ga

** skip to content **

Mes fichiers [0]

Ce sont les fichiers que vous avez ajouté à votre collection.

  • ** cart_no_document_in_cart **

ACMTS » Resources » Academic Detailing Templates » Academic Detailing Material Overview » Patient Information Materials - Evaluation

Patient Information Materials - Evaluation

Introduction

Patient information materials represent another means of facilitating appropriate prescribing activities. The provision of patient materials recognizes that prescribing decisions are a joint decision of patients and prescribers. By informing patients about their conditions or why certain prescribing decisions are being made, it is hoped that more appropriate prescribing and better patient outcomes will result. These materials may be designed for direct distribution to patients or for prescribers to provide during patient visits. Academic detailing organizations may develop or utilize other organizations’ patient information materials as value-added products to complement detailing visits.

Methods

Patient information materials were collected from a variety of Canadian and International academic detailing organizations. Summary descriptive information was abstracted from each patient information sample. The number of pages, word count, use of colour, use of branding and a summary of key informational content was collected for each document. There was no a priori categorization system developed but the materials were given a descriptive categorization as they were reviewed.

The reading level of the patient information materials was felt to be an important assessment of their quality. Where possible, the texts were abstracted and assessed using the Flesch Reading Ease Score (FRES). This was calculated using the formula: FRES = 206.835 – (1.015 x ASL) – (84.6 x ASW) where ASL is the average sentence length and ASW is the average syllables per word. It is scored on a 100-point scale with higher score indicating greater reading ease. Given the abstract nature of this measure, the more intuitive Flesch-Kincaid Grade Level (FKGL) was also calculated using the formula: FKGL = (0.39 x ASL) + (11.8 x ASW) – 15.59.

This returns a value equivalent to the reading grade level. In general, a reading level of grade five to six is considered appropriate for materials produced for patients. We will base our evaluations on this target reading level. The reading level of each document was calculated using both tools (FRES and FKGL) for the purpose of this evaluation.

Other quality measures were based on the elements used in the assessment of newsletters and prescribing aids. A more pragmatic qualitative approach was taken with patient materials than with the newsletter materials. Similar to the evaluation of prescribing aids, the heterogeneity of the patient information materials did not allow for the individual application of all 20 elements used in the newsletter evaluation. Once again composite quality elements were used to give the flexibility required to accommodate the heterogeneous nature of patient information materials.

The evaluation consisted of a written commentary on five composite quality elements. One researcher conducted the evaluation of each of the patient information documents. A second researcher then reviewed these evaluations and provided further comments as necessary.

The final version of the evaluation questionnaire for academic detailing material provided to patients is available in Appendix 31. The rationale for each element is discussed below:

Element #1

Readability – Evaluation of the patient information readability was considered over and above the assessment of reading ease and grade level. The focus here was on the design elements that supported readability regardless of the complexity of the text.

  • In documents where prose was utilized, the appropriate division of text into readable “chunks” was evaluated and the document was monitored for overly long sections of text.

  • In documents where prose was utilized, the column width was assessed recognizing that, to enhance readability, columns should have 7 to 12 words per line.

  • The justification of text was assessed recognizing that un-justified (left flush) text provides a variety in line length that helps readers locate the next line when reading. The over-use of hyphenation was also monitored.

  • The consistent and appropriate use of colouring and highlighting (including use of bold and underlined text) was assessed recognizing that appropriate use can improve readability and inappropriate use can cause confusion.

  • The font size was assessed to ensure ease of reading.

  • The general editorial consistency within charts (similar format, colour patterns and structure) and within text (similar heading formats and use of bullet points) were assessed.

Element #2

Decision Support – Patients are playing an increasing role in the decision regarding their health. The evaluation of patient materials assessed the ability of the documents to provide appropriate support for patients in making these decisions. This assessment included:

  • The presence of relevant therapeutic information including alternative agents, dosing considerations, side effects, prescription status and any other information required to support patient decisions.

  • The presence of information on medication cost was assessed as an important factor affecting patient’s choice and decision regarding drug therapy.

  • Internal referencing (supporting document) and external referencing (providing links to other patient resources) were evaluated. The presence or absence of referencing was evaluated.

  • The presence of mechanisms for storage and retrieval were assessed. These mechanisms support the use of the material for future reference by patients.

Element #3

Impact – The potential impact of the materials on patient behaviour was assessed by reviewing the content and design elements used in the assessment of newsletters.

  • Both the presence of key points or main messages and whether they were highlighted within the document was assessed. Readers may only remember one or two points and insuring these stand-out and are easily retrieved may be an effective way to enhance retention.
  • The presence or absence of a specific patient behaviour target was assessed. While many patient documents provide information, the best have been designed with to affect a change in patient behaviour.

Element #4

Strengths – Highlight of the best qualities of the patient information material, including consideration of any positive aspects that are not evaluated through elements 1-3.

Element #5

Weaknesses – Highlight of the worst qualities of the patient information materials, including consideration of any negative aspects that are not evaluated through elements 1-3.

Results

A total of 17 patient information documents from six different academic detailing organizations were evaluated. We defined six different categories of patient information materials.

  • Patient Information Leaflets – These information materials were presented on standard 8.5 x 11 inch paper. The “Treating Your Depression” (PI_10) is a good example of this format.

  • Patient Information Brochures – The informational materials are similar to leaflets but with higher formatting and production values. The “Put Out the Fire” (PI-09) is an excellent example.

  • Patient Information Tear Off Pads – This format allows for smaller paper sizes and is distributed in pads that can be sent to physicians’ offices. The “Nonsteroidal anti-inflammatory drugs” (PI-07) is a good example.

  • Alternate Prescription Pads – This format provides support for patients and physicians in circumstances where a prescription may be expected but may not be necessary. The “Symptomatic management” (PI-01) is one of several examples of this approach.

  • Posters – Informational posters directed at patient behaviour represent another approach. The BC CDUP used this approach for antibiotics and viral infections (PI-13).

  • Patient Clinical Guidance Forms – This form goes beyond information and provides a template for a clinical plan of disease management for patients. RxFiles and Health Quality Council in Saskatchewan did this with their “Asthma Action Plan” (PI-17).

The patient information materials had an average length of 1.7 pages with a range from one to four pages. The average word count was 428 and ranged from 33 to 897. Note that word counts were only possible on 14 of the 17 documents.

The average Flesch Reading Ease Score was 55.6 with a range from 44 to 70.3. This translates into an average Flesch-Kincaid Grade Level of 8.6 with a range from 5.4 to 10.1. Note that reading level assessments were only possible on 13 of the 17 documents.

The catalogue of individual patient information materials and their associated evaluation is included in Appendix 32.

Limitations

There are a number of limitations to the evaluation of patient information materials. It was not possible to abstract the text from all documents. It was therefore not possible to perform the word count and reading level assessment for these documents. The remaining assessment made use of more crude composite elements than was used in the newsletter assessment. The second researcher review was not independent and may have been significantly influenced by the comments of the first reviewer. The elements used to evaluate the material were highly subjective in nature. Although the design and content elements considered have face validity as an assessment of patient information quality, no attempt was made to validate this scale with outcomes. Ideally, the quality outcomes would validate characteristics of patient information material against outcomes or a surrogate patient behavioural change. This complex task is beyond the scope of the current project. The evaluation scale and assessment does attempt to descriptively analyse multiple dimensions of the different documents to provide useful template recommendations.

We have a variety of categories/formats of patient information materials used by academic detailing organizations. This variety has to be considered as an important outcome of the project. The variety does, however, challenge the use of uniform assessment of quality. This limitation should be considered when viewing individual assessments of patient information material quality.

Discussion

Importance

Patient information materials are not used by all academic detailing organizations and when used, it is to varying degrees depending on the topic under discussion. The increased involvement of patients in the decision making process suggests that this type of document will gain increasing importance in the future. In some circumstance, certain patient information materials (Alternative Prescription Pads) address a particular behavioural target (barrier) in the patient-prescriber encounter. In some cases, this material may also have a role in direct distribution to the public. However, in most cases, they perform a supplemental role to aid healthcare professionals achieve certain educational outcomes. There is also a trend to create interactive documents that support joint decision making. The documents require joint participation and partial completion of the form by prescriber and patients working together. As a potential toolkit item, patient information materials represent an important supplement made for healthcare consumers. If properly designed, some patient information material could be made available for direct distribution to consumers in areas of the country where academic detailing is not available.

Content and Format

The content and format are highly dependent on the topic and associated behavioural targets. In most circumstances, patient information materials should be limited to one to two pages. It appears that the vast majority of patient materials currently produced have a reading level exceeding the target grade five to six level. The document format must have an explicit design goal to meet these reading level targets. We have defined six different patient information formats. Careful consideration of the best format to fit the outcome objective will need to be considered. The use of graphics to illustrate concepts may help to address both clinical requirements and reading level limitations. It should also be recognized that list and check-offs inherently lower the reading level and enhance design-based readability. While a variety of formats may be used to fit the content specific purposes, uniform design elements will help to enhance recognition by both prescribers and patients. This recognition can be an important factor in building on academic detailing relationships to establish these products as useful sources of non-commercial drug information.

Process

Patient information materials in Canadian academic detailing organizations are viewed as supplemental. While most would acknowledge their potential value, their production requires additional development time beyond the core materials. Given the timeframe for the development of core materials, it is often not possible for Canadian academic detailers to include these materials. As supplementary materials, COMPUS could play a key role in the central development, production and testing of patient information materials. Even well established academic detailing organizations have expressed a willingness to make use of this type of supplementary materials. This supplementary nature would allow these materials to be more widely distributed through non-academic detailing organizations. Thus academic detailers represent only one value added distribution point of these materials.

The interviews with academic detailing organizations suggest it takes a minimum of several weeks to several months to produce the core materials (usually a newsletter). Additional supplementary material development would extend this time-line. Some academic detailing organizations do not have the time to develop patient materials or develop them relatively quickly. Central COMPUS production should allow for more polished development (and testing) with economies of scale to allow for higher production value. In this context, centrally produced patient information materials could be of considerable value to Canadian academic detailers. As with all materials, the planning horizon of academic detailers must be considered. Well-planned delivery dates and topic announcements will allow academic detailing organizations to plan around the release of COMPUS materials. Release of early drafts of materials may also help academic detailing organizations decide how they will best use, supplement and adapt the COMPUS materials to their programs.