Primary care Randomised controlled trial of self management leaflets and booklets for minor illness provided by post

Objective To assess the effectiveness of providing information by post about managing minor illnesses. Design Randomised controlled trial. Setting Six general practices. Participants Random sample of 4002 patients from the practice registers. Intervention Patients were randomised to receive one of three kinds of leaflet or booklet endorsed by their general practitioner: control (surgery access times), booklet, or summary card. Main outcome measures Attendance with the 42 minor illnesses listed in the booklet. Perceived usefulness of leaflets or booklets, confidence in managing illness, and willingness to wait before seeing the doctor. Results 238 (6%) patients did not receive the intervention as allocated. Of the remaining 3764 patients, 2965 (79%) had notes available for review after one year. Compared with the control group, fewer patients attended commonly with the minor illnesses in the booklet group (>2 consultations a year: odds ratio 0.81, 95% confidence interval 0.67 to 0.99) and the summary card group (0.83; 0.72 to 0.96). Among patients who had attended with respiratory tract infections in the past year there was a reduction in those attending in the booklet group (0.81; 0.62 to 1.07) and summary card group (0.67; 0.51 to 0.89) compared with the control group. The incidence of contacts with minor illness fell slightly compared with the previous year in the booklet (incidence ratio 0.97; 0.84 to 1.13) and summary card groups (0.93; 0.80 to 1.07). More patients in the intervention groups felt greater confidence in managing illness (booklet 32%, card 34%, control 12%, P < 0.001), but there was no difference in willingness to wait score (all groups mean = 32, P = 0.67). Conclusion Most patients find information about minor illness provided by post useful, and it helps their confidence in managing illness. Information may reduce the number attending commonly with minor illness, but the effect on overall contacts is likely to be modest. These data suggest that posting detailed information booklets about minor illness to the general population would have a limited effect. Introduction Increasing attendance in primary care is an important problem for the health service. It increases stress on health professionals and has contributed to changing arrangements for out of hours care. It is also a potential threat to consultation time and the quality of care provided for patients. If changing patient expectations and a demand for advice have contributed to the rising rates of consultation, then providing written information could reduce consultation rates for minor or self limiting illness. Little is known about the effect of general information leaflets in general practice. Although information leaflets about specific acute illness may enhance patients’ ability to manage their own illness and can modify reattendance, these data cannot necessarily be extrapolated to the provision of general information leaflets. Previous research on providing general patient information in the United Kingdom predates the apparent rise in patient expectations and changes in out of hours arrangements that have occurred in the last 15 years. Nevertheless, the study showed a possible role for provision of information, particularly for younger people. A study targeting information at young families in Denmark in a single practice showed a significant reduction in attendance with minor illness, and a brochure aimed at new enrollees in a health maintenance organisation in the United States showed modest changes in consultation behaviour. However, neither study can be easily applied to patients in typical general practice settings. We hypothesised that providing information by post about the self management of minor illness and when to contact the doctor could help patients’ confidence in managing minor illness, help in their decision to consult the doctor, and hence reduce rates of consultation for minor illness. We report the main results of a randomised controlled trial of two kinds of general patient information about minor illness: an extensive booklet detailing the management of 42 conditions and a two page summary card dealing predominantly with the self management of respiratory illness. Participants and methods This study was approved by the Southampton and South West Hants, and Salisbury local research ethics Primary Medical Care Group, Aldermoor Health Centre, Southampton SO16 5ST Paul Little MRC clinician scientist Jane Somerville research assistant Ian Williamson senior lecturer Nightingale Surgery, Greatwell Drive, Romsey Greg Warner general practitioner Three Swans Surgery, Rollestone Street, Salisbury Michael Moore general practitioner Health Research Unit, School of Occupational Therapy and Physiotherapy, Southampton University Rose Wiles senior research fellow Health Care Research Unit, Wessex Institute of Health Research and Development, Community Clinical Sciences, Health Medicine and Biological Sciences Division, Southampton University