A comparison of patient information sheets for methotrexate

S. A. Hussain, E. George and T. D. Kennedy

Department of Rheumatology, Wirral Hospitals NHS Trust, Wirral, UK

SIR, Current management of rheumatoid arthritis includes the use of disease-modifying anti-rheumatic drugs much earlier in the natural course of the disease. Counselling of patients has become an integral part of prescribing practice and written information is provided to improve and augment patient education on these important yet potentially dangerous agents.

Patients have expressed the wish for more written information both in general and more specifically in rheumatic diseases [1]. Written information material has been shown to reinforce verbal communication, acting as a point of future reference and reminder [2]. Written information used as an adjunct to verbal communication is also beneficial because patients tend to forget a great deal of what they are told [3, 4].

Methotrexate patient information sheets are produced both nationally by recognized bodies and individually in many units, giving rise to a huge number of information sheets throughout the UK. Recognizing that there is no detailed study exploring the potential for variation in this information, we conducted an observational study to determine and describe this variation and examined the evidence behind each of the statements therein. Samples of methotrexate information sheets were obtained by writing to 20 UK Trusts. Information was extracted from the sheets and grouped for comparison under the general headings used by the information sheet produced by the Arthritis Research Campaign (ARC). A detailed literature search was then made to explore the strength of the evidence for each item of information.

Our observation revealed considerable variation between different information sheets in terms of the information coverage, use of terminology and emphasis on various aspects of methotrexate treatment. This included monitoring of specific blood indices, description of potential side-effects, and other important issues, such as vaccination whilst receiving methotrexate treatment. Although the majority of sheets did not cover all the treatment aspects mentioned under the appropriate headings, the information was seen to be accurate in most cases when each of the statements was compared with the literature.

As patient drug information sheets are not legal substitutes for consent to treatment, the content of written material will inevitably show variation, reflecting the different thought processes involved in their construction by medical units or individuals. However, key areas, such as vaccination, which was included in only four out of the 20 sheets, should be included to enhance patient education and awareness of public health issues relating to the use of such agents. However, the lack of information on certain issues may be a reflection of suboptimal research in these key areas.

Although a number of health units around the UK provide the ARC information sheet, many have and are continuing to distribute their own versions, perhaps reflecting the desire to provide information with the specific purposes of prioritizing and catering for the educational needs of the local patient population. Additionally, many units believe that, although information sheets need to be accurate in content, all aspects of the agent do not need to be included as the information sheets are adjuncts and only part of patient counselling and education.

There is potentially a dilemma between using nationally produced information sheets, such as the ARC information sheet and those from the Centre for Health Information Quality (CHIQ), the PatientWise software and the Doctor Online web site, and the need to develop locally produced and owned information sheets. The latter are more likely to reflect a broader opinion and fulfil the requirements of a guideline [5].

This study has demonstrated the variability of information given to patients between rheumatology units. For information to be of value it must be owned by the team who use it, but its content must, as far as possible, be based on available knowledge and evidence. It is important that units collaborate so that studies comparing the different approaches to patient care are undertaken and reported so that good practice can be promulgated.

Notes

Correspondence to: S. A. Hussain, Department of Rheumatology, Wirral Hospital, Arrowe Park, Arrowe Park Road, Upton, Wirral, Merseyside L49 5PE, UK. E-mail: asadhussain{at}ic24.net Back

References

  1. Doan JI, Blake D. Patient compliance: deviance or reasoned decision-making? Soc Sci Med 1992;34:507–13.[CrossRef][ISI][Medline]
  2. Anderson JL, Dodman S, Copelman M, Fleming A. Patient information recall in a rheumatology clinic. Rheumatol Rehabil 1979;18:18–22.[ISI][Medline]
  3. Vignos PJ, Parker WT, Thompson HM. Evaluation of a clinic education program for patients with rheumatoid arthritis. J Rheumatol 1976;3:155–65.[ISI][Medline]
  4. Ley P. Communicating with patients: Improving communication. Satisfaction and compliance. Memory for medical information. London: Chapman & Hall,1992:27–52.
  5. Norheim OF. Healthcare rationing—are additional criteria needed for assessing evidence based clinical practice guidelines? Br Med J 1999;319:1426–9.[Free Full Text]
Accepted 21 June 2002