The Organization and Distribution of Patient Education Materials in Family Medicine Practices

Further Observations. Surprisingly, those physicians who used large numbers of handouts were not necessarily those who had the most organized or accessible patient education materials. Many of the practices with large but unused collections of patient education materials had them neatly arranged and indexed for easy retrieval. Several practices had computer programs that could generate patient education materials from an easily searchable list of many patient education topics. These computer programs were only rarely observed being used. In addition, although a few providers who used large amounts of patient education materials had them available in the examination room, others used handouts frequently though they had to retrieve them from a less convenient place (eg, an office down the hall). Similarly, the physicians’ interest in educating patients did not seem to be related to their use of informational handouts. Some physicians spent a great deal of time counseling and educating their patients but relied solely on verbal instruction, without the use of printed materials.

Discussion

Previously published studies have suggested that clinics should accumulate and organize large amounts of material on a great variety of topics as a means of increasing the use of patient education materials.^3,30-32,37 The results of our study suggest that this strategy is associated with lower usage in actual practice. Providers that concentrated their attention on maintaining a small repertoire of patient education handouts used those materials more frequently. It appears that provider involvement and familiarity with patient education materials are key to their use in clinical practice. Clinicians were less likely to use handouts when they were selected and maintained by other clinical staff or by the larger health system. This suggests that when physicians assume a passive role in the collection of educational materials they have less awareness of the topics available, less certainty about the quality of the information, and therefore use the handouts less often. A more efficient strategy might be for each provider in a practice to choose and maintain a small number of patient education materials particularly suited to their educational style, practice profile, and the perceived informational needs of their patients.

The engagement of physicians to maintain a mportant because of the dominant role they play in distributing such materials. Physicians distributed most of the patient education materials in the study practices, with staff members playing only a minor role. Nurses and other staff members gave out materials only in response to set protocols developed for a narrow range of topics. They did not offer patient education materials targeted to individual informational needs, because they did not have access to the clinical information necessary, they lacked the clinical skills to do so, or because patient education fell outside of their defined professional role in the clinic. Handouts tailored to specific patient concerns have been shown to be more effective than generic ones,⁸ so this strategy of distributing materials using fixed clinical protocols may have less impact on patient behavior.

The use of libraries or displays of education materials for self-selection by patients was a strategy used to some extent by all of the clinics, but these resources were underused. Patient education materials were often not located in convenient areas. Other factors such as privacy concerns may have inhibited patients from picking up brochures; this is an area that should be explored in further research.

Because this was a qualitative study, these findings may not be generalizable to all practices; other practices outside of our study may have developed different strategies for organizing patient education materials. Another limitation of this study was that it was observational. Future intervention studies are needed to determine if physicians who adopt the personal stash approach are able to more efficiently use patient education materials. It is also necessary to explore how willing physicians would be to accept some greater responsibility for maintaining personal collections of patient education to enhance their distribution. Government agencies, private health organizations, health systems, and individual practices expend considerable resources on patient education materials. Future research should focus not simply on the development of new handouts but also on exploring ways they can be incorporated into actual clinical practice.

Acknowledgements

The study was funded by the Agency for Health Care Policy and Research Grant #5 RO1 HSO8776092 and the State of Nebraska Department of Health and Human Services LB 506–Cancer and Smoking Funds. The authors would like to thank Jason Lebsack and Diane Dodendorf for data management, Constance Gibb and Jenine Rouse for data collection, Linda Swoboda for manuscript preparation, and Helen McIlvain and Jeff Susman for manuscript review.