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Ariel R, Babineau A, Tauber SK. Teaching older adults to use retrieval practice improves their self-regulated learning. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024; 31:823-845. [PMID: 37847784 DOI: 10.1080/13825585.2023.2271531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
Retrieval practice can reduce associative memory deficits for older adults but they underutilize this potent learning tool during self-regulated learning. The current experiment investigated whether teaching older adults to use retrieval practice more can improve their self-regulated learning. Younger and older adults made decisions about when to study, how often to engage in retrieval practice, and when to stop learning a list of medication-side effect pairs. Some younger and older adults received instructions before learning that emphasized the mnemonic benefits of retrieval practice over restudying material and described how to schedule retrieval practice to learn to a goal criterion level. This minimal intervention was effective for improving both younger and older adults' associative memory. These data indicate that a simple strategy for improving older adults self-regulated learning is to provide them with instructions that teach them how to use criterion learning to schedule their retrieval practice for to-be learned material.
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Affiliation(s)
- Robert Ariel
- Department of Psychology, Virginia Wesleyan University, Virginia, USA
| | - Addison Babineau
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | - Sarah K Tauber
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
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2
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Popova L, Massey ZB, Giordano NA. Warning Labels as a Public Health Intervention: Effects and Challenges for Tobacco, Cannabis, and Opioid Medications. Annu Rev Public Health 2024; 45:425-442. [PMID: 38166502 DOI: 10.1146/annurev-publhealth-060922-042254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Warning labels help consumers understand product risks, enabling informed decisions. Since the 1966 introduction of cigarette warning labels in the United States, research has determined the most effective message content (health effects information) and format (brand-free packaging with pictures). However, new challenges have emerged. This article reviews the current state of tobacco warning labels in the United States, where legal battles have stalled pictorial cigarette warnings and new products such as electronic cigarettes and synthetic nicotine products pose unknown health risks. This article describes the emerging research on cannabis warnings; as more places legalize recreational cannabis, they are adopting lessons from tobacco warnings. However, its uncertain legal status and widespread underestimation of harms impede strict warning standards. The article also reviews opioid medication warning labels, suggesting that lessons from tobacco could help in the development of effective and culturally appropriate FDA-compliant opioid warning labels that promote safe medication use and increased co-dispensing of naloxone.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA;
| | - Zachary B Massey
- School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Goulette M, Schlienz NJ, Case AA, Hansen E, Rivard C, Ashare RL, Goniewicz ML, Bansal-Travers M, Hyland A, Smith DM. Self-reported knowledge of tetrahydrocannabinol and cannabidiol concentration in cannabis products among cancer patients and survivors. Support Care Cancer 2024; 32:210. [PMID: 38443674 PMCID: PMC10915076 DOI: 10.1007/s00520-024-08374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Cannabis use may introduce risks and/or benefits among people living with cancer, depending on product type, composition, and nature of its use. Patient knowledge of tetrahydrocannabinol (THC) or cannabidiol (CBD) concentration could provide information for providers about cannabis use during and after treatment that may aide in risk and benefit assessments. This study aimed to examine knowledge of THC or CBD concentration among patients living with cancer who consume cannabis, and factors associated with knowledge of cannabinoid concentrations. METHODS People living with cancer who consumed cannabis since their diagnosis (n = 343) completed an anonymous, mixed-mode survey. Questions assessed usual mode of delivery (MOD), knowledge of THC/CBD concentration, and how source of acquisition, current cannabis use, and source of instruction are associated with knowledge of THC/CBD concentration. Chi-square and separate binary logistic regression analyses were examined and weighted to reflect the Roswell Park patient population. RESULTS Less than 20% of people living with cancer had knowledge of THC and CBD concentration for the cannabis products they consumed across all MOD (smoking- combustible products, vaping- vaporized products (e-cigarettes), edibles-eating or drinking it, and oral- taking by mouth (pills)). Source of acquisition (smoking-AOR:4.6, p < 0.01, vaping-AOR:5.8, p < 0.00, edibles-AOR:2.6, p < 0.04), current cannabis use (edibles-AOR:5.4, p < 0.01, vaping-AOR: 11.2, p < 0.00, and oral-AOR:9.3, p < 0.00), and source of instruction (vaping only AOR:4.2, p < 0.05) were found to be variables associated with higher knowledge of THC concentration. CONCLUSION Self-reported knowledge of THC and CBD concentration statistically differed according to MOD, source of acquisition, source of instruction, and current cannabis use.
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Affiliation(s)
- Michelle Goulette
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Nicolas J Schlienz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Amy A Case
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Eric Hansen
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Cheryl Rivard
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | | | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
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Bordelon AJ, Wilson P, Book B, Baker C, Donald BJ. Syntax Error: Variations in the Verbiage of Prescription Labels for Pediatric Liquid Medications. Cureus 2024; 16:e56039. [PMID: 38606237 PMCID: PMC11008777 DOI: 10.7759/cureus.56039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Background Pharmacists can modify prescriptions from prescribers for clarity and patient understanding, provided the confines of the original order are met, yet the verbiage used by pharmacists is not standardized. Prescription directions for children, especially children eight years old and younger, should be written with the verb "give" instead of "take" as their parents or caregivers are expected to administer them. Errors in prescribing, dispensing, and administering medication comprise a significant portion of preventable medical errors in children. To intervene and assist pharmacies, we must first identify and characterize the problem. This study aimed to determine if there is a relationship between prescribers and pharmacists using the verb "give" or "take" when prescribing and printing prescription labels for pediatric liquid medications. In addition, it aimed to determine if there is a relationship between chain pharmacies and independent pharmacies using the verb "give" or "take" when printing labels for pediatric liquid medications. Methodology The participants in this study were caregivers of children eight years old and younger who had been prescribed a new liquid medication. We recruited prescribers in North Louisiana to serve as a referral base for the study. Caregivers were referred to the study by prescribers. A rubric was created to investigate the text of prescription labels. Fisher's exact test was used to determine the relationship between verb choice and prescribers and pharmacists, as well as the relationship between verb choice and chain pharmacies and independent pharmacies. Results A total of 11 (26.83%) prescriber texts used the verb "give," while 12 (29.27%) prescriber texts used the verb "take." Overall, 18 (43.90%) prescriber texts did not use a verb at all. Of these 18 prescriber texts that did not include a verb, 14 prescription labels used the verb "give," and four used the verb "take." In total, 10 (23.81%) chain pharmacy prescription labels used the verb "give," and 10 (23.81%) chain pharmacy prescription labels used the verb "take." The two-tailed p-value of Fisher's exact test comparing verb choice between prescribers and pharmacists equaled 0.0001. A total of 19 (46.34%) independent pharmacy prescription labels used the verb "give," and two (4.88%) independent pharmacy prescription labels used the verb "take." The two-tailed p-value of Fisher's exact test comparing verb choice between chain pharmacies and independent pharmacies equaled 0.0063. Conclusions The relationship between prescriber texts and pharmacist prescription labels shows a relationship between their verb choice (p = 0.0001). The relationship between chain pharmacy and independent pharmacy prescription labels shows a relationship between their verb choice (p = 0.0063). This study has illuminated how medication orders begin before they are modified, if necessary, for the patient's clarity and understanding. This study can be used to instruct prescribers on writing more accurate prescription instructions to prevent medical errors, and it can help pharmacists recognize potential dangers and prevent them through editing.
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Affiliation(s)
| | - Paige Wilson
- Pediatrics, Edward Via College of Osteopathic Medicine, Monroe, USA
| | - Bailey Book
- College of Pharmacy, University of Louisiana Monroe, Monroe, USA
| | - Carrie Baker
- Pediatrics, Edward Via College of Osteopathic Medicine, Monroe, USA
| | - Bryan J Donald
- College of Pharmacy, University of Louisiana Monroe, Monroe, USA
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Ferreira-Alfaya FJ, Zarzuelo-Romero MJ, Cura Y. Pharmaceutical pictograms to improve textual comprehension: A systematic review. Res Social Adm Pharm 2024; 20:75-85. [PMID: 38030546 DOI: 10.1016/j.sapharm.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Written instructive information for the patient is key in pharmaceutical care. However, the preexisting literature agrees on the discordance between the readability of written medication messages intended for patients. The aim of our work was to systematically review the available evidence on the effect of pharmaceutical pictograms as elements that facilitate understanding of the text in primary or secondary medication packaging. METHODS A parallel systematic search was conducted of the literature covering evidence of the effect of including pictograms in primary or secondary packaging on comprehension by potential users or caregivers up to April 9, 2023. The databases consulted were Scopus, MEDLINE and Web of Science. Only randomized controlled studies, whose main outcome measure was comprehension, were included. RESULTS Only 8 papers met our search criteria. In most of the included studies, the intervention of including pictograms improved participants' performance in comprehending instructions. A debatable methodological quality, and differences in the target population, textual complexity of the materials or the cultural affinity of the pictograms with the target population in each study, could have had a decisive influence on the results. CONCLUSION The heterogeneity in the design of each study poses a significant barrier to establishing commonalities and generalizing the results. This heterogeneity also prevented us from conclusively confirming the usefulness of pictograms complementary to instructional text in improving the comprehension of instructions for the rational use of medicines.
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Affiliation(s)
| | | | - Yasmin Cura
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Spain
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Saif S, Bui TTT, Srivastava G, Quintana Y. Evaluation of the design and structure of electronic medication labels to improve patient health knowledge and safety: a systematic review. Syst Rev 2024; 13:12. [PMID: 38167495 PMCID: PMC10763215 DOI: 10.1186/s13643-023-02413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Patient misunderstanding of instructions on medication labels is a common cause of medication errors and can result in ineffective treatment. One way to better improve patient comprehension of medication labels is by optimizing the content and display of the information. OBJECTIVES To review comparative studies that have evaluated the design of a medication label to improve patient knowledge or safety. METHODS Studies were selected from systematic computerized literature searches performed in PubMed, Embase (Elsevier), Cochrane Central (EBSCO), Cumulative Index to Nursing and Allied Health Literature-CINAHL (EBSCO), and Web of Science (Thomson Reuters). Eligible studies included comparative studies that evaluated the design of a medication label to improve patient knowledge or safety. RESULTS Of the 246 articles identified in the primary literature search, 14 studies were selected for data abstraction. Thirteen of these studies significantly impacted the patient understanding of medication labels. Three studies included a measure of patient safety in terms of medication adherence and dosing errors. The utilization of patient-centered language, pictograms/graphics, color/white space, or font optimization was seen to have the most impact on patient comprehension. CONCLUSION It is essential to present medication information in an optimal manner for patients. This can be done by standardizing the content, display, and format of medication labels to improve understanding and medication usage. Evidence-based design principles can, therefore, be used to facilitate the standardization of the structure of label content for both print and electronic devices. However, more research needs to be done on validating the implications of label content display to measure its impact on patient safety. SYSTEMIC REVIEW REGISTRATION PROSPERO CRD42022347510 ( http://www.crd.york.ac.uk/prospero/ ).
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Affiliation(s)
- Sara Saif
- Belmont University College of Pharmacy, Nashville, TN, 37212, USA.
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
| | - Tien Thi Thuy Bui
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Massachusetts College of Pharmacy, 179 Longwood Ave, Boston, MA, 02115, USA
| | - Gyana Srivastava
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Yuri Quintana
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
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Cox CL. Patient understanding: How should it be defined and assessed in clinical practice? J Eval Clin Pract 2023; 29:1127-1134. [PMID: 37338517 DOI: 10.1111/jep.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023]
Abstract
In order for patients to make autonomous decisions in a healthcare setting, they must understand relevant information. There is, however, a lack of consensus on how understanding should be defined or assessed in this context, despite the fact that in practice doctors are regularly required to judge whether a patient has understood medical information. Current accounts of patient decision-making often focus on the information which needs to be disclosed to the patient to support their autonomous decision-making. Far less attention has been afforded to questions about how we might determine whether a patient has understood the information disclosed to them. Theoretical approaches to the concept of understanding in this context, and practically useful frameworks for assessing it, are lacking. In this paper, I use a number of hypothetical clinical situations to explore the conditions that are required for a patient to adequately understand information in medical decision-making. Drawing upon the wider philosophical literature, I propose a number of criteria which are necessary for understanding in a medical context: patients must (1) grasp a body of information which (2) reasonably reflects a responsible body of medical professionals' best estimate of the truth, (3) to a degree which meets a context-specific threshold. These criteria may be helpful in guiding assessments of patient understanding in clinical practice.
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Affiliation(s)
- Caitríona L Cox
- The Healthcare Improvement Studies (THIS) Institute, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
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Reijnen E, Laasner Vogt L, Kühne SJ, Fiechter JP. Do Pictograms on Medication Packages Cause People to Consult Package Inserts Less Often? If so, With What Consequences? Behav Sci (Basel) 2023; 13:696. [PMID: 37622836 PMCID: PMC10451860 DOI: 10.3390/bs13080696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
Overall, pharmaceutical pictograms seem to improve medication adherence. However, little is known about how warning pictograms (e.g., "do not drive after taking") on medication packages influence patients' information-seeking strategies such as consulting the package insert (PI) to determine other features such as the correct dosage. In this online study, participants (358 students) were presented with three fictitious scenarios (e.g., headache after alcohol consumption; factor scenario) in which medication use would be contraindicated. Each scenario was accompanied by a visual presentation of a medication package that could contain three possible pictogram selections or arrangements (factor warning); some arrangements contained pictograms relevant to the situation represented by the scenario, while others did not. Participants had to decide which dosage of the represented medication they were allowed to take in the given scenario. In making this decision, they could consult the PI or not. Overall, in two out of the three scenarios (driving and pregnancy), medication packages with relevant pictograms resulted in fewer PI consultations but led to more correct dosage decisions ("no pill") than packages with irrelevant pictograms. Pictograms generally played no role in either the review of the PI consultation or dosage decisions in the alcohol scenario. Providing warning-relevant pictograms on medication packages can help people know when they should not take medication even without reading the PI.
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Affiliation(s)
- Ester Reijnen
- School of Applied Psychology, ZHAW Zurich University of Applied Sciences, Pfingstweidstrasse 96, CH-8005 Zurich, Switzerland; (L.L.V.); (S.J.K.)
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Khan G, Haq N, Ahmad N, Nasim A, Javaid A, Saood M, Yasmin R, Tahir M, Riaz S, Danish Z, Razzaq G, Khan A, Younis M, Rabbani T. Public awareness regarding the manufacturer provided information about medicine usage, safety, and adverse drug reactions in Balochistan, Pakistan. Front Pharmacol 2023; 14:1190741. [PMID: 37547330 PMCID: PMC10399575 DOI: 10.3389/fphar.2023.1190741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/16/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives: This study aimed to analyze the general public's awareness of medicine information, safety, and adverse drug reactions in Quetta, Pakistan. Methods: A cross-sectional descriptive study was conducted using random sampling from April 2020 to April 2021 in Quetta. Samples were collected from respondents who met the inclusion criteria and had visited community pharmacies. The analysis was done using SPSS version 23. Bivariate and multivariate analyses were performed to assess factors associated with good knowledge. Results: Multivariate analysis revealed that purchase on prescription was a determining factor of knowledge regarding knowledge of pharmaceutical products and their provided information, medicines usage and safety, and Medication ADRs. Patients who bought medicines on prescriptions were more likely to have better knowledge. Patients having education were more likely to have better knowledge. Conclusion: Public awareness about medicine information, safety, and the information provided by manufacturers is crucial to ensuring that patients have access to accurate information about their medications and can make informed decisions about their health. Healthcare providers and regulatory bodies must work together to improve access to information and promote safe medication practices.
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Affiliation(s)
- Gullab Khan
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Noman Haq
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Nafees Ahmad
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Aqeel Nasim
- Provincial Drug Testing Laboratory Balochistan, Quetta, Pakistan
| | - Asma Javaid
- Sardar Begum Dental Hospital, Peshawar, Pakistan
| | - Mujhammad Saood
- Provincial Drug Testing Laboratory Balochistan, Quetta, Pakistan
| | - Riffat Yasmin
- Balochistan Institute of Nephrology Urology Quetta, Quetta, Pakistan
| | - Maria Tahir
- Sardar Bahadur Khan Women’s University, Quetta, Pakistan
| | - Sohail Riaz
- Capital University of Science & Technology, Islamabad, Pakistan
| | - Zeeshan Danish
- Department of Pharmacy, University of Punjab, Lahore, Pakistan
| | - Ghulam Razzaq
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | | | - Muhammad Younis
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Tahmina Rabbani
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
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Shah H, Nagi J, Khare S, Hassan H, Siu A. Limiting Factors in Implementing Pharmacovigilance Principles in the Elderly. Cureus 2023; 15:e36899. [PMID: 37128538 PMCID: PMC10148568 DOI: 10.7759/cureus.36899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
The overarching aim of pharmacovigilance is to ensure the safe and effective usage of medication across the population and optimise medicines through holistic considerations. However, within the heterogeneous elderly population, several unique factors are at play, limiting the ability of clinicians to fulfil this aim. A matured physiology influencing the response and effects of drugs, increased polypharmacy enabling drug-drug interactions, and greater consumption of concurrent herbal medicines predispose patients to harmful drug events. This increasingly multimorbid subpopulation requires complex pharmaceutical regimens encouraging inappropriate prescribing and medicine non-adherence leading to suboptimal therapy. Furthermore, restrictive practices in clinical trials commonly exclude elderly patients creating disparities from expected findings within a real-world setting. These issues create an environment where elderly patients are at a heightened risk of adverse drug events and clinicians are forced to make significant decisions from limited information. With projections showing that this demographic will continue growing in size, the true burden of these limiting factors is yet to be realised.
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Suppiah SD, Tan YW, Tay SSC, Tan VSY, Tan NC, Tang WE, Chan A, Koh GCH, Malhotra R. Challenges encountered by pharmacy staff in using prescription medication labels during medication counselling with older adults and solutions employed: A mixed-methods study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100226. [PMID: 36785794 PMCID: PMC9918413 DOI: 10.1016/j.rcsop.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Background Prescription medication labels (PMLs) predominantly dispensed in English, are an important adjunct to medication counselling. PMLs are routinely used by pharmacy staff to counsel older adults about their medications. This study sought to identify challenges that pharmacy staff observe older adults face in using their PMLs, and to identify and quantify solutions employed by pharmacy staff during medication counselling to address such challenges. Methods Ten in-depth interviews were done with primary care pharmacy staff to gather the range of challenges and solutions. Subsequently, a quantitative survey, informed by the qualitative findings, was administered to 121 pharmacy staff to assess if the reported solutions were commonly used. Results The two main challenges were incongruity between PML language (English) and older adults' language proficiency, and poor PML legibility. The solutions, classified under three themes, were simplifying medication information on PMLs, supplementing PMLs with additional medication information and mitigating poor readability. Conclusions Pharmacy staff observed challenges faced by older adults in using PMLs during medication counselling. Ad-hoc improvisations by pharmacy staff to PMLs were pervasive. System-level PML improvements, such as provision of legible bilingual medication instructions, pharmaceutical pictograms and additional medication information, through patient information leaflets or using quick response (QR) codes on PMLs, should be considered. This will facilitate patient-provider communication, especially in settings with language dissonance between PMLs and patients.
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Affiliation(s)
| | - Yi Wen Tan
- Centre for Ageing Research & Education, Duke-NUS Medical School, Singapore
| | | | | | | | - Wern-Ee Tang
- National Healthcare Group Polyclinics, Singapore
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, USA
| | | | - Rahul Malhotra
- Centre for Ageing Research & Education, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Does Health Literacy Have an Impact on Adherence to Diabetes Mellitus Treatment? ENDOCRINES 2023. [DOI: 10.3390/endocrines4010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Health literacy is the intersection of general literacy, health, and healthcare, but it can also incorporate elements of other types of literacies to varying degrees. The notion of literacy surfaced from the fear that individuals would require more than general literacy skills to manage the complexities of health and health system issues. There is a substantial overlap between general literacy and health literacy. Diabetes patients frequently misinterpret medication instructions, resulting in non-adherence and poor health outcomes. (2) Aim: This study sought to review the literature on the impacts of health literacy on adherence and compliance to diabetes mellitus treatment. (3) Methods: A Narrative Literature Review method was used to identify, analyze, assess, and interpret the available information on health literacy regarding prescribed medication instructions. The following databases and search engines were used to locate the literature: electronic databases, search engines, and hand searches. Fifty-three (53) quantitative and qualitative studies and two books were reviewed. (4) Result: The review pointed out the following: the importance of health literacy, the implications of health illiteracy versus medication non-adherence, factors influencing health literacy versus medication adherence, and the interventions to improve medication non-adherence. (5) Conclusion: Relatively few studies have been conducted on how people living with diabetes should carry out their treatment. Therefore, more research on how people living with diabetes carry out their treatment daily is required. (6) Contributions: This study has identified that health literacy plays a role in adherence to treatment and contributes to improved health outcomes.
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Young HN, Pathan FS, Hudson S, Mott D, Smith PD, Schellhase KG. Impact of patient-centered prescription medication labels on adherence in community pharmacy. J Am Pharm Assoc (2003) 2023; 63:785-792. [PMID: 36725425 DOI: 10.1016/j.japh.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/14/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Prescription medication labels are often constructed in a manner which hinders safe and appropriate use of medicines. The United States Pharmacopeia released voluntary standards to revise medication labels in an effort to support patients' understanding and improve medication use. OBJECTIVE To examine the impact of label changes on medication adherence before and after pharmacy implementation of the United States Pharmacopeia patient-centered prescription medication label standards. METHODS This study used a retrospective pre-post cohort design. Prescription fill claims data were obtained from a community health plan serving Medicaid patients for 1 independent community pharmacy organization across 8 retail pharmacy sites. We calculated medication possession ratios (MPR) and proportion of days covered (PDC) for medications used for contraception, asthma, hypertension, and depression from 15 months before to 13 months after implementation of the label changes. RESULTS Findings showed significant increases in mean MPR for asthma controller (increased by 0.111 [t = 0.290, P<0.0001]), antihypertensives (increased by 0.062 [t = 0.146, P < 0.0002]), and contraceptives medications (increased 0.133 [t = 0.209, P < 0.0001]) from preintervention to postintervention periods. Results also revealed increases in mean PDC for asthma controllers (increased by 0.193 [t = 0.267, P < 0.0001]), antihypertensives (increased by 0.067 [t = 0.175, P = 0.049]), and contraceptives (increased by 0.111 [t = 0.208, P < 0.0119]) from preintervention to postintervention periods. CONCLUSION We report an association between a change to more patient-centered prescription medication labels and increased medication adherence based on MPR and PDC among Medicaid recipients.
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Rong H, Lu L, Wang L, Liu C, Zhang L, Li F, Yi D, Lei E, Zheng C, Meng Q, Chen JA. Investigation of health literacy status and related influencing factors in military health providers of Chinese People's liberation Army, a cross-sectional study. BMC Public Health 2023; 23:4. [PMID: 36593451 DOI: 10.1186/s12889-022-14958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate health literacy and analyze its influencing factors in military health providers of the Chinese People's Liberation Army (PLA Army). METHODS From November to December 2018, cluster sampling was used to select 1512 military health providers from the Army Medical University. Health literacy was measured by using the Chinese Citizen Health Literacy Questionnaire (HLQ) (2015 edition). Influencing factors that may affect health literacy were assessed using the chi-square test and multivariate logistic regression models. RESULTS The knowledge rate of health literacy was relatively low (21.6%). The knowledge rate of health-related skills (HRS, 18.7%) was the lowest of the three aspects of health literacy, and the knowledge rate of chronic diseases (CD, 19.6%) was the lowest of the six dimensions of health literacy. Participants who were older, were female, were of Han ethnicity, were the only child in their families, came from urban areas, never used tobacco, and had higher household income were likely to have higher health literacy. CONCLUSION The health literacy levels of military health providers of the PLA Army are relatively low. Further research and health education are necessary to improve health literacy.
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Affiliation(s)
- Honghui Rong
- Department of Health Education, School of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lu Lu
- Department of Health Education, School of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lei Wang
- Department of Medical Technologies and Health Care, NCO School, Army Medical University, Chongqing, Hebei, China
| | - Cairu Liu
- The Teaching Evaluation Centre, NCO School, Army Medical University, Chongqing, Hebei, China
| | - Ling Zhang
- Department of Health Education, School of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengju Li
- Department of Health Education, School of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dali Yi
- Department of Health Education, School of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Enyu Lei
- Department of Health Education, School of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chuanfen Zheng
- Department of Health Education, School of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingbin Meng
- Department of Basic Education, NCO School, Army Medical University, Chongqing, Hebei, China
| | - Ji-An Chen
- Department of Health Education, School of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China.
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Schackmann L, van Dijk L, Brabers AEM, Zwier S, Koster ES, Vervloet M. Comprehensibility of a personalized medication overview compared to usual-care prescription drug labels. Front Pharmacol 2022; 13:1004830. [DOI: 10.3389/fphar.2022.1004830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Poor understanding of prescription drug label (PDL) instructions can lead to medication errors, suboptimal treatment (side) effects, and non-adherence. A personalized medication hard-copy overview listing PDL instructions and visual information may support patients in their medication use. This study aimed to investigate the comprehensibility of PDL instructions on a personalized medication overview compared to usual-care PDL instructions presented on a medication box. A hypothetical-online-experiment was set up, comparing groups of respondents exposed vs not exposed to the medication overview and who received PDL instructions for three, five, or eight medications. Participants were divided randomly in six groups. Online questionnaires were sent to a stratified sample of 900 members from the Nivel Dutch Healthcare Consumer Panel. Outcome measures included comprehension of instructions for medication use, e.g. how often, dose timing, usage advice and warnings for a medication with simple use instructions (omeprazol) and more complex use instructions (levodopa/carbidopa (L/C)). To analyze differences between experimental conditions ANOVA testing was used. 604 respondents (net response 67%) completed the questionnaires. Respondents exposed (E) to the overview gave a higher proportion of correct answers compared to non-exposed (NE) respondents for usage advice (L/C: mean 0.83, SD 0.4 E; 0.03, SD 0.2 NE, p < 0.001; omeprazol: mean 0.85, SD 0.4 E; 0.10, SD 0.3 NE, p < 0.001). Both groups gave the same proportion of correct answers (mean 0.80, SD 0.4, p = 1.0) for dose timing of omeprazol. More NE respondents gave correct answers for how often (mean 0.85, SD 0.4 NE; mean 0.76, SD 0.4 E, p = 0.02) and dose timing (mean 0.92, SD 0.3 NE; mean 0.86, SD 0.4 E, p = 0.04) of L/C. No differences were found regarding number of medications nor were interaction effects found between the number of medications and information type. As a medication overview contains additional information, it can be a good addition in supporting patients in their medication use compared to usual-care PDLs. Future research should focus on identifying patient groups who might benefit more from a medication overview, by testing the effect of such overview on this group.
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Garcia JM, Morales Mejia YL, Ochoa Lopez AP, Woods SP, Valier H, Medina LD. Evidence for the reliability and validity of a Spanish translation of the Medication Management Ability Assessment administered via tele-assessment. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-13. [PMID: 35998647 DOI: 10.1080/23279095.2022.2114356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We translated the Medication Management Ability Assessment (MMAA) from English to Spanish for use via tele-assessment and examined its reliability and validity. Following International Test Commission Guidelines for Translating and Adapting Tests, we used translation/back-translation and a small focus group (n = 6) to adapt a Spanish version of the MMAA. Eighty-six Spanish-speaking adults completed the adapted MMAA via tele-assessment at baseline and at a two-week follow-up visit. Participants also completed several self-report and performance-based cognitive and functional measures. The internal consistency of the MMAA was excellent (standardized Cronbach's α = 0.90). Performance-based functional assessments (PBFAs) and objective cognition were positively associated with the MMAA at small to medium effect sizes. Self-report measures of daily function and cognition, measures of health literacy, and estimates of premorbid intellectual functioning were not significantly associated with MMAA performance. The test-retest reliability of the MMAA was good (CCC = 0.73, 95% CI [0.62, 0.81]; rs = 0.37, p < 0.001) and demonstrated a small practice effect (Cohen's d = 0.36, p = 0.001). Preliminary evidence for the construct validity of a Spanish-language MMAA administered via tele-assessment further expands the potential clinical utility of PBFAs in culturally diverse, Spanish-speaking populations.
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Affiliation(s)
- Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | | | - Helen Valier
- The Honors College, University of Houston, Houston, TX, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
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Merks P, Cameron JD, Balcerzak M, Religioni U, Świeczkowski D, Konstanty M, Hering D, Szymański FM, Jaguszewski M, Vaillancourt R. Evaluation of a pharmacist-led intervention to improve medication adherence in patients initiating dabigatran treatment: a comparison with standard pharmacy practice in Poland. BMC PRIMARY CARE 2022; 23:210. [PMID: 35986241 PMCID: PMC9389729 DOI: 10.1186/s12875-022-01821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022]
Abstract
Backround Dabigatran is a direct thrombin inhibitor used to treat cardiac arrhythmias, and rates of non-adherence to dabigatran in Polish populations are high. The current study examined how a pharmacist-led intervention of counselling with pictogram-enhanced medication instructions, and smartphone medication reminders, can improve adherence to dabigatran. Methods A 3-month pharmacist-led intervention was conducted in community pharmacies in Poland on 325 men and women filling a dabigatran prescription for the first time. Participating pharmacies were assigned into the Control Group (n = 172 patients) or the Intervention Group (n = 153 patients). The primary outcome of this prospective study was self-reported medication adherence assessed at 3 time points (day 7, day 21, and day 90) after initiation of dabigatran. Results Patients in the Intervention Group were significantly more adherent (mean days on Dabigatan/week) than the Control Group at 7 days (6.0 ± 0.9 vs 5.4 ± 1.1, p < 0.0001), 21 days (5.6 ± 1.0 vs 4.9 ± 1.3, p < 0.0001), and 90 days (5.5 ± 1.3 vs 4.4 ± 2.0, p < 0.0001), respectively. The percentage of patients in the Intervention Group who reported taking dabigatran twice/day as prescribed was significantly higher than the Control Group at 7 days (82.7% vs 71.4%, p = 0.0311), at 21 days (84.4% vs 58%, p < 0.0001), and at 90 days (78.4% vs 39.7%, p < 0.0001), respectively. The proportion of patients fully adherent (every day, twice/day) at 90 days was significantly higher in the Intervention Group than in the Control Group (26.1% vs 13.2%, p = 0.0145). Conclusions Our findings support the role for interventions in community pharmacies in Poland to improve medication adherence, thus providing evidence for the efficacy of a pharmacist-led pictogram and smartphone-based program to support optimal dabigatran treatment.
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Alharbi AK, Alhutayrashi AA, Alosaimi AN, Althubyani SM, Shatla M. Patient Satisfaction and Comprehension of Physician and Pharmacist Prescription in Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e27324. [PMID: 36042992 PMCID: PMC9411694 DOI: 10.7759/cureus.27324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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Sharko M, Sharma MM, Benda NC, Chan M, Wilsterman E, Liu LG, Demetres M, Delgado D, Ancker JS. Strategies to optimize comprehension of numerical medication instructions: A systematic review and concept map. PATIENT EDUCATION AND COUNSELING 2022; 105:1888-1903. [PMID: 35123834 PMCID: PMC9203902 DOI: 10.1016/j.pec.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/13/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for improving comprehension of quantitative medication instructions. METHODS This review included a literature search from inception to November 2021. Studies were included for the following: 1) original research; 2) compared multiple formats for presenting quantitative medication information on dose, frequency, and/or time; 3) included patients/lay-people; 4) assessed comprehension-related outcomes quantitatively. To classify the studies, we developed a concept map. We weighed 3 factors (risk of bias in individual studies, consistency of findings among studies, and homogeneity of the interventions tested) to generate 3 levels of recommendations. RESULTS Twenty-one studies were included. Level 1 recommendations are: 1) use visualizations of medication doses for liquid medications, and 2) express instructions in time-periods rather than times per day. Level 2 recommendations include: validate icons, use panels or tables with explanatory text, use visualizations for non-English speaking populations and for those with low health literacy and limited English proficiency. CONCLUSIONS Visualized liquid medication doses and time period-based administration instructions improve comprehension of numerical medication instructions. Use of visualizations for those with limited health literacy and English proficiency could result in improved outcomes. PRACTICE IMPLICATIONS Practitioners should use visualizations for liquid medication instructions and time period-based instructions to improve outcomes.
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Affiliation(s)
- Marianne Sharko
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA; Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
| | - Mohit M Sharma
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA
| | - Natalie C Benda
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA
| | - Melissa Chan
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Eric Wilsterman
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Lisa Grossman Liu
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Diana Delgado
- Weill Cornell Medicine Samuel J Wood Library, New York, NY, USA
| | - Jessica S Ancker
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Al Khayrallah Z, Al-Saeedy Z, Medriano RAA, Lee K, Sommerfield A, Sommerfield D, Ware B, Huppatz D, Campbell A, Lim LY, von Ungern-Sternberg BS. Prescribing in a pediatric hospital setting - Lost in translation? PATIENT EDUCATION AND COUNSELING 2022; 105:1614-1619. [PMID: 34688523 DOI: 10.1016/j.pec.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine parental understanding of directions on common pediatric prescription pharmacy labels and to identify enablers and barriers that affect interpretation of these labels. METHODS Prospective qualitative descriptive study (July to August 2020) of 20 parents in post-surgical wards at a single Australian tertiary pediatric center. RESULTS Four key themes emerged through inductive analysis of the interview transcripts: 1) the addition of specific directions, such as administration with/without food and treatment course duration were perceived to be beneficial; 2) explicit phrasing of dosing intervals and times were more easily interpreted; 3) the use of simpler and common terminology enhanced understanding of the directions; and 4) presentation of multiple-step directions (e.g. tapering regimens) in a simplified and more organized manner was identified as an enabler and was thought to reduce confusion. CONCLUSION Differences in wording and presentation of pediatric prescription medication label directions led to variable interpretation by parents. PRACTISE IMPLICATIONS Therefore, there is a need for guidelines to standardize the wording of prescription medication advice labels. Findings from this study can be used to achieve this goal.
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Affiliation(s)
- Zainab Al Khayrallah
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia; Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Zahraa Al-Saeedy
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Rose Ann Ayes Medriano
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia.
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia.
| | - Benjamin Ware
- Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Dean Huppatz
- Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Andrew Campbell
- Pharmacy Department, Sir Charles Gairdner Hospital, Nedlands, Australia.
| | - Lee Yong Lim
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia.
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Health Literacy Level and Comprehension of Prescription and Nonprescription Drug Information. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116665. [PMID: 35682249 PMCID: PMC9180079 DOI: 10.3390/ijerph19116665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the level of misunderstanding of medication information in Korean adults after stratifying by level of health literacy and to identify the factors influencing the misunderstanding of medication information and reading amounts of information on OTC drug labels. A cross-sectional survey was performed with 375 adult participants using the survey instrument. Multiple linear regression analyses were performed to identify factors which influence misunderstanding of medication information. Participants misunderstood 20% of words on OTC drug labels, 9% of prescription drug instructions, and 9% of pictograms. Participants on average read 59% of the overall contents of the OTC drug labels. As prescription drugs’ dosing regimens became more complicated, the level of misunderstanding instructions increased. The level of misunderstanding words on OTC drug labels significantly decreased as participants had adequate health literacy (β = −18.11, p < 0.001) and higher education levels (β = −6.83, p < 0.001), after adjusting for the study variables. The level of misunderstanding instructions for prescription drugs increased as participants became older (β = 8.81, p < 0.001) and had lower education levels (β = −5.05, p < 0.001), after adjusting for the study variables. The level of misunderstanding pictograms was similar to that of misunderstanding instructions for prescription drug labels. The amount of reading information on OTC drug labels significantly increased as respondents had adequate health literacy (β = 9.27, p < 0.001), were older (β = 12.49, p < 0.001), or had chronic diseases (β = 7.49, p = 0.007). Individuals’ health literacy level, reading behaviors, and complexity of medication instructions are associated with misunderstanding of medication information. Appropriate word choices in drug labels and an improved format of medication instructions could increase understanding of medication information and prevent adverse drug reactions.
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Maleki S, Glewis S, Fua T, Liu C, Rischin D, Alexander M, Na L, Lingaratnam S. A randomised controlled trial of clinical pharmacy intervention versus standard care to improve medication adherence in outpatients with head and neck cancer receiving radiotherapy. Support Care Cancer 2022; 30:4243-4253. [PMID: 35091845 DOI: 10.1007/s00520-021-06779-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient understanding of medicines information and adherence to medication instructions are important variables for ensuring optimal cancer care. This randomised controlled trial (RCT) aimed to evaluate the impact of an outpatient clinical pharmacy service on medication adherence and symptom burden in cancer patients. METHODS In this single-centre RCT, 115 patients were randomised 1:1 to a pharmacist-led pharmaceutical care program (intervention, n = 59) versus standard of care (control, n = 56) within an outpatient multidisciplinary radiotherapy clinic. The primary endpoint was medication adherence as assessed by Medication Understanding and Use Self-Efficacy (MUSE) scale and Teach-Back assessment. Secondary endpoints were patient-reported symptom burden assessed by the Edmonton Symptom Assessment Scale (ESAS). Patients were assessed at baseline (weeks 1-2) and at discharge from radiotherapy (weeks 5-7). RESULTS Polypharmacy (use of five or more medications) was observed in 26% of patients at baseline compared to 97% at discharge. Patient self-efficacy and medication adherence was higher in the intervention arm compared to the control arm, with a mean MUSE score difference of 2.70 (95% CI 1.24, 4.17) after adjustment for baseline, and a higher proportion of patients with average Teach-Back score of four or more (86% vs 14%; odds ratio (OR) 46.09, 95% CI 14.49, 146.56). The mean (SD) scores for aggregate ESAS (0-100) at discharge were 26.2 (14.0) in the intervention arm and 32.0 (15.8) in the control arm demonstrating lower overall symptom burden associated with the intervention (mean score difference adjusted for baseline - 0.52; 95% CI - 1.03, - 0.01). CONCLUSION A structured outpatient clinic pharmacy service significantly improved medication adherence and reduced overall symptom burden in patients receiving radiotherapy.
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Affiliation(s)
- Sam Maleki
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
| | - Sarah Glewis
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Chen Liu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Grattan St, Parkville Victoria, 3010, Australia
| | - Marliese Alexander
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Grattan St, Parkville Victoria, 3010, Australia
| | - Lumine Na
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Senthil Lingaratnam
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
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OUP accepted manuscript. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:332-341. [DOI: 10.1093/ijpp/riac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022]
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Tan YW, Suppiah SD, Chan A, Koh GCH, Tang WE, Tay SSC, Malhotra R. Older adult and family caregiver experiences with prescription medication labels and their suggestions for label improvement. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100087. [PMID: 35479844 PMCID: PMC9029911 DOI: 10.1016/j.rcsop.2021.100087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background Prescription medication labels (PMLs) are an important source of written medication information for patients. However, real-world PMLs do not entirely conform with available labelling best practices and guidelines. Given this disconnect, older adults remain particularly at risk of misinterpreting their PMLs. Past studies have commonly assessed hypothetical PMLs, warranting studies that explore the lived experiences of older adults with real-world PMLs. Furthermore, the perspective of family caregivers of older adults is yet to be studied. Objective(s) This qualitative study documented the challenges faced by older adults and their family caregivers in using real-world PMLs, their strategies to cope with these challenges, and their suggestions to improve existing PMLs. Methods We conducted two focus group discussions (n = 17) and 30 in-depth interviews with older adults (n = 20; including those who can read in English and those with limited English proficiency) and caregivers (n = 10) in Singapore. The data were systematically assigned to codes that were continuously refined to accommodate emergent themes. Results Challenges, coping strategies and suggested improvements were related to the comprehensibility, availability, readability and consistency of medication information on PMLs. Conclusions Real-world PMLs continue to pose challenges for older adults and their caregivers, necessitating them to seek unique and personal coping strategies. The identified PML improvements, desired by older adults and their caregivers, urge healthcare systems to implement improved PMLs. Future research should explore system-level logistical, financial, and administrative barriers (or opportunities) that hinder (or facilitate) this implementation. Older adults and caregivers still face challenges with English medicine labels. Small font and lack of desired information were also enduring challenges. Inconsistency in label format and content confused older adults and caregivers. Caregivers and pharmacy staff adopted unique strategies to help older adults. Challenges and ad-hoc strategies necessitate real-world, systemic change to labels.
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Affiliation(s)
- Yi Wen Tan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | | | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, USA
| | | | - Wern-Ee Tang
- National Healthcare Group Polyclinics, Singapore
| | | | - Rahul Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Corresponding author at: Health Services and Systems Research, Head of Research, Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, 8 College Road, Level 4, 169857, Singapore.
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Saleem A, Woodruff G, Steadman K, La Caze A. Investigating the impact of patient-centred labels on comprehension of medication dosing: a randomised controlled trial. BMJ Open 2021; 11:e053969. [PMID: 34794998 PMCID: PMC8603299 DOI: 10.1136/bmjopen-2021-053969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aims to implement a version of patient-centred labels (PCL) consistent with current labelling practice in Australia; assess the effectiveness of PCL in relation to the proportion of participants that correctly comprehend dosing instructions, and explore the proportion of correct comprehension of PCL in participants with both low and high health literacy. DESIGN Randomised controlled trial. SETTING A large tertiary care hospital in Brisbane, Queensland, Australia. PARTICIPANTS 121 participants with a majority born in Australia (65.3%), New Zealand (14.0%), the UK (6.6%) and Ireland (2.5%). INTERVENTION Participants were randomly assigned to either a panel of three PCL (n=61) or three standard labels (n=60) and asked to comprehend their assigned panel of labels. OUTCOME MEASURES Difference in the proportion of participants that correctly comprehend dosing instructions provided on PCL compared with standard labels. The two-proportion test was used to measure the impact of PCL on the proportion of participants correctly comprehending dosing instructions. RESULTS A greater proportion of participants were able to accurately comprehend PCL compared with standard labels. The proportion of participants who were able to correctly comprehend dose instructions provided on all three labels was significantly higher in the group that received PCL; 23.3% standard vs 83.6% PCL, p<0.001. The effect was observed in both low and high health literacy participants. The proportion of participants with accurate label comprehension was higher in participants with low Newest Vital Signs scores (8.3% standard vs 85.7% PCL, p<0.001) and low Rapid Estimate of Adult Literacy in Medicine scores (10.5% standard vs 96.0% PCL, p<0.001) who received PCL. CONCLUSION This study supports the use of PCL in Australian pharmacy practice. PCL provide simple, clear and explicit dosing instructions to patients. Implementing PCL may reduce the risk of misinterpreting dosing instructions by patients and improve quality use of medicines. TRIAL REGISTRATION NUMBER ACTRN12621000083897; Results.
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Affiliation(s)
- Ahsan Saleem
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Gemma Woodruff
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kathryn Steadman
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
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Davis TC, Arnold CL, Mills G, Lesser GJ, Brown WM, Schulz R, Weaver KE, Pawloski PA. Assessment of Oral Chemotherapy Nonadherence in Chronic Myeloid Leukemia Patients Using Brief Measures in Community Cancer Clinics: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111045. [PMID: 34769563 PMCID: PMC8582838 DOI: 10.3390/ijerph182111045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023]
Abstract
The purpose of this pilot study was to assess Chronic Myeloid Leukemia (CML) patients’ adherence to, beliefs about, and barriers to oral anticancer agents (OAC) using brief self-report measures in community-based cancer clinics. Patients completed a structured interview including a health literacy assessment, a Brief Medication Questionnaire, two single-item self-report adherence questions, and the Medications Adherence Reasons Scale. Of the 86 participants, 88.4% were white; 55.8% male; mean age, 58.7 years; and 22.1% had limited health literacy. Nonadherence (missing at least one dose in the last week) was reported by 18.6% of participants and associated (p < 0.003) with less-than-excellent perceived ability to take CML medications (16.3%). Black participants reported more difficulty taking CML medications than white participants (28.6% vs. 8.3%, p = 0.053). Among all participants, 43.0% reported their CML medicine was ineffective and 24.4% that taking CML pills was somewhat to very hard. The most common reasons for missing a dose were simply missed it (24.4%) and side effects (18.6%). Most patients perceived their ability to take CML medication was good to excellent, yet nearly one in five reported missing at least one dose in the last week. Brief, no-cost self-report assessments to screen CML patients’ OAC adherence, barriers, and beliefs could facilitate counseling in busy community cancer clinics.
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Affiliation(s)
- Terry C. Davis
- Department of Medicine, Louisiana State University Health—Shreveport, Shreveport, LA 71130, USA; (C.L.A.); (G.M.)
- Correspondence: ; Tel.: +1-318-675-8694
| | - Connie L. Arnold
- Department of Medicine, Louisiana State University Health—Shreveport, Shreveport, LA 71130, USA; (C.L.A.); (G.M.)
| | - Glenn Mills
- Department of Medicine, Louisiana State University Health—Shreveport, Shreveport, LA 71130, USA; (C.L.A.); (G.M.)
| | - Glenn J. Lesser
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - W. Mark Brown
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Richard Schulz
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA;
| | - Kathryn E. Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Pamala A. Pawloski
- Metro-Minnesota Community Oncology Research Consortium, St. Louis Park, MN 55416, USA;
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Benda NC, Yang Z, Li H, Zhang T, Ancker JS. Lower objectively and subjectively assessed numeracy are both associated with poorer self-rated health. BMC Res Notes 2021; 14:321. [PMID: 34419167 PMCID: PMC8379725 DOI: 10.1186/s13104-021-05737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare an objective with a subjective numeracy assessment for association with self-reported health status, where numeracy refers to “the degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health information needed to make effective health decisions” Results We completed a secondary analysis of two population-based surveys, the Empire State Poll (n = 763) and the Program for the International Assessment of Adult Competencies (PIAAC; n = 2609). The first survey assessed numeracy with a 3-item subjective instrument. The second assessed numeracy with more than 20 math problems. Both used the same measure for self-reported health status. Lower numeracy, whether subjectively or objectively assessed, was associated with worse self-reported health, even after controlling for education and other sociodemographic confounders. The odds ratios for the association were very similar (0.91 and 0.90 respectively). A lengthy objective numeracy assessment and a brief self-report assessment had similar associations with health status. A brief self-report measure of numeracy has similar properties to a lengthy objective assessment and is likely to be more feasible to use to screen patients in practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05737-y.
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Affiliation(s)
- Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA.
| | - Zihan Yang
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA
| | - Haojia Li
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA
| | - Tianran Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA
| | - Jessica S Ancker
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 stStreet, Suite 301, New York, NY, 10065, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Rm, Nashville, TN, 14122, USA
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Jazul JP, Arciga TMG, Ante MAC, Berlin DGB, Ravana LFL, Reyes SA, Singh J. Assessment of patient understanding of their conventional cardiac medicines and herbal prepared/derived products: preliminary survey and interviews with selected community-dwelling elderly patients in the Philippines. J Basic Clin Physiol Pharmacol 2021; 32:403-413. [PMID: 34214303 DOI: 10.1515/jbcpp-2020-0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this study was to identify the patterns of medication load, its medication burden, coordination of healthcare and patient's understanding of their conventional cardiac medications and related herbal-derived preparations. METHODS The study is a mixed-method both, quantitative and qualitative approach, which involved Filipino elderly patients (n=69) enrolled in the outpatient service of the National Center for Geriatric Health, Manila. Data were gathered through face-to-face surveys and interviews using a semi-structured questionnaire. Descriptive statistics were used during data analysis. Thematic analysis was also used to emphasize patterns in the responses of the participants. RESULTS Respondents were knowledgeable on the name (86.9%), visual characteristics (78.3%), and indication and administration of their medicine (88.4%). The frequency of their doctor's information on the possible side effects of the medicines was noted. The almost negligible difference in the proportions of those who asserted during the information dissemination on the medication side effect by their doctors was observed (<10.5%). Association on the age and awareness of any interaction on the drugs they are taking (p=0.032) and an association between the gender and awareness of the doctor/pharmacists about other drugs the patient is taking (p=0.033) were observed. During thematic analysis, elderly respondents were keen on the physician's advice than that of the pharmacist. This is due to the limited knowledge of elderly patients on the role of pharmacists to conduct medication counseling. CONCLUSIONS The majority of the elderly patients recognized the purpose and extent of medication. It was noted that pharmacists play a limited role in understanding selected Filipino elderly patients on their medication. Lack of communication between the patient and the pharmacist was noted as preliminary findings in the study. Respondents were not yet informed of the responsibility of the pharmacist to provide information regarding their medication. Integration of pharmacists' care for geriatric health must be strengthened and highly recommended. Supervision by the healthcare professionals, particularly by the pharmacists, must be fully established.
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Affiliation(s)
- Jay P Jazul
- University of Santo Tomas, Faculty of Pharmacy, Manila, Philippines
| | | | | | | | | | - Samantha A Reyes
- University of Santo Tomas, Faculty of Pharmacy, Manila, Philippines
| | - Jashanjit Singh
- University of Santo Tomas, Faculty of Pharmacy, Manila, Philippines
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Vaillancourt R, Cameron JD. Health literacy for children and families. Br J Clin Pharmacol 2021; 88:4328-4336. [PMID: 34155667 DOI: 10.1111/bcp.14948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 05/19/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022] Open
Abstract
The relationship between reading ability and health, known as health literacy, broadly reflects the skills and competencies required to operate within the healthcare environment. It is only recently that we have seen attempts to conceptualize health literacy in the context of medication use by using terms such as medication literacy. Health literacy changes over one's lifetime and is dependent on factors such as numeracy, education, income, gender and country. Low health literacy and low medication literacy have been identified as significant risk factors for poor health outcomes of adults and children. With an evaluation of common tools used to assess health literacy and medication literacy, the aim of this review is to describe the shared responsibility between patients and healthcare providers for the communication of health and medication information. Key strategies and interventions to improve two-way communication between patients and healthcare providers are highlighted, with a focus on how health literacy can impact child health outcomes.
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Tong V, Aslani P, Raynor DK, Shipp D, Parkinson B, Lalor D, Sobey A, Gilbert A, Crofton J, Young J, Carter S, Poon W, Chitlangia S. Developing and user testing new pharmacy label formats-A study to inform labelling standards. Health Expect 2021; 24:1125-1136. [PMID: 34076940 PMCID: PMC8369108 DOI: 10.1111/hex.13203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Dispensed prescription medicine labels (prescription labels) are important information sources supporting safe and appropriate medicines use. Objective To develop and user test patient‐centred prescription label formats. Methods Five stages: developing 12 labels for four fictitious medicines of varying dosage forms; diagnostic user testing of labels (Round 1) with 40 consumers (each testing three labels); iterative label revision, and development of Round 2 labels (n = 7); user testing of labels (Round 2) with 20 consumers (each testing four labels); labelling recommendations. Evaluated labels stated the active ingredient and brand name, using various design features (eg upper case and bold). Dosing was expressed differently across labels: frequency of doses/day, approximate times of day (eg morning), explicit times (eg 7 to 9 AM), and/or explicit dosing interval. Participants’ ability to find and understand medicines information and plan a dosing schedule were assessed. Results Participants demonstrated satisfactory ability to find and understand the dosage for all label formats. Excluding active ingredient and dosing schedule, 14/19 labels (8/12 in Round 1; 6/7 in Round 2) met industry standard on performance. Participants’ ability to correctly identify the active ingredient varied, with clear medicine name sign‐posting enabling all participants evaluating these labels to find and understand the active ingredient. When planning a dosing schedule, doses were correctly spaced if the label stated a dosing interval, or frequency of doses/day. Two‐thirds planned appropriate dosing schedules using a dosing table. Conclusions Effective prescription label formatting and sign‐posting of active ingredient improved communication of information on labels, potentially supporting safe medicines use. Patient and Public Involvement Consumers actively contributed to the development of dispensed prescription medicine labels. Feedback from consumers following the first round was incorporated in revisions of the labels for the next round. Patient and public involvement in this study was critical to the development of readable and understandable dispensed prescription medicine labels.
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Affiliation(s)
- Vivien Tong
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Diana Shipp
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | | | - Daniel Lalor
- Pharmacy Department, Canberra Hospital and Health Services, Canberra, ACT, Australia
| | - Andrew Sobey
- Pharmacy Department, Canberra Hospital and Health Services, Canberra, ACT, Australia
| | - Alice Gilbert
- Top End Health Service, Northern Territory Department of Health, Darwin, NT, Australia
| | - Jackie Crofton
- Department of Pharmacy, Royal Darwin Hospital, Darwin, NT, Australia
| | - Joanne Young
- Pharmacy Department, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sophie Carter
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Wing Poon
- School of Pharmacy, The University of Nottingham, Nottingham, UK
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Mohammad A, Saini B, Chaar BB. Pharmacists' experiences serving culturally and linguistically diverse patients in the Australian community pharmacy setting. Int J Clin Pharm 2021; 43:1563-1573. [PMID: 34076804 DOI: 10.1007/s11096-021-01284-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
Background There has been no in depth published study to date reporting on community pharmacists' current experiences and their future practice needs relating to providing culturally competent pharmaceutical care to Australian culturally and linguistically diverse patients with low English proficiency. Objective To explore community pharmacists' experiences serving culturally and linguistically diverse patients who have low English proficiency. Setting Community pharmacists in Australia. Method Focus group discussions with practising community pharmacists were conducted. Participants were recruited from metropolitan Sydney. Discussion centred around their current experiences and practice changes needed to enhance the provision of culturally competent pharmaceutical care. Thematic analysis using the constant comparison method within a grounded theory approach was performed on the data collected. Main outcome measure Participants' experiences in providing culturally competent care to culturally and linguistically diverse patients with low English proficiency. Results Thirty community pharmacists participated in six focus group discussions. Inadequate provision of culturally competent care was found to be primarily due to the issue of language incongruence between pharmacist and patient. Participants proposed various means with which such care may be provided to ensure patient safety. Conclusion Pharmacist participants expressed being inadequately equipped to provide culturally competent care in the community setting and identified potential means by which such care may be delivered. Addressing identified barriers that hinder community pharmacists' capacity to engage in culturally competent practice can potentially improve provision of pharmaceutical care to culturally and linguistically diverse patients with low English proficiency.
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Affiliation(s)
- Annim Mohammad
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Bandana Saini
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Betty Bouad Chaar
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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Maghroudi E, van Hooijdonk CMJ, van de Bruinhorst H, van Dijk L, Rademakers J, Borgsteede SD. The impact of textual elements on the comprehensibility of drug label instructions (DLIs): A systematic review. PLoS One 2021; 16:e0250238. [PMID: 34010291 PMCID: PMC8133485 DOI: 10.1371/journal.pone.0250238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/04/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Correct interpretation of drug labels instructions (DLIs) is needed for safe use and better adherence to prescribed drugs. DLIs are often too difficult for patients, especially for those with limited health literacy. What is yet unknown, is how specific textual elements in DLIs (e.g., the presentation of numbers, or use of medical jargon) and patients' health literacy skills are related to the comprehension of DLIs. In order to provide concrete directions for health professionals on how to optimize drug prescriptions, we performed a systematic review to summarize the available research findings on which textual elements facilitate or hinder the correct interpretation of DLIs in relation to patients' health literacy. METHOD A systematic search was performed in PubMed, EMBASE, PsychINFO, and Smartcat (until April 2019) to identify studies investigating textual elements that facilitate or hinder the correct interpretation of DLIs in relation to patients' health literacy. RESULTS A total of 434 studies were identified of which 28 studies met our inclusion criteria. We found that textual elements contributing to the correct interpretation of DLIs were: using explicit time periods in dosage instructions, using plain language, presenting numbers in a numerical format, and providing DLIs in patients' native language. Multistep instructions per instruction line, using abbreviations and medical jargon seem to hinder the correct interpretation of DLIs. Although health literacy was taken into account in a majority of the studies, none of them assessed the effectiveness of specific textual elements on patients' comprehensibility of DLIs. CONCLUSION Based on our findings, we provide an overview of textual elements that contribute to the correct interpretation of DLIs. Optimizing the textual instruction on drug labels may increase the safety and adherence to prescribed drugs, taking into account that a significant proportion of patients has low health literacy.
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Affiliation(s)
- Ekram Maghroudi
- Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands
- Department of Family Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands
- * E-mail:
| | | | - Heidi van de Bruinhorst
- Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands
- Universiteit Utrecht, Pharmacy, Utrecht, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Faculty of Mathematics and Natural Sciences, Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jany Rademakers
- Department of Family Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Mengesha Y, Amare E. Assessment of Patients Misunderstanding of Dosing Instructions Among Outpatients in Dessie Referral Hospital, Northeast Ethiopia. Risk Manag Healthc Policy 2020; 13:3079-3085. [PMID: 33376430 PMCID: PMC7764632 DOI: 10.2147/rmhp.s288390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Lack of clear and precise oral and written information from both the doctors and/or pharmacists on the management of prescribed medication has led to therapeutic failure, as a result of patients not comprehending instructions. Incorrect interpretation of labels can lead to incorrect usage of medication therefore the occurrence of medication error and/or adverse event. The concern of this study was to assess misunderstanding of dosing instructions among outpatients in Dessie Referral Hospital (DRH). Methods An institution-based cross-sectional study was conducted on 384 outpatients at DRH from February 10 to March 15, 2019. Study subjects were selected by using a systematic random sampling technique and data was collected by using questionnaires and observation. The data was coded individually and entered in a computer using Epi Info™ version 3.5.1 and then exported to SPSS version 23.0 for analysis. Univariate analyses were used to describe the categorical variables. Chi-square test was used to assess association of variables with primary outcome. P-value <0.05 was considered as statistical significance. Results This study showed that most of the respondents n=298 (77.6%) misunderstood more than one dosage instruction, 8.75% misunderstood the dose, 51.3% misunderstood the frequency while 58.59% misunderstood the duration of treatment. The misunderstanding was higher for labeled medications (11.4%) than unlabelled (7.7%). Conclusion The prevalence of misunderstanding of dosing instruction was high in outpatients of DRH. Hence standard procedures must be developed to provide easy and clear dosing instructions to patients, and continuous training must be provided for pharmacists on proper communication of dosing instructions to patients.
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Affiliation(s)
- Yohannes Mengesha
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Eskedar Amare
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Plaza-Zamora J, Legaz I, Osuna E, Pérez-Cárceles MD. Age and education as factors associated with medication literacy: a community pharmacy perspective. BMC Geriatr 2020; 20:501. [PMID: 33238894 PMCID: PMC7687724 DOI: 10.1186/s12877-020-01881-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Aging implies a higher prevalence of chronic pathologies and a corresponding increase in medication. The correct adherence and use of the medication are prerequisites for reducing risks of disease progression, comorbidity, and mortality. Medication literacy (ML) is the specific ability to safely access and understand the information available concerning medication, and to act accordingly. Currently, there are few specific instruments that ascertain the extent of ML in the general population. The aim of this work was to analyse ML in a large cohort of pharmacy customers. METHODS A total of 400 community pharmacy clients were analyzed to assess the level of ML (documental and numeracy) through the validated MedLitRxSE tool. RESULTS The results showed that out of a total of 400 community pharmacy clients only 136 (34%) had an adequate degree of ML, while the rest of the clients (n = 264; 66%) were adjudged not to have this ability. Statistically significant differences were found between the different age groups in terms of ML (P < 0.001; OR = 0.312; 95% CI: 0.195-0.499), the 51-65 and >65-year age groups having a lower frequency of adequate ML (23.5 and 7.1%, respectively) than the rest of the age groups. A statistically significant increase in adequate ML was observed as the academic level of the clients increased (P < 0.001; OR = 15.403; 95% CI: 8.109-29.257). Multivariate logistic regression confirmed the influence of both variables on ML. CONCLUSIONS An inadequate ML level was found in community pharmacy clients over the age of 51, and also in those with primary or non-formal studies. Our data add to our knowledge about ML, and should pharmacists and other health professionals to adopt new strategies to prevent, or at least reduce, errors in taking medicines, thus avoiding the undesirable effects of any misuse.
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Affiliation(s)
| | - Isabel Legaz
- Department of Legal and Forensic Medicine, Institute of Research into Aging. Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, Murcia, Spain.
| | - Eduardo Osuna
- Department of Legal and Forensic Medicine, Institute of Research into Aging. Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, Murcia, Spain
| | - María D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Institute of Research into Aging. Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, Murcia, Spain
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Wolf MS, Taitel MS, Jiang JZ, Curtis LM, Wismer GA, Wallia A, Parker RM. Prevalence of Universal Medication Schedule prescribing and links to adherence. Am J Health Syst Pharm 2020; 77:196-205. [PMID: 31974556 DOI: 10.1093/ajhp/zxz305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE A Universal Medication Schedule (UMS) that uses explicit language to describe when to take medicine has been proposed as a patient-centered prescribing and dispensing standard. Despite widespread support, evidence of its actual use and efficacy is limited. We investigated the prevalence of UMS instructions and whether their use was associated with higher rates of medication adherence. METHODS National pharmacy records were analyzed for a cohort of type 2 diabetic adults ≥18 years old (N = 676,739) new to ≥1 oral diabetes medications between January and June 2014. Prescription instructions (N = 796,909) dispensed with medications were classified as UMS or non-UMS. Instructions coded as UMS were further categorized as either providing precise UMS language (tier 1: "take 1 pill at morning, noon, evening, or bedtime") or offering some explicit guidance (tier 2: "take 1 tablet by mouth before breakfast"; tier 3: "take 1 tablet twice daily with a meal"). Adherence over 12 months was measured by proportion of days covered. RESULTS One-third of instructions (32.4%, n = 258,508) were classified as UMS (tier 1: 12.6%, n = 100,589; tier 2: 6.0%, n = 47,914; tier 3: 13.8%, n = 110,005). In multivariable analyses, UMS instructions (all tiers) exhibited better adherence compared to non-UMS instructions (relative risk [RR], 1.01; 95% confidence interval [CI], 1.00-1.02; P = 0.01). Patients older than 65 years who were less educated and taking medication more than once daily received greater benefit from tier 1 UMS instructions (RR, 1.14; 95% CI, 1.07-1.21; P < 0.001). CONCLUSION While infrequently used, the UMS could help older, less-educated patients adhere to more complex regimens with minimal investment.
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Affiliation(s)
- Michael S Wolf
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL.,Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, IL
| | - Michael S Taitel
- Health Analytics, Research and Reporting, Walgreen Co., Deerfield, IL
| | - Jenny Z Jiang
- Health Analytics, Research and Reporting, Walgreen Co., Deerfield, IL
| | - Laura M Curtis
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Guisselle A Wismer
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Amisha Wallia
- Division of Endocrinology, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Ruth M Parker
- Division of General Internal Medicine, Emory School of Medicine, Atlanta, GA
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Guo M, Carter SR, Lau E, Rimington J, Babu C, Penm J. User testing to examine patient understanding of pharmacy generated medication labels. PATIENT EDUCATION AND COUNSELING 2020; 103:2290-2296. [PMID: 32448626 DOI: 10.1016/j.pec.2020.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine patients' and carers' understanding of pharmacy generated medication labels. METHODS A user testing questionnaire was conducted individually for 80 participants at 2 hospitals through a face-to face semi-structured interview. Pharmacy generated medication labels from different locations were grouped based on components into 4 different variations. Participants were asked to read and demonstrate understanding of the dose and frequency from 1 of the 4 variations for 4 prescription medications. Twenty participants for each variation were recruited so that demographic characteristics matched between variations. RESULTS Overall, only 45% of participants were able to correctly understand the dose and frequency presented on all the pharmacy labels presented on medications. Medication labels with standardised timing performed better than other variations with 91% of participants able to determine the correct frequency. The use of numeric figures was understood by 80-90% of participants compared to the use of capitalised text (65-70%). Pharmacy generated medication labels that proposed one step were better understood than instructions that incorporated several steps. CONCLUSION/PRACTICE IMPLICATIONS The study supports the use of simple, clear and explicit written instructions along with the use of numeric figures in pharmacy generated medication labels to achieve higher understandability in patients.
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Affiliation(s)
- M Guo
- University of Sydney, Camperdown, NSW, Australia.
| | - S R Carter
- University of Sydney, Camperdown, NSW, Australia
| | - E Lau
- St George Hospital, Kogarah, NSW, South Eastern Sydney Local Health District, Australia
| | - J Rimington
- Prince of Wales Hospital, Randwick, NSW, South Eastern Sydney Local Health District, Australia
| | - C Babu
- University of Sydney, Camperdown, NSW, Australia
| | - J Penm
- University of Sydney, Camperdown, NSW, Australia
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Appalasamy JR, Quek KF, Md Zain AZ, Joseph JP, Seeta Ramaiah S, Tha KK. An Evaluation of the Video Narrative Technique on the Self-Efficacy of Medication Understanding and Use Among Post-Stroke Patients: A Randomized-Controlled Trial. Patient Prefer Adherence 2020; 14:1979-1990. [PMID: 33116441 PMCID: PMC7585263 DOI: 10.2147/ppa.s253918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Self-efficacy is positively associated with medication understanding and use self-efficacy (MUSE) among post-stroke patients. It is also closely related to knowledge, belief, and perception, which vary among people from different socioeconomic backgrounds and cultures. As interventions using video and peer stories have emerged to be successful on behavior modification, this study aimed to explore the effectiveness of video narratives incorporated with Health Belief constructs on MUSE and its associated factors among patients with stroke at a local setting. METHODS A randomized controlled trial (RCT) for 12 months was carried out on patients diagnosed with stroke at Hospital Kuala Lumpur, Malaysia. The RCT recruited up to 216 eligible patients who were requested to return for two more follow-ups within six months. Consented patients were randomized to either standard care or intervention with video narratives. The control of potential confounding factors was ensured, as well as unbiased treatment review with prescribed medications, only obtained onsite. RESULTS AND DISCUSSION A repeated measure of MUSE mean score differences at T0 (baseline), T2 (6th month) and T4 (12th month) for antithrombotic, antihypertensive, and all medication categories indicated significant within and between groups differences in the intervention group (p<0.05). Moreover, this impact was reflected upon continuous blood pressure (BP) monitoring compared to the control group (F (1214) =5.23, p=0.023, ƞ2=0.024). Though BP measure differences were non-significant between the groups (p=0.552), repeated measure analysis displayed significant mean differences between intervention and control group on BP control over time (F (1.344, 287.55) =8.54, P<0.001, ƞ2=0.038). Similarly, the intervention's positive impact was also present with similar trends for knowledge, illness perception, and the belief about medicine. Though significant differences (p<0.05) of all outcome measures gradually decreased between T2 and T4 in the intervention group; nevertheless, these positive findings confirmed that personalized video narratives were able to motivate and influence MUSE and its associated factors among post-stroke patients. The significant improvement in medication-taking self-efficacy and the sustenance of BP monitoring habits among patients in the intervention group strengthened our conceptual framework's practicality.
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Affiliation(s)
- Jamuna Rani Appalasamy
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Anuar Zaini Md Zain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Joyce Pauline Joseph
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | | | - Kyi Kyi Tha
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Ancker JS, Grossman LV, Benda NC. Health Literacy 2030: Is It Time to Redefine the Term? J Gen Intern Med 2020; 35:2427-2430. [PMID: 31659662 PMCID: PMC7403287 DOI: 10.1007/s11606-019-05472-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
For decades, health literacy has been used to describe the ability of individuals to locate, interpret, and apply health information to their decisions. The US Department of Health and Human Services has now proposed redefining the term to emphasize the role of society in providing accessible, comprehensible information. This redefinition would reflect a welcome shift to encompass the roles of those who communicate information, not simply those who seek it. However, redefining an accepted term would have serious negative effects on the indexing of the research literature and create difficulties interpreting studies conducted under the previous definition. Therefore, we strongly caution against redefining the accepted term. Instead, we propose introducing a new term-health information fluency-defined as universal effective use of health information. The old term can continue to be used to describe the set of concerns about individual skills, but by promoting the new term, the Department of Health and Human Services can encourage research into creating accurate, accessible health information that people can easily find, understand, and use to inform their decisions.
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Affiliation(s)
- Jessica S Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Natalie C Benda
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
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Appalasamy JR, Joseph JP, Seeta Ramaiah S, Md Zain AZ, Quek KF, Tha KK. Video Narratives Intervention Among Stroke Survivors: Feasibility and Acceptability Study of a Randomized Controlled Trial. JMIR Aging 2020; 3:e17182. [PMID: 32469839 PMCID: PMC7382013 DOI: 10.2196/17182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/20/2020] [Accepted: 05/15/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A large number of stroke survivors worldwide suffer from moderate to severe disability. In Malaysia, long-term uncontrolled stroke risk factors lead to unforeseen rates of recurrent stroke and a growing incidence of stroke occurrence across ages, predominantly among the elderly population. This situation has motivated research efforts focused on tapping into patient education, especially related to patient self-efficacy of understanding and taking medication appropriately. Video narratives integrated with health belief model constructs have demonstrated potential impacts as an aide to patient education efforts. OBJECTIVE The aim of this study was to investigate the feasibility and acceptability of study procedures based on a randomized controlled trial protocol of a video narratives intervention among poststroke patients. We also aimed to obtain preliminary findings of video narratives related to medication understanding and use self-efficacy (MUSE) and blood pressure control. METHODS A parallel group randomized controlled trial including a control group (without video viewing) and an intervention group (with video viewing) was conducted by researchers at a neurology outpatient clinic on poststroke patients (N=54). Baseline data included patients' sociodemographic characteristics, medical information, and all outcome measures. Measurements of MUSE and blood pressure following the trial were taken during a 3-month follow-up period. Feasibility of the trial was assessed based on recruitment and study completion rates along with patients' feedback on the burden of the study procedures and outcome measures. Acceptability of the trial was analyzed qualitatively. Statistical analysis was applied to ascertain the preliminary results of video narratives. RESULTS The recruitment rate was 60 out of 117 patients (51.3%). Nevertheless, the dropout rate of 10% was within the acceptable range. Patients were aged between 21 and 74 years. Nearly 50 of the patients (>85%) had adequate health literacy and exposure to stroke education. Most of the patients (>80%) were diagnosed with ischemic stroke, whereby the majority had primary hypertension. The technicalities of randomization and patient approach were carried out with minimal challenge and adequate patient satisfaction. The video contents received good responses with respect to comprehension and simplicity. Moreover, an in-depth phone interview with 8 patients indicated that the video narratives were considered to be useful and inspiring. These findings paralleled the preliminary findings of significant improvement within groups in MUSE (P=.001) and systolic blood pressure control (P=.04). CONCLUSIONS The queries and feedback from each phase in this study have been acknowledged and will be taken forward in the full trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN 12618000174280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373554.
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Affiliation(s)
- Jamuna Rani Appalasamy
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Joyce Pauline Joseph
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | | | - Anuar Zaini Md Zain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kyi Kyi Tha
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Abstract
Elderly patients are the main users of drugs and they differ from younger patients. They are a heterogeneous population that cannot be defined only by age but should rather be stratified based on their frailty. The elderly have distinctive pharmacokinetic and pharmacodynamic characteristics, are frequently polymorbid, and are therefore treated with multiple drugs. They may experience adverse reactions that are difficult to recognize, since some of them present non-specific symptoms easily mistaken for geriatric conditions. Paradoxically, the elderly are underrepresented in clinical trials, especially the frail individuals whose pharmacological response and expected treatment outcome can be different from those of non-frail patients. This means that the benefit-risk balance of drugs used in frail elderly patients is frequently unknown. We present some proposals to overcome the barriers preventing the enrollment of frail elderly patients in clinical trials, and strategies for monitoring their therapy to minimize the risk of adverse reactions. Automated alerts for drug and drug-disease interactions could help appropriate prescribing but should flag only clinically relevant interactions. Pharmaceutical forms should be designed to allow easy dose adjustment and, together with packaging and labeling, should account for the physical and cognitive limitations of frail elderly patients. Aggregate pharmacovigilance reports should summarize the safety profile in the elderly, but rather than presenting the results by age they should focus on patients' frailty, perhaps using the number of comorbidities as a proxy when information on frailty is not available.
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Jean YK, Gitlin MC, Reynolds J, Candiotti KA. Tramadol-associated hallucinations: a systematic review and narrative synthesis of their pathophysiology, diagnosis, and treatment. Can J Anaesth 2020; 67:360-368. [PMID: 31845292 DOI: 10.1007/s12630-019-01548-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 09/28/2019] [Accepted: 10/02/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent prescribing trends reflect government-led efforts undertaken in both the U.S. and Canada to decrease opioid use. These provisions reflect a reduction in the use of many potent opioids in favour of tramadol. Despite the purported benefits of tramadol over other opioids, little remains known about tramadol-associated hallucinations (TAH). METHODS We conducted a systematic literature search in Embase, Medline, Cochrane CENTRAL, CINAHL, PubMed, Scopus, PAHO Virtual Health Library, MedNar, and ClinicalTrials.gov to find reported cases of hallucinations associated with the use of tramadol. For all corresponding cases reporting hallucinations secondary to tramadol use, we extracted data on patient demographics, medical management, and the details on hallucinations. Cases were categorized as "probable TAH" if the evidence supported an association between hallucinations and tramadol use, or "possible TAH" if hallucinations were attributed to tramadol use but the supporting evidence was weak. The "probable TAH" cases were further classified as "isolated TAH" if hallucinations were the primary complaint, or "other existing medical condition" if concurrent signs and symptoms alluded to a diagnosis of an existing medical condition. We then conducted a narrative synthesis of the available literature to contextualize these results. RESULTS A total of 941 articles were identified in the initial search. No observational studies or randomized clinical trials were identified with our systematic review; only case reports were found. After a thorough screening, 34 articles comprising 101 patients reported an association between tramadol use and hallucinations. Among these 101 cases, 31 were "probable TAH" and 70 were "possible TAH". Of the 31 cases of "probable TAH", 16 cases were "isolated TAH" while the remaining 15 cases belonged to "other existing medical condition". CONCLUSIONS Tramadol-associated hallucinations can result in auditory or visual disturbances, although multisensory symptoms have also been reported. The mechanism underlying TAH remains poorly understood and likely involves numerous receptor types. The relative risk of hallucinations from tramadol compared with other opioids remains unclear.
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Affiliation(s)
- Yuel-Kai Jean
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL, 33136, USA
| | - Melvin C Gitlin
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL, 33136, USA.
| | - John Reynolds
- Department of Health Informatics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keith A Candiotti
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL, 33136, USA
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McCarthy DM, Curtis LM, Courtney DM, Cameron KA, Lank PM, Kim HS, Opsasnick LA, Lyden AE, Gravenor SJ, Russell AM, Eifler MR, Hur SI, Rowland ME, Walton SM, Montague E, Kim KYA, Wolf MS. A Multifaceted Intervention to Improve Patient Knowledge and Safe Use of Opioids: Results of the ED EMC 2 Randomized Controlled Trial. Acad Emerg Med 2019; 26:1311-1325. [PMID: 31742823 DOI: 10.1111/acem.13860] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Despite increased focus on opioid prescribing, little is known about the influence of prescription opioid medication information given to patients in the emergency department (ED). The study objective was to evaluate the effect of an Electronic Medication Complete Communication (EMC2 ) Opioid Strategy on patients' safe use of opioids and knowledge about opioids. METHODS This was a three-arm prospective, randomized controlled pragmatic trial with randomization occurring at the physician level. Consecutive discharged patients at an urban academic ED (>88,000 visits) with new hydrocodone-acetaminophen prescriptions received one of three care pathways: 1) usual care, 2) EMC2 intervention, or 3) EMC2 + short message service (SMS) text messaging. The ED EMC2 intervention triggered two patient-facing educational tools (MedSheet, literacy-appropriate prescription wording [Take-Wait-Stop]) and three provider-facing reminders to counsel (directed to ED physician, dispensing pharmacist, follow-up physician). Patients in the EMC2 + SMS arm additionally received one text message/day for 1 week. Follow-up at 1 to 2 weeks assessed "demonstrated safe use" (primary outcome). Secondary outcomes including patient knowledge and actual safe use (via medication diaries) were assessed 2 to 4 days and 1 month following enrollment. RESULTS Among the 652 enrolled, 343 completed follow-up (57% women; mean ± SD age = 42 ± 14.0 years). Demonstrated safe opioid use occurred more often in the EMC2 group (adjusted odds ratio [aOR] = 2.46, 95% confidence interval [CI] = 1.19 to 5.06), but not the EMC2 + SMS group (aOR = 1.87, 95% CI = 0.90 to 3.90) compared with usual care. Neither intervention arm improved medication safe use as measured by medication diary data. Medication knowledge, measured by a 10-point composite knowledge score, was greater in the EMC2 + SMS group (β = 0.57, 95% CI = 0.09 to 1.06) than usual care. CONCLUSIONS The study found that the EMC2 tools improved demonstrated safe dosing, but these benefits did not translate into actual use based on medication dairies. The text-messaging intervention did result in improved patient knowledge.
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Affiliation(s)
| | - Laura M Curtis
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | - D Mark Courtney
- Department of Emergency Medicine, Northwestern University, Chicago, IL
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Patrick M Lank
- Department of Emergency Medicine, Northwestern University, Chicago, IL
| | - Howard S Kim
- Department of Emergency Medicine, Northwestern University, Chicago, IL
| | - Lauren A Opsasnick
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | - Abbie E Lyden
- College of Pharmacy, Rosalind Franklin School of Medicine and Science, Chicago, IL
| | | | - Andrea M Russell
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | - Morgan R Eifler
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | - Scott I Hur
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | - Megan E Rowland
- Department of Emergency Medicine, Northwestern University, Chicago, IL
| | - Surrey M Walton
- Department of Pharmacy Administration, University of Illinois at Chicago, Chicago, IL
| | - Enid Montague
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
- School of Computing, DePaul University, Chicago, IL
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
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Bailey SC, Opsasnick LA, Curtis LM, Federman AD, Benavente JY, O'Conor R, Wolf MS. Longitudinal Investigation of Older Adults' Ability to Self-Manage Complex Drug Regimens. J Am Geriatr Soc 2019; 68:569-575. [PMID: 31765007 DOI: 10.1111/jgs.16255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self-management. DESIGN Longitudinal cohort study funded by the National Institute on Aging. SETTING One academic internal medicine clinic and six community health centers. PARTICIPANTS Beginning in 2008, 900 English-speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4). MEASUREMENTS At T1, subjects were given a standardized, seven-drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini-Mental State Examination. RESULTS Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0-21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1-18 errors; P < .001) at T4. In a multivariate model, limited literacy (β = .69; 95% confidence interval [CI] = .18-1.20; P = .01), meaningful cognitive decline (β = 1.72; 95% CI = .70-2.74; P = .01), number of chronic conditions (β = .21; 95% CI = .07-.34; P = .01), and number of baseline dosing errors (β = -.76; 95% CI = -.85 to -.67; P < .001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1. CONCLUSIONS Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow-up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors. J Am Geriatr Soc 68:569-575, 2020.
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Affiliation(s)
- Stacy Cooper Bailey
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren A Opsasnick
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Laura M Curtis
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julia Y Benavente
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachel O'Conor
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Fronteau C, Paré M, Benoit P, Tollec S, Hamon C, Schwiertz V, Maillard C, Cransac A, Volteau C, Huon JF, Burgeot V, Tching-Sin M, Guérin C, Flet L. What do adult outpatients included in clinical trials know about the investigational drugs being assessed: A cross-sectional study in France. PLoS One 2019; 14:e0220383. [PMID: 31408456 PMCID: PMC6692008 DOI: 10.1371/journal.pone.0220383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 07/15/2019] [Indexed: 11/18/2022] Open
Abstract
This study aimed to assess patient investigational medication knowledge and to identify factors associated with medication understanding by adult outpatients included in clinical trials. A cross-sectional prospectively designed survey was conducted on consecutive volunteers at 21 university teaching hospitals (in France) from February to December 2014. Investigational medication understanding was assessed at the time of the first dispensing using a structured interviewer-administered questionnaire based on information obtained from the literature that provided an 8-point score. Demographic and other baseline data were collected using structured interviews. Of the 236 participants, 139 (58.9%) of the respondents were male, and the median age was 54.9 years (range: 18–83 years). The mean understanding score was 6.24 and 72.5% of the patients had a score of 6 or higher. In univariate analysis, the medication understanding score was negatively correlated with age (r = -0.15, p = 0.0247) and positively correlated with the level of education (r = 0.25, p = 0.0002). In multivariate analysis, prognostic factors of a higher medication understanding score were: graduation from high school or a higher level of education; HIV infection; phase II/III/IV studies; mention of the drug on the prescription form, and the dispensing of a single investigational medication. Only a quarter of the adult outpatients included in clinical trials had a maximum possible investigational medication understanding score. Being old and having a low level of education were found to be important risk factors for inadequate medication understanding. This and other data suggest that sponsors should encourage initiatives aimed at improving investigational medication understanding in adults enrolled in clinical trials.
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Affiliation(s)
| | - Maxime Paré
- Department of Pharmacy, Nantes University Hospital, Nantes, France
| | - Philippe Benoit
- Department of Pharmacy, Reims University Hospital, Reims, France
| | - Sophie Tollec
- Department of Pharmacy, Orléans Regional Hospital, Orléans, France
| | - Catherine Hamon
- Department of Pharmacy, Rennes University Hospital, Rennes, France
| | | | | | - Amélie Cransac
- Department of Pharmacy, Dijon University Hospital and LNC-UMR1231, Dijon, France
| | | | - Jean-François Huon
- Department of Pharmacy, Nantes University Hospital, Nantes, France.,EA3826 Laboratory, Nantes University; UFR des Sciences Pharmaceutiques, Nantes University, Nantes, France
| | | | | | - Corinne Guérin
- Department of Pharmacy, AP-HP Cochin Hospital, Paris, France
| | - Laurent Flet
- Department of Pharmacy, Nantes University Hospital, Nantes, France
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Boon H, Bozinovski N. A Systematic Narrative Review of the Evidence for Labeling of Natural Health Products and Dietary Supplements. J Altern Complement Med 2019; 25:777-788. [DOI: 10.1089/acm.2018.0533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Send AFJ, Bittmann JA, Dyckhoff G, Haefeli WE, Seidling HM. What do laypeople consider 'medication' and are they aware of modulators of a drug's effects? Eur J Hosp Pharm 2019; 25:218-221. [PMID: 31157024 DOI: 10.1136/ejhpharm-2016-001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 11/04/2022] Open
Abstract
Objectives Healthcare providers expect patients to be responsible partners during drug treatment, who know potential risks impeding drug effects and are able to accurately report prescribed and non-prescribed medication. This presumes that they have the same understanding of the term 'medication' as healthcare providers. We assessed which products laypeople label as medication and which modulators of drug effects they know. Methods People visiting the otorhinolaryngology outpatient clinic at a university hospital were invited to anonymously complete a questionnaire assessing which products out of 23 listed examples are medications and valuing 12 modulators potentially influencing drug effects. Results Among 94 participants, 86 (91.5%) identified on average 14.4±3.3 (62.6%) of the products and 79 (84.0%) identified 6.7±2.0 (55.5%) of the modulators correctly. Women performed better than men (p<0.01). Regular medication intake, education level and age did not influence the results. Conclusions Laypeople are at risk of misclassifying medications and modulators of drug effects.
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Affiliation(s)
- Alexander F J Send
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
| | - Janina A Bittmann
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Dyckhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
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Pizzol TDSD, Moraes CG, Arrais PSD, Bertoldi AD, Ramos LR, Farias MR, Oliveira MA, Tavares NUL, Luiza VL, Mengue SS. Medicine package inserts from the users' perspective: are they read and understood? REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190009. [PMID: 30892472 DOI: 10.1590/1980-549720190009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/01/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The written information on medicines has been acknowledged as an important tool for health education. OBJECTIVE To analyze the use and understanding of medicine package inserts by users and assess sociodemographic and medical factors associated with their comprehension. METHOD Data in this analysis are part of the PNAUM National Survey - a cross-sectional population-based study conducted in Brazil. Descriptive statistics and the Pearson χ2 tests were performed to compare proportions between sociodemographic and medical characteristics, as well as use and understanding of medicine package inserts. RESULTS A total of 28.427 individuals responded to questions related to medicine package inserts. From these, 59.6% (95%CI 57.7 - 61.5) said they usually read the inserts, and 98.4% (95%CI 98.0 - 98.8) considered them necessary. Among people who read the medicine package inserts, more than half indicated difficulties with legibility (57.4%; 95%CI 55,2 - 59,6) and readability (54.1%; 95%CI 52.1 - 56.1). People from a lower education level reported greater difficulty in understanding them. CONCLUSION The larger portion of the population usually read medicine package inserts. Nevertheless, people have difficulty in reading and understanding them.
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Affiliation(s)
- Tatiane da Silva Dal Pizzol
- Medicines Production and Control Department, Pharmacy College and Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul - Porto Alegre, RS, Brazil
| | | | - Paulo Sérgio Dourado Arrais
- Pharmacy Department, Pharmacy, Odontology and Nursering College, Universidade Federal do Ceará - Fortaleza,CE, Brazil
| | - Andréa Dâmaso Bertoldi
- Social Medicine Department. Medicine College, Universidade Federal de Pelotas - Pelotas, RS, Brazil
| | - Luiz Roberto Ramos
- Preventive Medicine Department, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo, SP, Brazil
| | - Mareni Rocha Farias
- Pharmaceutical Sciences Department, Health Sciences Center, Universidade Federal de Santa Catarina - Florianópolis, SC, Brazil
| | | | | | - Vera Lucia Luiza
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz - Rio de Janeiro, RJ, Brazil
| | - Sotero Serrate Mengue
- Post Graduate Program in Epidemiology of Universidade Federal do Rio Grande do Sul - Porto Alegre, RS, Brazil
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48
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Leung AYM, Leung ISH, Liu JYW, Ting S, Lo S. Improving health literacy and medication compliance through comic books: a quasi-experimental study of Chinese community-dwelling older adults. Glob Health Promot 2018. [DOI: 10.1177/1757975918798364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: This study aims to investigate the effect of two interventions (verbal advice and comic books) on health literacy and medication compliance among older adults living in 15 public estates in Hong Kong. Methods: This is a two-phase multi-site quasi-experimental study with a pre-and-post design with four measurement points (T1–T4). In both phases, the two interventions were conducted by trained medical/nursing/pharmacy students. Two home visits were carried out in each phase. After the baseline measurement at Time 1 (T1), students verbally advised the older adult participants on how to read, understand, and interpret information on drug labels and how to store drugs properly. A post-assessment was conducted at T2. One year later, another pre-assessment was conducted at T3, and then students used a comic book to educate the older adults. A post-assessment was carried out at T4 after the use of the comic book. Health literacy was measured using the 24-item Chinese Health Literacy Scale for Chronic Care and medication compliance was measured using the Medication Compliance, Knowledge and Storage scale. Generalised Linear Mixed Models were used. Results: A total of 165 subjects were included. The majority (60.6%) were female, aged from 67 to 96. About half (47.3%) had received no formal education. Controlling for age and cognition, there was a significant increase in health literacy after the use of the comic book (coefficient = 2.742, p = 0.001). There was also a significant improvement in medication compliance (total score) (coefficient = −1.018, p < 0.001), reduced knowledge deficiency (coefficient = −0.236, p < 0.05), and reduced storage problems (coefficient = −0.293, p = 0.001) after using comic books. Conclusion: Comic books are a good strategy to improve the health literacy level and medication compliance of community-dwelling older adults.
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Affiliation(s)
- Angela Y. M. Leung
- Centre for Gerontological Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Isaac S. H. Leung
- Centre for Gerontological Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Justina Y. W. Liu
- Centre for Gerontological Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Sylvia Ting
- Centre for Gerontological Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Integrated Health Clinic, The Hong Kong Polytechnic University, Hong Kong, China
| | - Selina Lo
- Hong Kong Housing Society, Hong Kong, China
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Gleason LJ, Escue ED, Hogan TM. Older Adult Emergency Department Pain Management Strategies. Clin Geriatr Med 2018; 34:491-504. [PMID: 30031429 DOI: 10.1016/j.cger.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Older adults frequently present to the emergency department (ED) with pain, which is often underrecognized and undertreated. There is high variability of pain management and prescribing practices by ED providers. This article focuses on treatment of older adults in the ED who present with pain and addresses special considerations for this population. Social supports and follow-up must be considered in discharge treatment recommendations.
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Affiliation(s)
- Lauren J Gleason
- Section of Geriatrics and Palliative Medicine, 5841 South Maryland Avenue, MC6098, Chicago, IL 60637, USA
| | - Emily D Escue
- Section of Geriatrics and Palliative Medicine, 5841 South Maryland Avenue, MC6098, Chicago, IL 60637, USA
| | - Teresita M Hogan
- Section of Geriatrics and Palliative Medicine, 5841 South Maryland Avenue, MC6098, Chicago, IL 60637, USA; Section of Emergency Medicine, L-550A (MC 5068), 5841 S, Maryland Avenue, Chicago, IL 60637, USA.
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50
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Samaranayake NR, Bandara WG, Manchanayake CM. A narrative review on do's and don'ts in prescription label writing - lessons for pharmacists. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:53-66. [PMID: 29942789 PMCID: PMC6005331 DOI: 10.2147/iprp.s163968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Providing medicines information is a key role of a pharmacist. Miscommunication between pharmacist and patient may lead to adverse drug events or therapeutic failure. The aim of the review was to summarize the available research findings on factors that lead to poor communication between pharmacist and patient when providing written medicines information on dispensing and auxiliary labels and identify successful interventional approaches that help to alleviate these concerns. We selected articles available on PubMed, SAGE, and Google Scholar databases that are relevant to our objective. A total of 33 articles that matched the objectives of this review were retrieved and evaluated by all three authors. It was found that patient literacy levels, number of medicines dispensed, format and organization of the label, complexity of dosing instructions, precision of writing dosing instructions and use of icons, graphics and pictograms were aspects that were frequently used, and hence assessed by research groups on medicine label writing. Most studies reported that simple and straight forward instructions written legibly were better comprehended by patients. Based on our findings, we provide here useful tips for pharmacists on writing dosing instructions for patients. Finally, we spotlight crucial research gaps related to communicating written dosing instructions that need to be addressed in the future.
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Affiliation(s)
- Nithushi R Samaranayake
- Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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