The Organization and Distribution of Patient Education Materials in Family Medicine Practices
METHODS: Eighteen purposefully selected family medicine practices were directly observed for 4 to 12 weeks each. A total of 57 providers were shadowed by a research nurse, and detailed field notes on 1600 patient encounters were recorded. A 3-member analysis team reviewed the qualitative data and identified emergent patterns.
RESULTS: Clinics’ use of patient education materials fell mostly into 2 distinct patterns. “Stockpilers” were providers who relied on the clinic staff to develop and organize a common library of patient education handouts. Providers with a “personal stash” collected much smaller numbers of materials that they personally maintained. Providers in the latter group had a known repertoire of a limited amount of educational material and used it more often than providers with access to a greater variety and number of handouts. In all practices, providers distributed most handouts; staff and self-selection by patients played a minor role.
CONCLUSIONS: It appears that provider involvement and familiarity with patient education materials are key to their use in clinical practice. Clinicians use written patient education materials most efficiently by personally selecting and maintaining a small number of handouts that address topics most relevant to their practice.
Patient education has been defined as a “learning experience using a combination of methods such as teaching, counseling and behavior modification techniques which influence patient’s knowledge and health behavior.”1 Health information provided by physicians is a type of patient education valued by patients2,3 and that plays a role in the complex issue of improving overall health status and psychosocial functioning.4,5 Various educational formats are used by physicians including verbal instruction, counseling, referral to education specialists, audio or videotapes, and written education material. Printed handouts, however, have several theoretical advantages over other methods of patient education:6 Patients may have difficulty remembering instructions that are presented only verbally,3,7,8 and written handouts can supplement or reinforce information presented during the office visit. Handouts are also proposed to be a cost-effective means for the busy clinician to educate patients without having to convey all the information personally.
Several studies have confirmed the theoretical utility of written patient education materials. Patients both read and retain written materials given to them by health professionals.9-11 This written information has been shown to increase compliance with medication use,12-14 physicians’ instructions,15,16 smoking cessation,4,8 and the use of preventive health services.8,17 Information handouts have also been shown to increase patient knowledge,18-20 to increase satisfaction with patient care,9,10,21 and to reduce patient anxiety.5,8 Written information has even been shown to reduce unnecessary medical visits22-24 and inappropriate telephone calls.25 For these reasons, both providers and patients report they value written materials.26-28
Large amounts of patient education materials are available, covering topics ranging from prevention and safety issues to strategies for coping with chronic diseases. The American Cancer Society, for example, spent $56 million on producing patient education materials in 1989.29 In spite of the amount of material available, little information has been published on how handouts are used in actual clinical practice.
Few studies in the medical literature describe strategies clinicians can use to organize and disseminate written materials in the office setting. Most authors recommend compiling a comprehensive set of written handouts covering a broad array of clinical topics and indexing these materials to facilitate retrieval by medical personnel.3,30-32 Some of these authors have also described the use of computers to both index and generate written materials.3,30,33-35 The various strategies described for disseminating written materials to patients have included using the clinician, nursing staff or receptionists,36 patient libraries,32,37 and racks in waiting rooms.3,8 None of these strategies have been adequately evaluated in terms of their effectiveness in enhancing the use of written patient education materials, and no studies have described what office systems exist in actual practices to support their use.
This paper describes how patient education materials are organized and disseminated in family practices, and the office system factors that contribute to their use in real world settings.
Methods
The “Prevention and Competing Demands in Primary Care Practice” study was designed to examine the organizational contexts that support or inhibit the delivery of preventive services in family medicine practices. From November 1996 to February 1999, extensive descriptive field notes were recorded throughout this large comparative case study of family practice organizations. Eighteen practices were studied using a multimethod ethnographic design that involved observation of clinical encounters and the office system by a research nurse who spent 4 weeks or more in each practice. A total of 44 physicians and 13 other primary care providers were shadowed and interviewed, and approximately 1600 patient encounters were directly observed. Data collection generated approximately 20,000 pages of text materials. Descriptions of how patient education materials were organized and used in practices were drawn from this larger data set that looked more broadly at preventive services delivery.
