“Talking Labels” Improving Consultations in General Practice for non-English speaking patients

1. “Talking Labels” Improving Consultations in General Practice for non-English speaking patients Margot Jackson & John Skinner Sheffield West Primary Care Trust Background A significant percentage of the information given in medical consultations is forgotten. Research1, 2 has shown that 40 – 80% of medical information provided by hospital practitioners is forgotten immediately and almost half of the information that is remembered will be incorrect3. In most cases medical advice is spoken but it seems that written information is better remembered and leads to better treatment adherence4. Written information however is not necessarily appropriate for people with low literacy or to non-English speakers. Compliance with the information given in a consultation is vital to recovery, and is made more difficult if information is forgotten. For people from BME groups who are not fluent in English the problems with understanding, asking questions, and remembering advice given is likely to be more acute. Tape recordings of consultations have successfully been carried out in hospital settings and show that both patients and physicians find them a valuable tool improving patient-physician communication5,6. This study piloted the application of a new technology to information giving in primary care through the use of digital recording devices. “Talking Labels” “Talking Labels” are small digital recording devices, slightly larger than a credit card, (80mm x 57mm x 10mm) which will allow up to one minute of audio information to be recorded. A small microphone is built into the back of the device and information can be played back by pressing a large button on the front of the device. The message on the digital recording device can be changed at any time by recording over any existing audio information. The microphone is activated by pressing a sunken switch with the point of a pen or pencil. It is therefore easy for someone who knows how, to record information but not easy for someone to accidentally erase or change the message. They are small enough to be carried around in a pocket or could be clipped onto a box of prescribed medicine, and have been produced at a low unit cost. These devices have only recently become available, but offer the potential of personalising information for patients to take away to listen to at home so they can be reminded of the advice they have been given. For people from black and ethnic minority groups, if an interpreter is present during a consultation they enable information to be recorded onto the Talking Label in their own language. Aim The project aimed to investigate patients’ perceived benefits of receiving personalised health information in an audio format on a digital recording device, and to establish whether the equipment used was suitable for purpose. Method All Somali patients attending general practice who needed an interpreter were invited to take part in the study and receive a personalised digital recording of information about their health to take home with them at the end of their consultation with a health professional. Participants were followed up one week later by trained interpreters who carried out a telephone administered questionnaire on acceptability and usage in their own language. In total 68 recording devices were given out and 58 people were interviewed. Results Of the patients who took part 81% were women, mainly aged 55+. Some people were at first reluctant to accept a digital recording device as they did not want to be telephoned at home. However, after the project had been going a few weeks people began to come to the surgery and ask for a recording device. 51 of the 58 interviewees had listened to the information on the DRD, around half reporting that they had listened many times.  The digital recording devices were robust and easy to use. Only one person could not get the device to work and this could have been a battery problem. Patients Perceptions Patients perceived the audio recordings helped them in different ways. Many patients mentioned that they used to forget how to take their prescribed medication, but the DRD helped them to take it correctly. “I listen whenever I want to take my medication to make sure that I am taking the right amount or in the right time”. Those unable to read English found the devices especially useful in enabling them to remember advice given. Many patients said that it helped them to remember appointments that they would otherwise have forgotten. “I am elderly woman, I always forget appointment, but now the device helps me.” Older people and those with memory problems felt that the digital recording device was useful as they were aware that they forgot many things “I have got hard time remembering things so to have it recorded helps me.” “I use to forget the way I am taking the medication, but since I receive the device I find very useful remembering.” The digital recording devices in this study were used mainly to record information about appointments and medication. People who were interviewed felt that they could be used to record anything that was relevant to their health, e.g. “Any information that will help me be medically wise.” Limitations The recording time limits the amount of information that can be stored on the device. One minute is enough to record summary information or details of medication. If longer explanations are required or a patient is on multiple medications it is not sufficient. The devices can be re-used as each time a new message is recorded it wipes out the old message. Their re-use is dependent on patients returning with them at their next appointment. There could be a danger in giving patients more than one device as messages could get out of date or mixed up. Some form of labelling on the outside of the device may help overcome this problem. Conclusion This study was looking at the benefits patients perceived of being given personalised audio information to take home with them. The results seem to indicate that for older people from this practice population, and for those with memory problems the recordings were useful to patients. The devices were reliable, used frequently and found to be acceptable. They were used to record information about appointments and medication and patients identified other types of information they would find useful. It is also possible to see that a small investment in digital recording devices could have an impact on attendance rates either of patients coming very frequently because they do not fully understand the advice given or non attendance for scheduled appointments and the consequent cost and staff time involved in providing reminders and rescheduling appointments. They may also have an impact on compliance with prescribed medication. Many patients commented on medication and the fact that they now understood how to take their medication or remembered when to take it. The cost of the digital recording devices needs to be considered against the above patient benefits. References 1. Goodwin Y. Do they listen? A review of information retained by patients following consent for reduction mammoplasty. Br J Plas Surg 2000; 53: 121-125 2. Kessels R P C, Patients’ memory for medical information. J R Soc Med 2003; 96: 219-222 3. Anderson J L, Dodman S, Kopelman M, Fleming, A. Patient information recall in a rheumatology clinic. Rheumatol Rehabil 1979; 18: 18-22 4. Blinder D, Rotenberg L, Peleg M, Taicher S. Patient compliance to instructions after oral surgical procedures. Int J Oral Maxillofac Surg 2001; 30: (3) 216-19 5. McClement S E, Hack T F. Audio-taping the oncology treatment consulation: a literature review, Patient Educ Couns, 1999; 36 (3): 229-38 6. Leahy M, Douglass J, Barley V, Jarman M, Cooper G. Audiotaping the heart surgery consultation: qualitative study of patients experiences, Heart2005; 000: 1-3 doi 10.1136/hrt2004.048769 Acknowledgements This research was funded by the Dorothy Dixon Barrow Award Ethical approval was given by North Sheffield Ethics Committee. We are grateful to the staff at Hanover Medical Centre in Sheffield for all their help. For Further Information Contact: Margot Jackson or John Skinner Sheffield West PCT, West Court, Hillsborough Barracks, Langsett Road Sheffield, S6 2LR