Sharing letters with patients and their carers: problems and outcomes in elderly and dementia care

Should patients still be copied into their letters? A rapid review

OBJECTIVE

To systematically identify, synthesise and evaluate the strength of the international evidence on copy letter practice.

METHODS

A systematic search identified original research studies on copy letters. Searches were limited by date and language as permitted in rapid review methods guidance. Article screening, data extraction and strength of evidence assessment were completed independently by multiple authors.

RESULTS

Thirty-seven studies were included. There was a lack of information about copy letter content. Many patients report being satisfied with copy letters, understand them and find them useful. However, there is a lack of objective, high quality evidence to suggest that copy letters increased patient understanding or improved physical or psychological health outcomes. Many letters were written at a level which would make them inaccessible to patients with low health literacy. The strength of evidence was either "emerging" or "acceptable" practice for most studies (n = 30).

CONCLUSION

There is a lack of objective, high quality evidence to demonstrate the benefits of copy letters as described in health policy.

PRACTICE IMPLICATIONS

Personalising letters and using lay rather than medical terms appears to be useful for improving copy letter readability. Further research is required to explore this, especially in people with low health literacy levels.

Does a business-like letter written for a general practitioner meet the standards for patients?

Aims and Method

To gauge the acceptability of copying a business-like clinic letter for general practitioners, written by a doctor working in the Newbury Community Mental Health Team for Older Adults. Between August 2004 and March 2006 every letter written by each doctor was stored electronically. The letters contained a clear statement of the diagnosis, the active problems and a bullet-point care plan. Any concerns or reactions to the letters were documented as they were received. Between September and October 2006, 50 service user or carer recipients of the letters were sent a questionnaire, checking whether the letter met standards of clarity, helpfulness and content.

Results

Over 20 months 427 service users and carers received a total of 731 letters. One carer asked for the letter not to be sent in future; four carers asked for details of the letter to be modified; in only one was the content of the letter to the general practitioner modified before it was sent to the service user. The questionnaire about the suitability of the clinic letter had a 90% reply rate and all respondents said the letters were clear, understandable and that their content was of no surprise to them.

Clinical Implications

This report of a successful use of a frank business-like letter copied to service users or carers should be understood in the context of the following factors: the doctor who wrote them was familiar with and confident about the clinical work and comfortable with the style of the letter; he had a good rapport with a generally well-educated population and positive support from his colleagues. With these factors in place, the direct style of the letter was well received by patients and carers.

Patient and carer participation in old age psychiatry in England. Part II: models of participation

BACKGROUND

There are a number of models of patient and carer participation. Their usefulness and applicability to old age psychiatry is considered.

METHODS

Models of participation are reviewed and related to examples of participation initiatives drawn from the author's work in the context of the National Health Service in the United Kingdom.

RESULTS

Models of participation which emphasize collaboration and partnership are found to be useful. Simple interventions such as copying letters to patients and/or carers can lead to change in the balance of power between staff and patients/carers. Initiatives which draw on the experiences of patients and carers can facilitate organizational learning and development. Involving patients and carers in education offers a way to influence services and the staff working in them.

CONCLUSION

Participation is better understood as a spectrum rather than a hierarchy. Old age psychiatry services would benefit from developing greater patient and carer participation at all levels.

Does copying clinical or sharing correspondence to patients result in better care?

BACKGROUND

Communication between healthcare professionals and patients is suboptimal and the measures to improve patient satisfaction such as sharing correspondence have been reported in different settings.

METHODS

A review of published literature was undertaken to specifically examine patient satisfaction and the professional healthcare provider experience across a range of specialities and settings.

RESULTS

Patients generally report high rates of satisfaction when receiving copies of correspondence although both patient and professional experience within general psychiatry indicates that further consideration may be required before routinely adopting the practice of copying letters in this discipline.

CONCLUSIONS

Dictating letters in the presence of patients can improve patient satisfaction accuracy and modalities such as the use of audio or video recordings may be useful in more specialised settings.