The Organization and Distribution of Patient Education Materials in Family Medicine Practices
Personal Stash Organization
Another set of practices adopted a different strategy of using patient education materials. In these practices, the physicians themselves took responsibility for the patient education handouts. The individual physicians each selected, organized, and maintained a small private collection of materials. Even within group practices, physicians using this organizational scheme would maintain separate collections of patient handouts that fit their unique instructional needs. In these practices, patient education materials were used more frequently.
The Personal Stash. One physician and a recently hired nurse practitioner worked in a clinic with a diverse patient population ranging from trendy young professionals to homeless families. The physician consistently incorporated verbal patient education into almost every clinical encounter. In counseling patients, he demonstrated remarkable versatility in acknowledging patients’ unique social and familial circumstances, as well as their readiness to adopt healthier behaviors.
Very few (28) patient handouts were available in the practice. The physician had developed many of these handouts himself by photocopying articles from popular magazines and books. He was responsible for organizing and maintaining his supply of handouts, and he personally retrieved them from his office filing cabinet to distribute to patients. This physician used patient education handouts quite frequently (in 13 of 52 observed visits—25%).
Providers using the personal stash approach were observed using handouts more frequently than those using shared stockpiles. Where providers drew from a small but known repertoire of patient education materials they used them more often than those in practices with a large number of handouts.
Hybrid Approach
Exceptions to this overall pattern were 4 cliniciansin 2 separate group practices that used the stockpile approach. These clinics had large numbers of patient education handouts maintained by staff members for communal use. In contrast to their partners, these 4 clinicians used handouts extensively (30/122 observed visits). These providers had a personal interest and involvement in the practice’s library of patient education materials. They each maintained a portfolio of selected handouts kept in their own examination rooms or offices, and they had each personally developed some materials. These 4 clinicians had forged a hybrid approach of maintaining hands-on involvement within a system that delegated responsibility to staff. In this way, they were able to maintain familiarity with the materials and use them frequently.
Role of Staff and Patient Self-Selection
In all of the practices, clinicians distributed the majority of patient education materials, and the role of other clinic staff and patient self-selection was minor. In a few clinics, staff gave out written information in response to established protocols (eg, to all new patients or before certain procedures). The clinic staff did not appear to have access to sufficient clinical information to tailor the patient education materials to meet specific patient needs. Frequently they were privy only to the patient’s stated chief complaint and not to the final diagnosis. In addition, many nurses were observed functioning in a very mechanical, highly structured way that did not allow them to respond to the educational needs of patients. Some nursing assistants spent all day escorting patients from the waiting room to the examination room, obtaining a set of vital signs en route. Their professional role was highly circumscribed and did not involve more complex tasks or in-depth interactions with patients.
Even though all of the clinics had education materials available for patients to help themselves, they were only rarely taken. This may have been because sometimes the racks of patient education materials were placed in areas that were difficult for patients to access.
The Information Hallway. In one practice, patient educational material was kept in 2 racks in the hallway. One of these racks was positioned at an exit that was accessible to patients, but the congestion caused by traffic made it difficult for patients to stop and browse the selection of handouts. Another wall rack full of patient education handouts was at the end of a hallway next to the restroom, which was out of the way for most patients. In this practice, patients did not seem to have the opportunity to review the education topics available and select any materials to take with them, so these racks were almost never used.
Other inconvenient places for patients to access materials were in nurse check-in areas where they rarely spent enough time to pick up a handout. However, even when materials were easily accessible, patients were seldom seen taking any handouts. Patients observed in this study also rarely accessed racks of patient education materials placed in waiting rooms or in special patient libraries.
