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

doi:10.1136/bmj.322.7296.1214

BMJ 2001;322:1214 ( 19 May )

Primary care

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

Paul Little, MRC clinician scientist, ^a Jane Somerville, research assistant, ^a Ian Williamson, senior lecturer, ^a Greg Warner, general practitioner, ^b Michael Moore, general practitioner, ^c Rose Wiles, senior research fellow, ^d Steve George, reader, ^e Ann Smith, primary care advisor, ^f Robert Peveler, professor. ^g

^a Primary Medical Care Group, Aldermoor Health Centre, Southampton SO16 5ST, ^b Nightingale Surgery, Greatwell Drive, Romsey, ^c Three Swans Surgery, Rollestone Street, Salisbury, ^d Health Research Unit, School of Occupational Therapy and Physiotherapy, Southampton University, ^e Health Care Research Unit, Wessex Institute of Health Research and Development, Community Clinical Sciences, Health Medicine and Biological Sciences Division, Southampton University, ^f Southampton and South West Hants Health Commission, Southampton, ^g Mental Health Group, Department of Psychiatry, Community Clinical Sciences, Health Medicine and Biological Sciences Division, Southampton University

Correspondence to: P Little psl3{at}soton.ac.uk

Objective: To assess the effectiveness of providing informationby post about managing minorillnesses.
Design: Randomised controlledtrial.
Setting: Six generalpractices.
Participants: Random sample of 4002 patients from the practiceregisters.
Intervention: Patients were randomised to receive one ofthree kinds of leaflet or booklet endorsed by their general practitioner:control (surgery access times), booklet, or summarycard.
Main outcome measures: Attendance with the 42 minor illnesses listedin the booklet. Perceived usefulness of leaflets or booklets,confidence in managing illness, and willingness to wait beforeseeing thedoctor.
Results: 238 (6%) patients did not receive the interventionas allocated. Of the remaining 3764 patients, 2965 (79%) had notesavailable for review after one year. Compared with the controlgroup, fewer patients attended commonly with the minor illnessesin 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 respiratorytract infections in the past year there was a reduction in thoseattending in the booklet group (0.81; 0.62 to 1.07) and summarycard group (0.67; 0.51 to 0.89) compared with the control group.The incidence of contacts with minor illness fell slightly comparedwith the previous year in the booklet (incidence ratio 0.97; 0.84to 1.13) and summary card groups (0.93; 0.80 to 1.07). More patientsin the intervention groups felt greater confidence in managingillness (booklet 32%, card 34%, control 12%, P<0.001), but therewas no difference in willingness to wait score (all groups mean=32,P=0.67).
Conclusion: Most patients find information about minorillness provided by post useful, and it helps their confidencein managing illness. Information may reduce the number attendingcommonly with minor illness, but the effect on overall contactsis likely to be modest. These data suggest that posting detailedinformation booklets about minor illness to the general populationwould have a limitedeffect.

What is already known on this topic
Increasing attendance for minor illness in primary care is a threat to consultation time and quality of care

Few recent studies have examined the effect of providing patients with information on self management of minor illness

What this study adds
Most patients find information about minor illness provided by post useful, and it helps their confidence in managing illness

Information booklets and leaflets reduced the number attending frequently with minor illness, but the effect on overall contacts was not significant

Information booklets on minor illness provided by post may have a limited role in the NHS

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