Patient Information Materials - Template Recommendations

The template recommendations for patient information materials will build on the previous template recommendations made for newsletters. The design recommendations for formatting and content of newsletters also generally apply to patient information materials. Additional recommendations on patient materials provided below are based on our experience with the development of academic detailing material, our survey of eight academic detailing organizations based in Canada, the United States and Australia, and the catalogued evaluation of 17 patient information materials from these organizations.

Following the template recommendations are recommendations on when patient information materials could be utilized as part of an academic detailing intervention. All individual documents discussed in the recommendations are available in Appendix 32.

Formatting Recommendations

The formatting recommendations made for newsletters also apply to patient information materials. Specifically, the number of sections should be less than five, with line length of 7 to 12 words. Table and text hierarchical structure needs to be consistent and should not have more than three levels. These recommendations have been dealt with in detail in the newsletter section and will not be considered further here. In general, design related readability is even more important in patient information materials. Design elements may help to support the unique requirement of patient information materials to address the issue of reading level.

Reading grade level is a unique requirement for patient information materials. The documents evaluated may not have explicitly addressed this issue during their production. This is evident by the number of patient information documents with grade nine and ten reading level requirements. The heartburn prescription (PI-08) was the only patient material to achieve our reading level target of grade five to six. An explicit template requirement for patient information materials should be that materials do not exceed a grade six reading level. This is best achieved by careful attention to the design elements and careful use of language. The avoidance of jargon will also be essential in achieving this goal.

Content Recommendations

Many of the content recommendations for newsletters can be adapted for application to patient information materials.

1. Peer review and Referencing

   While peer review (i.e. by medical professionals) may enhance credibility with patients, it is true peer review (i.e. by patients) that is perhaps more important. Patient information materials should be reviewed by patients and revised accordingly prior to use.

   Referencing of the document to the scientific literature may be of limited value but referencing of other external resources (ex. websites, association contacts, etc.) may be very helpful. References for website and contact phone numbers for additional information and support may be very helpful to patients. The “Treating Your Depression” (PI-10) document is an excellent example of external referencing.

2. Therapeutic Decision Making

   Patients are becoming increasingly involved in decisions about their health. In this context, it is important to provide patients with the information required to make these decisions in an informed way. The “Put out the Fire” (PI-09) illustrates this type of guidance in OTC selection for the management of heartburn.

3. Key Messages and Graphics

   Patients have the same need as healthcare professionals to pull key messages from written material quickly. This is best achieved by graphics and key message summaries. The “How Do I split a Medicine Tablet” (PI-15) does a good job of illustrating the use of graphics to deliver a point quickly.

4. Behaviour Target and Format

   Consideration must be given to the target behavioural change in patients. The desired change may dictate the format (leaflet, alternative prescription pad, clinical guide form). The dynamics of patient-physician interaction in PPI use and antibiotic use for viral infections suggest that an alternative prescription pad might help to re-direct patient needs in these circumstances. The IDIS heartburn prescriptions (PI-08) and NPS symptom management prescription (PI-01) provide good examples of this approach.

Patient Information Material Utilization Recommendations

We have catalogued and evaluated a variety of patient information materials. There are two main situations where patient information materials can be an important compliment to an academic detailing intervention.

The first situation is when patients lack information about their overall disease condition or the medications they are prescribed. Patients’ lacking information on their disease condition is most common in silent conditions, such as hypertension, or conditions that are more difficult to characterize or quantify such as depression (PI-10). Patients’ lacking understanding of their medications is quite common, patient information materials are more important when that lack of understanding may impact the patient’s health or quality of life such as in the use of opioids (PI-04) or sleeping aids (PI-03 and PI-11).

The second situation where patient information materials are useful is when the patients have a large influence on a particular prescribing behaviour. Direct to consumer advertising can also create situations where patients may seek to influence prescribing. Educating the patient on expected benefits to therapy, as was done for statin therapy (PI-16) and other cardiovascular agents (PI-14), can help patients make informed decisions. Another common example of patient influence is the desire to be prescribed antibiotics for infections that are most likely viral. Prescribing aids for situations like this focus on informing patients of recommended management (PI-02) or how to manage the symptoms without an antibiotic (PI-01 and PI-12). Highly symptomatic conditions such as heartburn is another condition where patients may heavily influence the prescribing behaviours. Information around appropriate disease management and pros/cons to alternative therapies may help facilitate appropriate prescribing (PI-09). Alternative “prescriptions” (PI-06 and PI-08) can be an important tool for prescribers in management of patients expecting to receive a prescription.