Do Reading Materials For Health Professionals Improve Patient Outcomes?
Health professionals widely use printed educational materials - short clinical guidelines, newsletters, journal articles - to raise their awareness and to improve professional practice and patient health care outcomes. Yet there is little proof that they do so.
In a review of studies, Anna Farmer, Ph.D., a researcher at the University of Alberta, Canada, found that these materials had some effect on practitioner behavior, notably prescribing behavior.
However, few studies directly compared patient outcomes when physicians used or did not use such materials. Based on what little was documented in the formal literature, Farmer found no effect on patient outcomes.
“This doesn’t mean there was no difference,” she said. “It just means we couldn’t find any based on the statistics we had.”
Farmer and colleagues at institutions in the Canada, the United Kingdom and the United States could not determine the clinical significance of the study findings, nor the effectiveness of printed materials compared to other educational interventions.
There have been previous published reviews about the effect of written information on practitioners, she said, but this review was different in that it looked closely at the educational materials to try to identify the specific characteristics that made them effective.
“Physicians receive all kinds of mail on a regular basis and they can’t read it all. What prompts them to read what they do? Unfortunately, we were not able to come to any conclusions, because these types of details were not usually recorded,” Farmer said.
The review comprised 23 studies, most from North America, and all focused on paper publications, rather than electronic or video media.
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
One key observation is that printed educational materials (PEMs) appear to be more effective when coupled with other media strategies. “We saw, for example, that there was a lot of media attention surrounding hormone replacement therapy a few years ago. If we look at prescribing behavior in Canada and the United States, considering when the new guidelines were published, you can see a distinct change in prescribing habits.”
Farmer said that the researchers contacted about 20 of the authors of the journal articles for additional, anecdotal information. While this information relied largely on the authors’ memory, certain kinds of materials appear to be effective. For example, research published in high profile journals seemed to be successful. A paper’s appearance, how it was delivered, and how often contributed to its effectiveness.
“From what we can see, printed educational materials have a role in increasing knowledge and awareness,” Farmer says. “As far as changing behavior, we weren’t able to show that. There is still a lot of value to using them as a source of information, however. It’s a good starting point in increasing awareness — whether or not it’s related to action.”
The review “presents a valuable overview of interventions relating printed educational materials to changes in professional practice and patient health care outcomes,” said Debra Roter, Ph.D., who was not involved with this study. Roter, a professor at Johns Hopkins Bloomberg School of Public Health, agreed that information alone, while necessary, is insufficient for behavior change. These results are neither surprising, nor should they be disappointing, she said.
“This is not to say that the small benefit derived from providing PEMs to clinicians is not worth the effort and should be abandoned,” Roter said. “This review is a valuable reminder that impact is likely to be very modest. The challenge remains to better understand and optimize informational interventions.”
Farmer’s takeaway message is that PEMs have a place in the whole continuum of practice.
“I try to encourage those who do community-based research to evaluate what they do and also to publish the process of implementing their research, so people can benefit from their work, rather than try to reinvent the wheel.”