The Many Benefits of Parent Handouts

Printed materials are the mainstay of any parent education program. They are an inexpensive form of intervention and have the following advantages:

1. Increase the amount of information that can be transmitted to and absorbed by the parent.

   Most parents would like to know everything about their child's condition. Most health care providers want to be their educator, but time constraints in the office limit the amount of information the health care provider can discuss with parents. With parent handouts the health care provider can highlight the more crucial aspects of home treatment and rest assured that the instruction sheets will cover the details. The information sheets supplement the health care provider's counseling and teaching. In a sense, these information sheets serve as a health care provider extender that expands the health care provider's influence over the patients' health care.

2. Increase the number of people who receive this information.

   The patient instructions can be read by other caretakers who are not present during the office visit. These caretakers may include the father, grandmother, child care provider, or baby sitter.

3. Counteract forgetfulness and improve parent compliance with treatment regimens.

   Written instructions reinforce verbal ones. Forgetfulness is the most common cause of noncompliance. Most people can remember only two or three instructions. Normally people forget 50% of what was said during an office visit within 5 minutes after leaving the office. At times of crisis, people remember even less. Several studies have shown that compliance is increased if the specific recommendations are written out, but the health care provider rarely has time to write out all instructions.

   Written instructions are especially important with complex problems, e.g., enuresis, ADD, and asthma. To achieve a true understanding of such conditions, the parent needs to reread and rethink the information.

   These printed instructions increase the parents' accountability by making it impossible for them to say that they were not instructed to provide a specific type of care. The printed instructions can serve as a form of contract if the health care provider requests that the parent read it, ask questions, and then sign it before leaving the office.

4. Save health care provider time.

   Printed instructions can increase office efficiency.

   Initially the health care provider saves the time required to write out instructions for each patient.

   Some of the time required for verbal presentation of the treatment plan is also saved. Instead of trying to cover everything, the health care provider has time to cover the parents' main agenda. The health care provider can limit the verbal instructions to two or three main points and let the parents read the details before or after the visit. If routine information is covered in an instruction sheet--e.g., for the common cold--the health care provider can use his or her time to address more complex issues, such as the nuts and bolts of how to suction the nose of a fussy 3-month-old.

   Telephone calls about forgotten instructions are also avoided. Written instructions are especially helpful for first-time parents or parents who need "constant" teaching.

5. Reduce repetition and boredom.

   Health care providers need handouts covering the most repetitive problems. For example, during epidemics of diarrhea, coughs, and colds health care providers often can't remember whether they have already given the parent currently in their presence their routine spiel on that condition. Routine information can be transmitted with printed instructions, often before the patient is examined.

6. Help the health care provider get back on schedule.

   The most common office stress is getting behind in the appointment schedule. Sometimes health care providers feel that if they try to answer all of each parent's questions, they won't have any time left to see more patients. Written information can improve office efficiency and get the provider back on schedule. Some health care providers have found that after they make a diagnosis, they can give the parent something to read, see another patient, and then come back to discuss specific questions with the previous parent.

   Written instructions can also help with demanding parents who want more information from the health care provider. One option is to refer them to a subspecialist for a second opinion, but another is to give them printed information--e.g., about ventilation tubes or infectious mononucleosis--and reappoint them for a follow-up visit.

7. Protect against malpractice risk.

   Printed instructions document the exact treatment instructions, drug dosages, and follow-up plan. For example, one of the more common ways for the delayed diagnosis of meningitis to present is in a child who is receiving antibiotics for an ear infection. The handout on ear infections states clearly to call immediately if the child becomes worse or if the fever or earache persists for more than 48 hours on antibiotics.

   Clarification of the indications for recontacting the health care provider is essential in providing quality medical care (e.g., in cases of croup and head trauma). In emergency room settings, parents can sign on the encounter form that they have received specific written instructions.

8. Reduce unnecessary telephone calls.

   The Pediatric Advisor handouts encourage appropriate calls and discourage inappropriate ones. By providing the details of home treatment, the handouts on common illnesses reduce telephone calls for information only.

   The handouts on specific illnesses (e.g., asthma) prevent call-backs about drug dosages. The handouts clarify for each topic when to call the health care provider--immediately, during office hours, or not at all (i.e., when it is safe to continue to treat a child at home). They prevent unnecessary calls about minor symptoms (over 50% of calls) from worried parents. More importantly, they prevent undercalling from parents who might overlook serious symptoms--e.g., a lethargic newborn, drooling, signs of dehydration, swollen scrotum, bulging soft spot, stiff neck, and purpura or petechiae.

   Keep in mind that parents don't like to make unnecessary phone calls since it often requires several attempts before they can get through to your office.

9. Increase parent satisfaction.

   Most parents love printed materials. They like to leave the health care provider's office with a piece of paper. Giving parents something tangible is one way to show we care. Information sharing also shows that we consider them partners in health care and that we respect their thinking and common sense. If given in the waiting room, information sheets show that we value their waiting time.

   In the case of recurrent illnesses--e.g., colds and diarrhea--printed handouts save parents time and money. This is important to them, especially if they both work outside the home.

   If parents post handouts on their refrigerator and the health care provider's name is printed on them, these handouts can become a marketing tool that attracts new families to the practice.

10. Help with the delegation of tasks to office staff.

    These computer-generated instruction sheets can serve as standard protocols (standing orders) in a health care provider's office. The office nurse can use them to debrief the patient after the health care provider has arrived at a diagnosis. They can be used as standard protocols for triaging incoming telephone calls in an efficient and safe manner. The requests for telephone advice seem to be increasing, possibly because working parents don't want to come in unless absolutely necessary. The time-consuming routine task of telephone triage and giving advice can be delegated safely.