Patients who are given self help books are no less likely to see their doctor

Giving patients self care health books does not reduce the number or length of consultations with their GP, a new report says (Scandinavian Journal of Primary Health Care 2005:23;142-8).

Research that was based on nearly 2000 patients in a large general practice in the south east of England shows that although many of the patients who were given such books said they would be less likely to consult a doctor, the actual likelihood that they saw their doctor was the same as for patients who were not allocated books.

“Handing out of self-care health books may provide qualitative benefits for patients but is unlikely to reduce attendance at the GP practice,” the researchers concluded.

In the study 1967 adult patients who volunteered to take part in the study were randomised to receive one of two self help books or to a control group. The two books were the UK edition of the Healthwise Handbook and the NHS Direct Healthcare Guide. Data on consultations over the next 12 months were collected from searches of computer systems. Questionnaires asked participants about their use of the books.

Among the patients who were allocated a book, after three months 69% of those reporting a health problem and 49% of those who reported no problem had consulted their book. The percentages after nine months were similar. Some 60% reported that the book made them more likely to deal with a problem themselves, but the mean numbers and duration of consultations over the 12 months, including routine GP consultations and emergency consultations with a GP or nurse practitioner, did not differ between the three groups. The mean lengths of consultations in minutes in the control, Healthwise, and NHS Direct book groups were, respectively, 9.9 (95% confidence interval 9.6 to 10.1), 9.7 (9.4 to 9.9), and 10 (9.8 to 10.3).

The authors, from the Department of Epidemiology and Public Health at University College London and the Parkbury House Surgery, St Albans, also said that differences between the groups in numbers of visits to hospital emergency departments, home visits, and visits to nurse clinics were small and not significant.

A total of 160 of the patients made an average of 1.2 calls to NHS Direct, and an analysis showed that the odds ratio for calling NHS Direct was nearly double for patients who were allocated the NHS Direct guide.

The authors wrote, “The study shows that approximately half of patients given either self-care book consulted it compared with only a quarter of those in the control group who consulted any healthcare book … The books did not, however, reduce the number of visits to the GP. This is surprising given that around 57% reported that the book made them more likely to try to deal with their health problem themselves and around 40% reported that the book make them less likely to contact the practice,” the report says.

One possible explanation for this apparent contradiction is that patients who dealt with their health problem with the help of one of the books later visited the GP for reassurance and confirmation.

“Using the approach we adopted, it seems unlikely that either of these books can reduce consultation rates or workload. We can, however, speculate as to whether the books may benefit the appropriateness or quality of patients' consultations,” the authors wrote.