Dear all,
Last week I posted the following request for help:
"I was hoping that you may be able to help me. I'm searching the literature
for evidence that shows (or does not show) that providing the patient with
information improves health outcomes (where information can be any
information at all - e.g. health promotion material, information on medical
devices/pharmaceuticals etc.). The disease categories that I'm interested
in are coronary heart disease and diabetes."
I had a great many responses, and many people asked me to share the information
with them. I thought the easiest way to do this was to post a collated list of
responses to the lists.
This I have done below, though I have not included all responses: for example,
those containing Word files as I thought these may clog up some people's e-mail
systems.
Many thanks to everyone who responded.
Best wishes,
Adam
-----------------------------------------
Lorig K, Konkol L & Gonzalez V, 1987, Arthritis patient education: a review
of the literature, Patient Education and Counselling, 10, 207-252
The reference above is a well cited article around patient
information/education. Although it concerns arthritis, it may provide some
info re background issues or be a starting point for you. Unfortunately I
have not come across anything for CHD / diabetes (but then I haven't
looked).
The literature that I've come across has implied that information alone does
not have any great impact on health outcomes - patients need to know what to
do with the information and believe they can do it for it to have any
effect.
--------------------------------------------
Check out Greenfield, S, Kaplan S, Ware J. Expanding patient involvement in
care: effects on patient outcomes. Annals of Internal Medicine,
1985;102:520-528. Should be just what you're looking for.
-------------------------------------------------------------------------------------------
The Centre for Health Information Quality may be able to help.
www.hfht.org/chiq
[log in to unmask]
tel: 01962 872245
------------------------------------------------------------------------------------------------
Clenland, J.G. & Van Ginniken, J.K. (1988) Maternal education and child
survivalo in developing countries: The search for pathways of influence.
Social Science Medicine, 27 (1), 357-368.
Grosse, R.N., Auffrey, B. (1989). Literacy and health status in developing
countries. Annual Review of Public Health, 10, 281-297.
Perrin, B. (1989) Literacy and health project: Phase one. Making the world a
healthier and safer place for people who can't read. ERIC Document #ED346357.
Smith, C. (1994). Health education and adult literacy (HEAL) project final
evaluation report. Boston: World Education.
http://www.prenataled.com/newsletters/v3n10/v3n10-3.htm
Should we test patients' "health literacy"?
http://www.prenataled.com/newsletters/v3n11/v3n11-2.htm
Prepared to teach low literacy patients?
http://www.prenataled.com/literacy.htm
Literacy
http://www.prenataled.com/quiz1-1.htm
Check Your Prenatal Ed IQ (effects of access to info on pregnancy and
birth outcomes)
http://www.prenataled.com/bibsig.htm
Significance of Information Giving to Health & Satisfaction,
Literature Review Summary
Kirsch IS, Jungeblut A, Jenkins L, Kolsted A (1993) Adult Literacy in
America. National Center for Education Statistics, US Department of
Education, Washington, D.C. GPO 065-000-00588-3. To order: (202)
783-3238.
Weiss BD, Hart G, McGee DL, and D?Estelle. (1992) Health status of
illiterate adults: Relation between literacy and health status among
persons with low literacy skills. J Am Board Fam Pract 5, 257-264.
Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin K, Coates WC, Nurss
JR. (1995) Inadequate functional health literacy among patients at two
public hospitals. JAMA, 274(21):1677-82
PATIENT & MATERIALS ASSESSMENT TOOLS
Davis TC, Long SW, Jackson RH, et al. (1993) Rapid Estimate of Adults
Literacy in Medicine: a shortened screening instrument. Fam Med;
25:391-395.
Doak CC, Doak LG, Root JH. (1996) Teaching patients with low literacy
skills (2nd edition). J.B. Lippincott Company. Philadelphia. Includes a
materials assessment tool, the SAM (Suitability Assessment of Materials)
that incorporates readability, graphics, format, cultural orientation.
Parker RM, Baker DW, Williams MV, Nurss JR. (1995) The test of
functional health literacy in adults (TOFHLA): a new instrument for
measuring patients' literacy skills. J Gen Intern Med, 10(10):537-41.
Weiss BD, Coyne C. (1997) Communicating with patients who cannot read.
New England J Med 337(4), 272-273.
----------------------------------------------------
Skipper J.K, Leonard RC Social interaction and patient care. Philadelphia,
Lippincott, 1965.
Tagliacozza D, Ima K Knowledge of illness as a predictor of patient
behaviour. Journal of Chronic Disease, 1970; 22 pp765-775.
Greenfield S, Kaplan S, Ware JE Expanding patient involvement in care:
effects on patient outcomes. Annals of Internal Medicine, 1985; 102 pp520-528.
Egbert LD, Battit GE, Welch CE et al Reduction of post-operative pain
encouragement and instruction to patient. New England Journal of Medicine,
1964, 270 (April 16) pp 825-827
Young JW, The effects of perceived physician competence on patients'
symptom disclosure to male and female physicians. Journal of Behavioural
Medicine, 1980, 3, pp279-290.
1. Gattuso SM, Litt MD, Fitzgerlad TE. Coping with gastrointestinal
endoscopy: Self-efficacy enhancement and coping style. J Consult Clin
Psychol 1992;60:133-139.
2. Hartfield MT, Cason CL, Cason GJ. Effects of information about a
threatening procedure on patients' expectations and emotional distress.
Nursing Research 1982;31.
3. Levy N, Landmann L, Sterner E, Erdreich M, Beny A, Meisels R. Does a
detailed explanation prior to gastroscopy reduce the patient's anxiety?
Endoscopy 1989;21:263-265.
Carey RG, Posavac EJ Using patient information to identify areas for
service improvement. Health Care Management Review, 1982, 7; p43-48.
-----------------------------------------------------
The Center for Advancement for Health has published selected evidence
> for Behavioral Risk Reduction in Clinical Settings in the following
> areas:
>
> Dietary Practices
> Diabetes
> Depression
> Chronic Back Pain
> Cardiovascular Disease
> Asthma
> Alcohol and Other Misuaed Drugs
> Smoking
> Physical Inactivity
>
> They have also published a Status Report on Health Behavior Change in
> Managed Care. All this material may be dowloaded from their web sit
> or hard copies ordered (which make a nicer presentation).
>
> Their email address is: www.cfah.org
>
> I have discovered two additional sites:
>
> www.communityhealth.hrsa.gov
>
> www.hrsa.gov/stateprofiles
>
> Health Resources and Services Administration provides a Community
> Status Report for every US County! There is also a comparison of
> counties to peers - similar size, population composition, and density.
> They have also developed state profiles.
>
> Not only are there demographics but risk factors for premature deaths,
> access to care, preventive services use, measures of health (Healthy
> People 2010), vulnerable populations, uninsured residents, teen
> mothers, environmental health, health status compared to peers,
> leading causes of death, and measures of birth and death!
----------------------------------------------------
Pritchard DA et al. J Epidemiol Comm Hlth 1999;53(5), 311-6. Nutritional
counselling in general practice: a cost effective analysis.
Segal L, et al. Hlth Promotion Int 1998;13(3), 197-209. Cost-effectiveness of
the primary prevention of NIDDM.
-------------------------------------------------------
> you've probalbly tried bmj.com, they had a recent letter (29 April 2000)
> concerning expense of leaflets vs touch screens and have a good and
> accessible and free cross referncing to previous issues. i'd be
> interested in any references you come across about info/evidence of
> health improvement for people with learning difficultes.at present, we
> are involved in developing info for home carers on managing complex
> health issues eg gastrostomy management at home.
-----------------------------------------------------------
Mullen PD; Mains DA; Velez R. A meta-analysis of controlled trials of
cardiac patient education. Patient Educ Couns 1992 Apr;19(2):143-62
Dusseldorp E; van Elderen T; Maes S; Meulman J; Kraaij V . A meta-analysis
of psychoeduational programs for coronary heart disease patients. Health
Psychol. 1999 Sep;18(5):506-19.
Linden W; Stossel C; Maurice J. Psychosocial interventions for patients with
coronary artery disease: a meta-analysis. Arch Intern Med. 1996 Apr
8;156(7):745-52.
Brown SA Meta-analysis of diabetes patient education research: variations in
intervention effects across studies. Res Nurs Health 1992 Dec;15(6):409-19
Brown SA. Studies of educational interventions and outcomes in diabetic
adults: a meta-analysis revisited. Patient Educ Couns 1990 Dec;16(3):189-215
--------------------------------------------------------------------
My own opinion is that Adam will not find much, if anything, useful, if he is
searching for a direct causal link. The reason is education of all kinds
can be and has been associated with this or that outcome or measurement,. but
the relationship is one of CORRELATION, not CAUSATION.
That's because the learning process involves many factors, and many (if not
most) of those factors cannot be controlled in a research design. Health or
education professionals who "think" as a scientist/researcher and
consciously, or unconsciously, search for "proof" based on the scientifc
method of hypothesis to conclusion often express frustration at how
wishy-washy research in education seems to be.
To some extent we are talking philosophy. I conclude that education is not a
science, but an art.
That is not to say that data that show CORRELATION are not important and
useful.
--------------------------------------------------
Studies showing improved HEALTH outcomes are few and far between. Most
studies that I know of have looked at Knowledge Attitude or Behaviour.
There was a monograoph (now ratrher old and can;t remember the title
offhand) from YORK on costs and benefits of patient information. There have
also been a few reviews in the last five years so including eg
Ellis......but I am sure you will have these.
Some refs that you may not have in CHD, diabetes are the work by Sarah
Mcghee here in Glasgow
She did and RCT of shared-care bwhere part of the shared care intervention
was a personalised booklet. this has been published in the following. Sarah
is now in Hong Kong on [log in to unmask]
1.McGhee SM, Symington E, Jones RB, Hedley AJ, McInnes G. Evaluation of a
shared-care scheme for hypertension.. In: Roberts J, ed. In Current
Perspectives in Health Computing. Weybridge: British Journal Healthcare
Computing, 1989;19-21.
2. McGhee SM, Hedley AJ, Jones RB, et al. A computer-based shared-care
scheme for hypertension in Glasgow: feasibility and acceptability.. In:
Anonymous, ed. Lectures Notes in Medical Informatics.. Berlin:
Sprinzer-Verlag, 1990;553-556.
3.McGhee SM, Hedley AJ, Jones RB, et al. A cost-effectiveness analysis :
shared-care compared with nurse-practitioner and specialist clinics.. In:
Anonymous, ed. First Asia-Pacific Medical Informatics Conference.. Hong
Kong: 1991;324-327.
4.Day JL, Rayman G, Hall L, Davies P. 'Learning Diabetes' - a multi-media
learning package for patients, carers and professionals to improve chronic
disease management. Med Inform 1997; 22:91-104.
In diabetes John Day in Ipswich has looked mainly at knowledge (I think).
The studies are not RCTs and so offer only weak evidence anyway.
1. Graham AJ, Rayman G, Davies M, Mackie A, Day JL. Evaluation of 'Learning
Diabetes' a multimedia education programme. (Abstract) Diabetic Medicine
1999;16 Suppl 1:19
In other patient groups there have been studies looking at KAB, eg
wendy graham in aberdeen in
Graham W, Smith P, Kamal A, Fitzmaurice A, Smith N, Hamilton N. Randomised
controlled trial comparing effectiveness of touch screen system with
leaflet for providing women with information on prenatal tests. BMJ 2000;
320:155-160.
and my own work in
cancer
Jones R, Pearson J, McGregor S, Cawsey A, Barrett A, Atkinson JM, Craig N,
Gilmour WH, McEwen J. Randomised trial of personalised computer based
information for cancer patients. BMJ 1999;319:1241-1247.
anxiety (this was the pilot study, the main RCT is still awaiting a
publishing result)
White J, Jones R, McGarry E. Interactive treatment in primary care: can
computers provide 'real' therapy? Clinical Psychology Forum 1999; 131: 18-20.
and schizophrenia (ditto)
AR Morton, L Patterson, R Jones, JM Atkinson, D Coia. Personalised patient
information for patients with schizophrenia living in the community. In
Current Perspectives in Healthcare Computing 1998 pp94-104. Published by
BJHC Books, Weybridge Surrey.
and primary care patient held records
Jones RB, McConville J, Mason D, Macpherson, Naven L, McEwen J. Attitudes
towards, and utility of, an integrated medical-dental patient-held record
in primary care. BJGP 1999; 49:368-373.
---------------------------------------------------------------
Decision aids for patients facing health treatment or screening decisions:
systematic review
Annette M O'Connor, Alaa Rostom, Valerie Fiset, Jacqueline Tetroe, Vikki
Entwistle, Hilary Llewellyn-Thomas, Margaret Holmes-Rovner, Michael Barry,
and Jean Jones
BMJ 1999; 319: 731-734.
-------------------------------------------------------------
Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care.
Effects on patient outcomes. Ann Intern Med 1985 102 520-8
Brody DS, Miller SM, Lerman CE Smith DG, Caputo GC. Patient perception of
involvement in medical care: relationship to illness and outcomes. J Gen
Intern Med 1989;4;506-11
Kaplan SH, Greenfield S, Ware JE Assessing the effects of physician-patient
interactions on the outcomes of chronic disease. Med Care 1989; 27 S110-27.
---------------------------------------------------------------
there is an excellent seminal early piece of work (in the professional
nursing literature)
regarding the giving of information (Or not) pre-op and shorter inpatient
stays' / quicker recovery from op if info given / heightened awareness
it was
published by the royal college of nursing around the seventies....
written by jack heywood called 'prescription for pain' principle wuld apply
for what you're trying to prove i feel even though it is more general
------------------------------------------------------------
If the interest is in the effect of physician patient agreement, especially
with regard to the outcomes of care, here are a few more references:
Starfield B et al. The influence of practitioner-patient agreement on
outcome of care. Am J PUblic Health 1981; 71:127-32
Starfield B et al. Patient-provider agreement about problems. Influence on
outcome of care. JAMA 1979; 242:344-6
Starfield B et al. Presence of observers at patient-practitioner
interactions: impact on coordination of care and methodologic implications.
Am J Public Health 1979:69:1021-5
Please also check Chapter 9 (Practitioner-Patient Interactions) in my book
Starfield, B. Primary Care: Balancing Health Needs, Services, and
Technology. Oxford University Press (NY) 1998
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|
