The Physician’s Role in Educating Patients: A Comparison of Mailed Versus Physician-Delivered Patient Education
METHODS: Using a nonrandomized controlled research design, we compared patient satisfaction with self-care information provided by traditional direct-mail approaches and by physicians during routine office visits. We also studied a control group of patients receiving usual care.
RESULTS: Patients who received a medical self-care book from a physician were significantly more likely to be satisfied with their office visit than those who received the book in the mail or those who experienced usual care. The intervention group reported greater satisfaction with 11 out of 13 variables related to physician-patient communication and quality of care. There were no significant differences between the control group and the direct-mail group.
CONCLUSIONS: The patients who received self-care information from their physicians were significantly more satisfied with their care and their physician-patient communication experience than those in either the direct-mail group or the control group. Our findings lend support to the growing evidence that patients informed by their physicians are more satisfied with their care.
Patients appear to be most satisfied when they consider the physician a partner in the exchange of information rather than an authority who controls the relationship.1 Also, patient satisfaction is strongly associated with the quantity and quality of the educational information provided by physicians.2-5 In a study of the relationship between patient satisfaction and health education, patients were significantly more likely to be satisfied with their physician if the physician had discussed one or more health education topics with them in the past 3 years.2
Patients’ needs for health education, however, continue to be unmet.6 A primary complaint of those dissatisfied with care is the inadequate level of information provided by their physicians.7 Indeed, there are documented discrepancies between what patients value and what physicians think is important during routine office visits.8-10 We examined whether an increased physician role in educating patients is an effective means of improving patient satisfaction.
Advising physicians that their patients prefer more education and counseling will not increase the likelihood that they will provide such information.11,12 A recent study concerning the physician’s role in patient education illustrates a gap between physician and patient expectations. Laine and colleagues10 demonstrated that although physicians’ and patients’ opinions were similar in describing the importance of many aspects of care, they were dissimilar in their evaluation of the importance of the communication of health-related information. Patients ranked the importance of receiving information much higher than did the physicians.
Self-care education programs have traditionally been delivered directly to patients as a way to offer standardized consumer information about the self-management of common health problems.13-16 Because self-care education programs bypass the physician, little is known about the effect of self-care education on patient satisfaction and physician-patient communications.17-19 Most studies of self-care education focus on use rather than patient satisfaction.20-26 Relatively little is known about the value of the self-care education that is provided by the physician or any subsequent effect on patient satisfaction with physician-patient communication.27-29
The purpose of our study was to compare patient satisfaction with the self-care information delivered by traditional direct-mail approaches with that provided by physicians during routine office visits. These 2 approaches to information distribution were compared with a control group of patients receiving usual care.
The selected self-care book, Well-Advised: A Practical Guide to Everyday Health Decisions,30 includes more than 100 topics and provides home remedies, advice for dealing with children’s symptoms, and information about when to call the physician. It was written by health educators in cooperation with professional writers. It was reviewed and approved by more than 150 physicians from family practice, internal medicine, pediatrics, and other specialties.
We hypothesized that patients receiving self-care education from their physicians would be more satisfied with their physician-patient communication than those who either received the education materials in the mail or experienced only usual care. In addition, we believed patients receiving self-care education during their office visits would be more satisfied with the information than with those who received it in the mail.
Methods
Setting
We conducted this study at the Park Nicollet Clinic, HealthSystem Minnesota, an outpatient multispecialty clinic within a vertically integrated health care system, from November to December 1997. The Park Nicollet Clinic employs more than 400 physicians and has 15 clinic sites that provide primary care in Minneapolis and its suburbs. For our study, we selected 4 clinic sites according to patient volume and demographic characteristics. Those selected included an inner city primary care site with a diverse population and 3 suburban sites with busy primary care practices and relatively homogeneous white middle-class patient populations.
