Improving Patient Understanding of Prescription Drug Label Instructions

Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 11/2008; 24(1):57-62. DOI: 10.1007/s11606-008-0833-4
Source: PubMed

ABSTRACT Patient misunderstanding of instructions on prescription drug labels is common and a likely cause of medication error and less effective treatment.
To test whether the use of more explicit language to describe dose and frequency of use for prescribed drugs could improve comprehension, especially among patients with limited literacy.
Cross-sectional study using in-person, structured interviews.
Three hundred and fifty-nine adults waiting for an appointment in two hospital-based primary care clinics and one federally qualified health center in Shreveport, Louisiana; Chicago, Illinois; and New York, New York, respectively.
Correct understanding of each of ten label instructions as determined by a blinded panel review of patients' verbatim responses.
Patient understanding of prescription label instructions ranged from 53% for the least understood to 89% for the most commonly understood label. Patients were significantly more likely to understand instructions with explicit times periods (i.e., morning) or precise times of day compared to instructions stating times per day (i.e., twice) or hourly intervals (89%, 77%, 61%, and 53%, respectively, p < 0.001). In multivariate analyses, dosage instructions with specific times or time periods were significantly more likely to be understood compared to instructions stating times per day (time periods--adjusted relative risk ratio (ARR) 0.42, 95% Confidence Interval (CI) 0.34-0.52; specific times--ARR 0.60, 95% CI 0.49-0.74). Low and marginal literacy remained statistically significant independent predictors of misinterpreting instructions (low--ARR 2.70, 95% CI 1.81-4.03; marginal--ARR 1.66, 95% CI 1.18-2.32).
Use of precise wording on prescription drug label instructions can improve patient comprehension. However, patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language.

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Available from: Michael Wolf, Sep 26, 2015
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    • "Besides, a recent study has shown that patients with limited health literacy have difficulties in handling health information even when a more explicit and clear language is used. Such a finding supports that poor health literacy skills could be understood as significant and independent determinants of misunderstanding of health information (Davis, et al., 2009). "
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    ABSTRACT: This paper is aimed at discussing the role played by pharmacies in addressing the needs of patients with limited health literacy. Indeed, pharmacies are one of the most fitting contexts to manage the effects of the inadequate understanding of health information on the effectiveness of health care provision. From this point of view, their ability to handle the needs of poor health literate patients deeply affects the appropriate functioning and the sustainability of the National Health Service. On the one hand, pharmacies pave the way to a friendly and comfortable interaction with patients; on the other hand, pharmacists operate in a crucial point to identify and fix the cases of patients’ inadequate understanding of health information, thus enhancing both their adherence with medical prescriptions and the appropriateness of care. Nonetheless, the scientific literature maintains that pharmacies are usually unaware about the consequences of poor health literacy on the appropriateness of care; as well, they are likely to overlook the role they could play in mediating the relationship between health literacy and health care appropriateness. This study provides empirical insights about the sensitivity to organizational health literacy of a convenience sample of municipal pharmacies operating within a Southern Italian district. The findings of this research are counter-intuitive. Even though they support that municipal pharmacies are aware about the consequences of poor health literacy on health outcomes, the units of analysis are not prone to introduce appropriate interventions to enhance their organizational health literacy.
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    • "Firstly, the medical staff were not blinded to the questionnaire, potentially improving the performance of the staff and thereby patient responses. However, patients were approached before leaving the department to avoid recall bias, and it is likely that they may have done better if they had the medication to look at, even though prescription label instructions can be challenging.15 Secondly, we did not collect data on mini-mental state examination scores or hearing status at time of admission. "
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    ABSTRACT: Higher prevalence of multiple illnesses and cognitive impairment among older patients pose a risk of comprehension difficulties, potentially leading to medication errors. Therefore, the objective of this study was to investigate comprehension of discharge instructions among older patients admitted to a Quick Diagnostic Unit (QDU). One hundred and two patients discharged from the QDU answered a questionnaire covering understanding of their hospitalization and discharge plan. Patients' ability to recall discharge instructions and awareness of comprehension deficits, ie, ability to identify the misconceived information, were evaluated by comparing the questionnaires with the discharge letters. The population was divided into an older group (age ≥65 years) and a younger group. The older group (n=40) was less able to recall correct medication instructions when compared to the younger group (54% versus 78%, respectively; P=0.02). In multiple logistic regression analysis, correct recall of medication instructions was 4.2 times higher for the younger group compared to the older group (odds ratio 4.2, 95% confidence interval 1.5-11.9, P=0.007) when adjusted for sex and education. The older patients were less aware of their own comprehension deficits, and in respect to medication instructions awareness decreased 6.1% for each additional year of age (odds ratio 0.939, 95% confidence interval 0.904-0.98, P=0.001) when adjusted for sex and education. Older patients were less able to recall correct medication instructions and less aware of their comprehension deficits after discharge from a QDU. The findings of the present study emphasize the importance of thorough communication and follow-up when treating older patients.
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    • "The core components of the instructions were deconstructed so that each action or intended behavior was separate and would potentially allow patients to be more cognizant of each step to be taken. This deconstruction is supported by previous research that more explicit medication instructions (in non-PRN medications) improve patient understanding and is a health literacy best practice (Davis et al., 2009; Wolf, Davis, et al., 2011). "
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    ABSTRACT: Recent studies have linked patient misunderstanding of label instructions for as needed (PRN) medications to dosing errors. This study conducted a preliminary field test of patient-centered PRN label instructions. Patients participated in a hypothetical dosing experiment and were randomized to a patient-centered label (referred to as "Take-Wait-Stop") or standard label. Participants were asked to demonstrate dosing the medicine over 24 hours. Three types of independent dosing errors were measured: (a) taking more than two pills at one time, (b) exceeding the maximum daily dose, and (c) waiting fewer than 4 hours between doses. Generalized linear models were used to assess the association between label type, health literacy, and sociodemographic characteristics. Participants' mean age was 39.8 years, 62.1% were female, 43.7% were White, and 72.4% had adequate literacy. Of participants, 31.8% who were shown the standard label demonstrated taking in excess of 6 pills in 24 hours compared with only 14.0% of participants who were shown the Take-Wait-Stop label (p = .05). Overall, only 1 person demonstrated he would take more than 2 pills in a single dose. Of the standard label group, 20.5% demonstrated dosing intervals of fewer than 4 hours compared with 23.3% of the Take-Wait-Stop label group (p=.75). In a multivariate model, participants who were exposed to the standard label were 2.5 times more likely to exceed the recommended maximum daily dose (95% CI [1.05, 7.70], p=.03). The Take-Wait-Stop label was beneficial in preventing participants from exceeding the maximum dose in 24 hours, although it did not significantly reduce other dosing errors.
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