The Physician’s Role in Educating Patients: A Comparison of Mailed Versus Physician-Delivered Patient Education
Discussion
Our study suggests that providing a self-care book during routine office visits substantially enhances satisfaction with physician-patient communication. The more commonly used approach of sending self-care education materials directly to consumers misses the opportunity to use self-care education to improve the physician-patient relationship.
Patients want to participate in their own health care more actively with their physicians. Ninety percent of patients want to receive written educational materials from their medical providers, and most read and save them.25 When patients are expected to pay a greater share of costs in the future, they will expect greater value from each visit, and educational materials can play a role in increasing such value. Although the Well-Advised book increased satisfaction with physician communications, having the physician distribute the book did not increase the value of the book to the patient. This observation is pertinent, given recent evidence that medical self-care books are a primary source of health information across communities.32 Using the physician as a self-care educator increases the value of the physician visit and complements the value of such books already used in the community.
Limitations
Our study has 2 noteworthy limitations. First, because our intervention was directed at patients visiting the physician, we can draw no conclusions about the value of self-care education to the general population. It is fair to speculate, however, that self-care information is as important for other patients who visit their physicians. Second, we did not try to assess a Hawthorne effect from book distribution by offering the control group a comparable intervention. It is possible that increased satisfaction was related to receiving a nice new book at the visit rather than to the educational aspects of the intervention. We cannot assess the extent to which book distribution merely served as a prompt for increased attention by the physician to the educational needs presented by the patient. There are any number of non–education-related prompts that could trigger increased physician-patient communication.
Conclusions
Since our physician-distributed intervention group showed significantly higher satisfaction than either the control group or direct-mail distribution group, it is unlikely that the book alone explains increased satisfaction. Other studies have established a link between patient satisfaction with care and patient education.3,4,6,33 In our study, it is difficult to separate the benefits of receiving the book from the patient education about self care delivered by the physician. It may be instructive to compare the effects of physician-delivered self-care education with satisfaction with physician messages that are not related to self-care. For example, a study could compare self-care education with information that helps the patients review their medical bills. In addition, a planned analysis of patient utilization practices during the year following this intervention should provide relevant information about the impact of the book on subsequent self-care related visits—whether delivered with or without physician education.
Our findings lend support to the growing evidence that informed patients are more satisfied with their care. Patient satisfaction is related to adherence to therapy and, consequently, better treatment results.24,25,34,35 The simple, relatively inexpensive practice of educating patients is an effective but underused method of improving physician-patient communication. Further research is needed to understand the barriers to physician-based patient education and to assess the effectiveness of using other health care providers to provide patient information.
Acknowledgements
Our research was partially funded through a grant from The Institute for Research and Education, HealthSystem Minnesola. The authors thank Jinnet Fowles, PHD; Elizabeth Kind, MS, RN; Amy Lennartson; and Susan Adlis, MS, for their assitance in editing and reviewing this paper.
