers used regression analyses to determine if health literacy was a predicator of knowledge and/or adherence.ResultsParticipants (N = 125) had high mean health literacy scores. The average medication knowledge score was 0.73. Adherence to medication regimen was 0.84. Controlling for patient covariates, health literacy was positively associated with education, race, and age. In adjusted analyses, health literacy was a significant predictor of health knowledge but not adherence. Race, neighborhood income, and confidence with contacting provider about medications were predictors of adherence.ConclusionStudy findings indicate that health literacy is independently associated with medication knowledge but not medication adherence in patients with rheumatoid arthritis. These results provide useful information for planning initiatives to support individuals with disease self-management.

Falls Among Patients Who Had Elective Orthopaedic Surgery: A Decade of Experience From a Musculoskeletal Specialty Hospital

STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate falls among elective orthopaedic inpatients at a musculoskeletal hospital. BACKGROUND Falls are the most commonly reported hospital incidents. Approximately 30% of in-hospital falls result in minor injury, and up to 8% of falls result in moderate to severe injury. Given the projected rise in elective orthopaedic procedures, it is important to better understand fall patterns in this population. METHODS A retrospective review of electronic medical records and patient charts (2000-2009) was conducted to identify falls in patients admitted for elective orthopaedic procedures. RESULTS There were 868 falls among orthopaedic patients older than 18 years. The fall rate was 0.9% of admissions, or 2.0 falls per 1000 inpatient days. The average age of the patients who had fallen was 68 years, and 57.6% were women. Knee replacements (38.2%), spine procedures (18.5%), and hip replacements (14.7%) were the procedures most commonly associated with falls. Three hundred eighty-six falls (45.8%) involved bathroom usage. One hundred ten first falls (13.1%) resulted in injuries. Twenty-eight falls (3.3%) resulted in serious events, including 5 returns to the operating room, 3 transfers to a higher level of care, 14 prosthesis dislocations, 6 fractures, 2 intracranial bleeds, and 1 hemorrhage. Patients with serious injuries were more likely to fall earlier (mean postoperative days, 2.7 versus 4.1; mean difference, 1.4 days; 95% confidence interval: 0.51, 2.3; P = .003) and to have had hip replacement (odds ratio = 3.7; 95% confidence interval: 1.7, 8.2). Serious injuries were not associated with body mass index, age, gender, hospital location, day, or fall history. CONCLUSION Falls are avoidable events that are poorly described among orthopaedic patients having elective procedures. This large series identifies hip replacement patients as being at almost 4-fold risk of having a serious adverse event after falling. Larger prospective trials are needed to confirm results and to inform prevention strategies.

Professional Nursing Practice in the Orthopedic Care Setting

The Magnet Model for Nursing Excellence® provides a conceptual framework to guide orthopedic nursing practice. Patient assessment is the cornerstone of patient care delivery and nursing practice communication is a key factor for effective care coordination. Nurses coach and support patients and families through multiple care transitions. Knowledge and self-care competency is achieved through patient and family education.

Practitioner Wellness, Person Centered Healthcare, Reflective Practice, and the Mission of Mindfulness Training Commentary on Garneau K, Hutchinson T, Zhan Q, & Dobkin PL Cultivating Person-Centered Medicine in Future Physicians European Journal of P

A primary purpose of healthcare is the enhancement of health, wellbeing and in understanding and responding to the illness experience in individual patientsA primary purpose of healthcare is the enhancement of health, wellbeing and in understanding and responding to the illness experience in individual patients.

Patient satisfaction with medication management.

This study describes the interdisciplinary development and psychometric testing of the instrument, Patient Satisfaction with Medication Management. A valid and reliable 3-factor instrument that measures patient perceptions of medication management was generated through an explanatory principal component analysis. The Patient Satisfaction with Medication Management should be useful to acute care institutions that are implementing initiatives aimed at improved medication management.