The Organization and Distribution of Patient Education Materials in Family Medicine Practices
A strategy for sampling the data from other practices was used to identify relevant portions of the larger data set for secondary data analysis. A sample of at least 10 patient encounters with each provider from the 18 practices was read, noting the content and type of patient education. We found that only 10 encounters were needed to reach saturation of our understanding of a provider’s educational style. In addition, all encounters in which a patient education handout was given were reviewed, for a total of 500 patient encounters. Computer searches using key words helped find places where patient education was discussed in the field notes and patient encounters. Photographs of all the practices were reviewed to provide a clear mental picture of the location of the patient education materials in different areas of the clinic.
During the second phase of analysis, the code book was applied to the relevant portions of the database using a template organizing style.52 Segments of the field notes and patient encounter notes that discussed aspects of patient education were identified and organized, and eventually used to construct matrices or tables.51 These matrices allowed visualization of emergent patterns and facilitated comparisons across cases.
Results
Use of patient education materials and the strategies to organize and distribute the handouts varied among providers. Some practices had acquired large numbers of patient education materials while others focused on a small number of handouts. Similarly, staff involvement in acquiring and organizing patient education materials varied from practice to practice. Two distinct patterns of organizational style emerged from the data related to these themes that had implications for the use of the materials Table 2 summarizes this data from each of the practices.
Stockpile Organization
Most of the practices in the study had accumulated large amounts of patient education materials, and many had more than 150 different handouts available. These were eclectic collections of materials that consisted of the pooled contributions of providers, nurses, office staff, and pharmaceutical representatives. Once assembled, these collections were intended for communal use by all providers in the clinic. In some instances, larger health systems had provided substantial collections of printed handouts to each of their clinics. Some practices had the ability to access and reproduce computer-generated patient education materials, further expanding the range of topics available. In these large collections there was often a great deal of redundancy. One 3-physician practice, for example, had 5 different brochures on childhood lead screening. Responsibility for maintaining and organizing these large collections of patient education materials was a time-consuming task that was usually delegated to a staff member. As a result, most physicians were unfamiliar with the handouts available in their practice. In those practices with extensive shared collections of patient education materials, very few handouts were actually used by the providers. The first case provides an example of this type of practice.
The Stockpile. This was a large physician group that recognized patient education as a priority for the practice. They had tried a variety of strategies to enhance their use of written materials, including the hiring of a health education coordinator. She was assigned the task of organizing and maintaining all of their patient handouts.
In this role, the health education coordinator had accumulated a huge number of handouts on a broad range of topics (45 different handouts on well-child care alone). The materials came from pharmaceutical companies, the clinic physicians, professional organizations, and the coordinator’s personal files, and more continued to filter in as the physicians brought in new materials. These education materials were stored at the nurses’ station in neatly color-coded file drawers. Other nursing staff distributed materials in response to physician requests.
Despite the tremendous amount of handouts available, their organization and quality, the staff involvement, and the physicians’ own commitment to using them, written patient education materials were rarely distributed (14/272 or 5% of observed visits).
This was a model clinic in the sense that it had the most staff resources dedicated to maintaining the stockpile of handouts and one of the most organized collections. Many other clinics used the same overall strategy, with similar infrequency of use.
Providers stated one of the reasons they did not use the materials organized in the stockpile was that they were unsure of the quality and accuracy of the information presented. One physician said, “I don’t always necessarily agree 100% with what’s in there, and I feel like if I’m going to hand it out, it’s something I should have read myself.” Another problem with the stockpile approach was that the providers did not know what was available. “There is so much there that it’s almost overwhelming,” one physician stated. Having too many handouts may have made it difficult for providers to familiarize themselves with the materials or to locate the ones they wanted to use.
