Enhancing care: simplified clinic letters

Publication Date24 October 2019
Date24 October 2019
AuthorRebecca Gove,Sidney Htut,Mo Eyeoyibo
SubjectHealth & social care,Learning & intellectual disabilities
Enhancing care: simplified clinic letters
Rebecca Gove, Sidney Htut and Mo Eyeoyibo
Purpose The purpose of this paper is to examine the content and style of clinic letters written by
psychiatrists and to compare these with national guidelines and standards. To then consider the impact that
writing directly to patients and carers has on their feeling of inclusion and understanding via a questionnaire.
Design/methodology/approach Two audits were completed, the first was carried out in 2012 and the
second during 2014 with both being over a three-month period. The first 50 clinic letters sent out during these
periods were examined using an audit tool that was developed using national standards from the Department
of Health and the Royal College of Psychiatrists. A questionnaire was then devised in 2016 and sent to
patients and carers regarding their views on the simplified clinic letters that were written directly to them.
Findings In the original audit none of the letters were simplified and written to the patient whereas in the
re-audit 66 per cent were simplified. The questionnaire sent out to patients and carers revealed that
50 per cent of patients felt that the simplified letter helped them to feel more included and gave them abetter
understanding of their care.
Originality/value This paper highlights the potentially positive impact of writing simplified clinic letters
directly to patients with intellectual disability and their carers. It also includes a clinic letter format designed so
that medical information is not lost in the written communication and so that the services workload is not
impacted on by having to write two separate letters to the patient and to their GP.
Keywords Intellectual disability, Patient-centred care, Learning disability, Patient satisfaction,
Patient inclusion, Simplified clinic letter
Paper type Technical paper
The shift from a paternalistic medical model towards one that is empowering patients and placing
them at the heart of their care has developed over the last 30 years as described by Kaba and
Sooriakumaran (2007). This is often described as a patient-centred approach and expressed
succinctly as Nothing about me without me(Billingham, 1998).
The importance of patient-centred care
A systematic review of randomised controlled trials by McMillan et al. (2013) has shown that
implementing a patient-centred approach to healthcare is associated with patient satisfaction
and improved perception of quality of care. There was, however, a moderate to high risk of bias
and variability in the research designs so further study was recommended. Another study by
Stewart et al. (2000) showed that patient-centred practice in a primary care setting improved
peoples health status and increased the efficiency of care by reducing referral rates and
diagnostic investigations. Patient-centred care has also been shown to improve compliance with
medications with good communication, including written communication, being key as shown by
Jin et al. (2008).
Patient-centred clinic letters
One aspect of care that can be considered is the approach clinicians have to formulating and
disseminating written information following an appointment with a patient. Traditionally this has
consisted of a written letter with the conversation being between the specialist doctor who has
Received 11 March 2019
Revised 9 August 2019
Accepted 28 August 2019
Rebecca Gove, Sidney Htut
and Mo Eyeoyibo are all based
at Mental Health of Learning
Disability Community Team,
Kent and Medway NHS and
Social Care Partnership Trust,
Dartford, UK.
DOI 10.1108/AMHID-11-2018-0044 VOL. 13 NO. 6 2019, pp.245-256, © Emerald Publishing Limited, ISSN 2044-1282

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