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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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Comprehension of Pictograms Demonstrating the Risk of Medication Use During Pregnancy: A Systematic Review. Matern Child Health J 2022; 26:2318-2338. [PMID: 36152142 DOI: 10.1007/s10995-022-03549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study aimed to summarize the comprehension of a pictogram about the risk of medication use during pregnancy. METHODS A systematic review was performed using the PRISMA checklist of the PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycInfo, LILACS, Academic Search Premier, Scopus, and Web of Science databases, grey literature (Google Scholar and OpenAIRE), ClinicalTrials.gov website, and design journals and congresses. The search was performed since the database inception, without language or year of publication restrictions. RESULTS Twelve studies met the inclusion criteria for this review, 2 of which were randomized clinical trials. The pictograms and methods used varied widely among studies. The comprehension of the pregnancy pictograms had a complex communication outcome with a variation of 21-96%. CONCLUSIONS FOR PRACTICE The lack of a standard pictogram and uniform methods to evaluate the comprehension of the pregnancy pictogram made it challenging to reach a conclusion with the studies available to date on the safety and efficacy of the pregnancy pictogram to alert the risk of medication use.
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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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Prenatal consults with illustrated literature (PnCIL): a RCT studying visual aids during prenatal consults. J Perinatol 2020; 40:1154-1162. [PMID: 32514007 DOI: 10.1038/s41372-020-0709-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/12/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We hypothesize that addition of illustrated handouts during prenatal consultations decreases maternal anxiety and improves maternal knowledge. STUDY DESIGN Inpatient gravid women at 25 0/7-34 6/7 weeks gestation were randomized to Standard or Illustrated consults, verbal consults supplemented with a visual handout. Post consult surveys were administered assessing maternal anxiety and knowledge acquisition. RESULT We enrolled 82 women; 54 to Standard Consult, 28 to Illustrated Consult. Consult duration was the same across arms. Anxiety and knowledge were not impacted by the intervention overall. We found higher mean knowledge by 17% for consults ≥31 min (P = 0.006; 95% CI 0.67-3.82), and 13% in primigravids (P = 0.032; 95% CI 0.15-3.21) in the intervention arm. CONCLUSIONS Using illustrated handouts is feasible and does not increase duration of prenatal consults. It may improve knowledge acquisition in long consults and in primigravida women, although it does not impact anxiety and knowledge overall.
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Vaillancourt R, Giby CN, Murphy BP, Pouliot A, Trinneer A. Recall of Pharmaceutical Pictograms by Older Adults. Can J Hosp Pharm 2019; 72:446-454. [PMID: 31853145 PMCID: PMC6910848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Low health literacy and high medication burden in the older adult population are contributing factors to the misunderstanding of medication instructions, leading to an increased risk of poor adherence and adverse events in this group of patients. OBJECTIVE To evaluate the ability of older adults to recall the meaning of 13 pharmaceutical pictograms 4 weeks after receipt of feedback on pictogram meaning. METHODS Older adults (aged 65 or older) were recruited from one community pharmacy in Canada. One-on-one structured interviews were conducted to assess the comprehensibility of 13 pharmaceutical pictograms from the International Pharmaceutical Federation's database of pictograms. Each participant was then told the meaning of each pictogram. Recall was assessed 4 weeks later. RESULTS A total of 58 participants met the inclusion criteria and agreed to participate. The number of pictograms meeting the ISO threshold for comprehensibility of symbols increased from 10 at the initial comprehensibility assessment to 13 at the recall assessment. Analysis of demographic data showed no associations between initial comprehensibility of the pictograms and age, sex, education level, or number of medications taken. CONCLUSIONS The results of this study indicate that after being informed of the meaning of pharmaceutical pictograms, older adults were able to recall the pictogram meanings for at least 4 weeks.
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Affiliation(s)
- Régis Vaillancourt
- , OMM, CD, BPharm, PharmD, FCSHP, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Cindy N Giby
- , PharmD, is with Shoppers Drug Mart, Ottawa, Ontario
| | - Bradley P Murphy
- , BSc, PharmD, was, at the time this study was conducted, a student at the University of Waterloo, School of Pharmacy. He is now with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Annie Pouliot
- , PhD, was, at the time this study was conducted, with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Anne Trinneer
- , MA, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario
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Devkota R, Khan GM, Alam K, Sapkota B, Devkota D. Impacts of counseling on knowledge, attitude and practice of medication use during pregnancy. BMC Pregnancy Childbirth 2017; 17:131. [PMID: 28449651 PMCID: PMC5408448 DOI: 10.1186/s12884-017-1316-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background Counseling has a significant role in improving knowledge, attitude and practice outcomes of pregnant women towards medication use. Proper counseling thus could be beneficial to prevent any medication related misadventure during pregnancy. The present study was aimed to assess the knowledge, attitude and practice (KAP) of pregnant women towards their medications, to provide counseling regarding their understanding of medication use during pregnancy and evaluate the impacts of such counseling. Methods Pre- post interventional (counseling) study was conducted at Manipal Teaching Hospital, Nepal among pregnant women who presented with complication and were prescribed at least one medication. A total of 275 pregnant women were included in the study. A structured questionnaire was used to assess the knowledge, attitude and practice of pregnant women before and after counseling. The impacts of counseling were then evaluated using suitable statistical methods. Results Of the total participants 229 completed the post counseling survey. Majority of the participants were in the age group 20-24 (43.2%), primigravida (59.4%) and in third trimester (58.6%). Housewives comprised 61.1% of participants and majority had received a University degree (33.2%). The mean and median scores assessed before counseling showed that there was no significant difference in the KAP scores with respect to age, trimester and gravidity whereas KAP scores with respect to occupation and level of education were statistically significant. There was an increase in mean and median KAP scores after counseling and the impacts of counseling was found to be statistically significant (p = <0.001). Conclusion Counseling had a positive impact on knowledge, attitude and practice of pregnant women towards medication and thus it could be considered a suitable method to encourage safe medication during pregnancy. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1316-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - G M Khan
- Pokhara University, Kaski, Nepal
| | - Kadir Alam
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Deepa Devkota
- People's Dental College and Hospital, Kathmandu, Nepal
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Pharmacists and patients feedback on empirically designed prescription warning labels: a qualitative study. Int J Clin Pharm 2017; 39:187-195. [PMID: 28070688 DOI: 10.1007/s11096-016-0421-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
Background Recommendations call for the inclusion of both patient and provider input in the redesign of prescription labels. Pharmacist opinions on prescription warning labels are important because they are the health providers who would eventually distribute and explain the revised labels during medication counseling. They may be the first health provider to notice a patient's misunderstanding on how to safely use their prescription medications. Objectives To explore the perspectives of patients and pharmacists on five newly designed PWLs, and examine if there were similarities and differences between patients' and pharmacists' perspectives. Setting Private room in Wisconsin. Methods A descriptive study using semi-structured 60-min face-to-face individual interviews with patients and pharmacists explored patients and pharmacists' feedback on five newly designed PWLs. Patients who were 18 years and older, spoke English, and took a prescription medication and pharmacists who filled prescriptions in an ambulatory setting participated in the study. The patient and pharmacist perspectives on the words (content), picture and color (cosmetic appearance), and placement of warning instructions on the pill bottle (convenience) was based on a label redesign framework. Qualitative content analysis was done. Main outcome measure Patient and pharmacist perspectives on the newly designed PWLs. Results Twenty-one patients and eight pharmacists practicing in an academic medical center outpatient setting (n = 5) or retail pharmacy (n = 3) participated. All patients and pharmacists wanted the PWLs positioned on the front of the pill bottle but not the side of the bottle or warning instructions embedded into the main prescription label. Other similarities included participants preferring: (1) pictures closely depicting the instructions and (2) the use of yellow highlighting on the PWL to draw attention to it. There were differences in patient and pharmacist perspectives regarding the addition of 'Warning' to the instruction on the PWL with the patient preference to include the word 'Warning'. Pharmacists thought some PWL pictures had racial stereotypes, but this feedback was never mentioned by patients. Conclusions Patients and pharmacists had different preferences for PWL design changes to improve understandability. Pharmacist preferences did not always correspond with patient preferences. However, patients and pharmacists generally agreed on the preferred location of the PWL on the pill bottle and the use of color for drawing patients' attention.
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Albert BB, Vickers MH, Gray C, Reynolds CM, Segovia SA, Derraik JGB, Lewandowski PA, Garg ML, Cameron-Smith D, Hofman PL, Cutfield WS. Oxidized fish oil in rat pregnancy causes high newborn mortality and increases maternal insulin resistance. Am J Physiol Regul Integr Comp Physiol 2016; 311:R497-504. [DOI: 10.1152/ajpregu.00005.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/05/2016] [Indexed: 11/22/2022]
Abstract
Fish oil is commonly taken by pregnant women, and supplements sold at retail are often oxidized. Using a rat model, we aimed to assess the effects of supplementation with oxidized fish oil during pregnancy in mothers and offspring, focusing on newborn viability and maternal insulin sensitivity. Female rats were allocated to a control or high-fat diet and then mated. These rats were subsequently randomized to receive a daily gavage treatment of 1 ml of unoxidized fish oil, a highly oxidized fish oil, or control (water) throughout pregnancy. At birth, the gavage treatment was stopped, but the same maternal diets were fed ad libitum throughout lactation. Supplementation with oxidized fish oil during pregnancy had a marked adverse effect on newborn survival at day 2, leading to much greater odds of mortality than in the control (odds ratio 8.26) and unoxidized fish oil (odds ratio 13.70) groups. In addition, maternal intake of oxidized fish oil during pregnancy led to increased insulin resistance at the time of weaning (3 wks after exposure) compared with control dams (HOMA-IR 2.64 vs. 1.42; P = 0.044). These data show that the consumption of oxidized fish oil is harmful in rat pregnancy, with deleterious effects in both mothers and offspring.
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Affiliation(s)
| | - Mark H. Vickers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Clint Gray
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | | | - Paul A. Lewandowski
- School of Medicine and Centre for Molecular and Medical Research, Deakin University, Waurn Ponds, Victoria, Australia; and
| | - Manohar L. Garg
- Nutraceuticals Research Group, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | | | - Paul L. Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Kilfoyle KA, Vitko M, O'Conor R, Bailey SC. Health Literacy and Women's Reproductive Health: A Systematic Review. J Womens Health (Larchmt) 2016; 25:1237-1255. [PMID: 27564780 DOI: 10.1089/jwh.2016.5810] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health literacy is thought to impact women's reproductive health, yet no comprehensive systematic reviews have been conducted on the topic. Our objective was to systematically identify, investigate, and summarize research on the relationship between health literacy and women's reproductive health knowledge, behaviors, and outcomes. METHODS PRISMA guidelines were used to guide this review. English language, peer-reviewed research articles indexed in MEDLINE as of February 2015 were searched, along with study results posted on Clinicaltrials.gov . Articles were included if they (1) described original data-driven research conducted in developed countries, (2) were published in a peer-reviewed journal, (3) measured health literacy using a validated assessment, (4) reported on the relationship between health literacy and reproductive health outcomes, related knowledge, or behaviors, and (5) consisted of a study population that included reproductive age women. RESULTS A total of 34 articles met eligibility criteria and were included in this review. Data were abstracted from articles by two study authors using a standardized form. Abstracted data were then reviewed and summarized in table format. Overall, health literacy was associated with reproductive health knowledge across a spectrum of topics. It was also related to certain health behaviors, such as prenatal vitamin use and breastfeeding. Its relationship with other reproductive behaviors and outcomes remains unclear. CONCLUSIONS Health literacy plays an important role in reproductive knowledge and may impact behaviors and outcomes. While further research is necessary, healthcare providers should utilize health literacy best practices now to promote high-quality care for patients.
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Affiliation(s)
- Kimberly A Kilfoyle
- 1 Division of Women's Primary Health Care, Department of Obstetrics & Gynecology, University of North Carolina School of Medicine , Chapel Hill, North Carolina
| | - Michelle Vitko
- 2 Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina , Chapel Hill, North Carolina
| | - Rachel O'Conor
- 3 Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University , Chicago, Illinois
| | - Stacy Cooper Bailey
- 1 Division of Women's Primary Health Care, Department of Obstetrics & Gynecology, University of North Carolina School of Medicine , Chapel Hill, North Carolina
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An acetaminophen icon helps reduce medication decision errors in an experimental setting. J Am Pharm Assoc (2003) 2016; 56:495-503.e4. [PMID: 27475837 DOI: 10.1016/j.japh.2016.04.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/25/2016] [Accepted: 04/17/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the effect of adding an acetaminophen ingredient icon to acetaminophen medication labels on consumer decision making about concomitant use of acetaminophen medications to avoid overdose, which is associated with liver injury. DESIGN Parallel-group randomized study. SETTING Consumer research facilities in Indianapolis, Baltimore, and Los Angeles. PARTICIPANTS A total of 517 adults (30% with limited health literacy) recruited at 3 consumer research sites. INTERVENTION Participants were randomized to a non-icon condition in which medications carried current labeling or an icon condition in which all acetaminophen medications were additionally marked with an icon. MAIN OUTCOME MEASURES Participants were presented with a medicine cabinet containing 12 diverse prescription and non-prescription medications, one-half containing acetaminophen, and made decisions about which medications were appropriate to take after an acetaminophen medication had already been taken. Outcome measures were errors in medication decisions and response time. RESULTS The icon reduced the odds of participants making medication-decision errors by 53% (CI 31%-68%), with effects evident across medication categories. The icon eliminated a trend for those with lower health literacy or less education to have a greater likelihood of making errors. The icon also reduced response times, indicating reduced cognitive load for decisions. CONCLUSION An icon can improve decision making regarding acetaminophen-containing medications, particularly among individuals with limited health literacy or education.
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Shiyanbola OO, Smith PD, Mansukhani SG, Huang YM. Refining Prescription Warning Labels Using Patient Feedback: A Qualitative Study. PLoS One 2016; 11:e0156881. [PMID: 27258026 PMCID: PMC4892508 DOI: 10.1371/journal.pone.0156881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/21/2016] [Indexed: 11/19/2022] Open
Abstract
The complexity of written medication information hinders patients' understanding and leads to patient misuse of prescribed medications. Incorporating patient feedback in designing prescription warning labels (PWLs) is crucial in enhancing patient comprehension of medication warning instructions. This qualitative study explored patient feedback on five newly designed PWLs. In-depth semi-structured face-to-face interviews were conducted with 21 patients, who were 18 years and older, spoke English, and took a prescription medication. These patients were shown different variations of the five most commonly used PWLs-Take with Food, Do not Drink Alcohol, Take with a Full glass of Water, Do not Chew or Break, and Protect from Sunlight. The 60-minute interviews explored feedback on patient comprehension of the PWL instructions and their suggestions for improving the clarity of the PWLs. At the end of the interview, patient self-reported socio-demographic information was collected with a 3-minute survey and a brief health literacy assessment was completed using the Newest Vital Sign. Twenty-one patients completed the interviews. Most patients were female (n = 15, 71.4%) with ages ranging from 23 to 66 years old (mean: 47.6 ± 13.3). The mean health literacy score was 2.4 on a scale of 0-6. Qualitative content analysis based on the text, pictures, and placement of the PWLs on the pill bottle showed preferences for including 'WARNING' on the PWL to create alertness, inclusion of a picture together with the text, yellow color highlighting behind the text, and placement of the PWL on the front of the pill bottle. Although patients had positive opinions of the redesigned PWLs, patients wanted further improvements to the content and design of the PWLs for enhanced clarity and understandability.
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Affiliation(s)
- Olayinka O. Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Paul D. Smith
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Sonal Ghura Mansukhani
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, United States of America
| | - Yen-Ming Huang
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, United States of America
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Abstract
Chronic opioid therapy during pregnancy is perilous, but not simply because of neonatal effects: it is perilous because women are at particular risk for misprescription, misuse, dependence, overdose, and death. Opioids may be teratogens and should be avoided in the periconception period. Accidental childhood poisoning and purposeful teen experimentation are increased with opioid prescriptions in the home. Risks to pregnancy span the pre- and periconception period; neonatal risk following in utero opioid exposure is well documented. When the authors' patients request opioids for chronic pain, they care for them in a comprehensive and compassionate matter, which often will require therapeutic approaches other than chronic opioid therapy.
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Affiliation(s)
- Marjorie Meyer
- Fletcher Allen Health Care and the University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA.
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DiSantostefano RL, Beck M, Yeakey AM, Raphiou I, Stempel DA. Patient Comprehension of Medication Guides for Asthma and Chronic Obstructive Pulmonary Disease Medications. Ther Innov Regul Sci 2014; 48:574-582. [PMID: 30231444 DOI: 10.1177/2168479014524407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study assessed patients' comprehension of the Advair and Serevent medication guides (MGs) and MG reading behaviors with the goal to improve risk communication. METHODS After reading their assigned MGs, 452 adults with asthma or chronic obstructive pulmonary disease participated in structured interviews to assess comprehension of safety risks in the Advair MG (asthma, n = 150; chronic obstructive pulmonary disease, n = 153) and Serevent MG (asthma, n = 149). Generalized estimating equations for correlated binary data were used to identify factors associated with correct responses. RESULTS For 10 of 12 individual risk questions, ≥75% of patients reported correct responses. After adjusting for patient characteristics, health literacy was significantly associated with correct responses (odds ratio = 1.03, 95% confidence interval = 1.02-1.05 per 1-point increase in the Rapid Estimate of Adult Literacy in Medicine). MG reading behaviors were inconsistent, with many patients reading MGs only once (40%) despite multiple prescriptions. CONCLUSIONS Comprehension of safety risks in the Advair and Serevent MGs was adequate for most patients in the study but decreased with health literacy. Initiatives to improve patient-directed risk communication should consider health literacy and reasons for inconsistent reading behaviors.
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Affiliation(s)
| | - Melissa Beck
- 2 Regulated Healthcare Market Research, Concentrics Research, Indianapolis, IN, USA
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Pires CM, Cavaco AM. Exploring the perspectives of potential consumers and healthcare professionals on the readability of a package insert: a case study of an over-the-counter medicine. Eur J Clin Pharmacol 2014; 70:583-8. [PMID: 24458540 DOI: 10.1007/s00228-014-1645-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore and compare the opinions of physicians, pharmacists and potential users on the readability of a package insert of an over-the-counter medicine. METHODS Exploratory study based on the administration of a semi-open questionnaire. This instrument was developed according to the readability guideline of the European Medicine Agency (EMA) and used to evaluate participants' accessibility to, and comprehensibility of, the package insert for diclofenac 12.5 mg tablets. Sixty-three participants were recruited from the Lisbon region and enrolled in three groups: physicians (Dg), pharmacists (Pg) and potential consumers (PCg), with a minimum of 20 participants each. RESULTS Almost all (85 %) of the 20 PCg participants were educated above the 9th grade, although the majority of them (95 %) referred to, at least, one package insert interpretation issue, mainly related to the comprehension of technical terms. Amongst other differences between the groups, the Pg participants (n = 22) obtained a significantly less favourable opinion regarding the layout of the titles. Furthermore, the Pg and Dg (n = 21) participants proposed technical enhancements, such as the use of a table to explain the posology, precautions in case of renal failure, or the recommendation to take the tablets with meals. CONCLUSIONS Differences in the way of using the diclofenac tablets are expected, considering the comprehension dissimilarities between health professionals and potential consumers. The package insert of diclofenac 12.5 mg could be enhanced for safer use. Regarding the readability assessment of this package insert, the method proposed in the EMA guidelines might not be as effective as expected. Future research is advisable.
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Affiliation(s)
- Carla M Pires
- iMed.UL Research Institute for Medicines and Pharmaceutical Sciences, Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal,
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Koster ES, Blom L, Winters NA, van Hulten RP, Bouvy ML. Interpretation of drug label instructions: a study among four immigrants groups in the Netherlands. Int J Clin Pharm 2013; 36:274-81. [DOI: 10.1007/s11096-013-9873-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/23/2013] [Indexed: 11/24/2022]
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Brennan MC, Rayburn WF. Counseling about risks of congenital anomalies from prescription opioids. ACTA ACUST UNITED AC 2012; 94:620-5. [DOI: 10.1002/bdra.23064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 11/10/2022]
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You WB, Wolf MS, Bailey SC, Grobman WA. Improving patient understanding of preeclampsia: a randomized controlled trial. Am J Obstet Gynecol 2012; 206:431.e1-5. [PMID: 22542120 DOI: 10.1016/j.ajog.2012.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/22/2012] [Accepted: 03/09/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We developed a standardized educational tool to inform women about preeclampsia. The objective of this study was to assess whether exposure to this tool led to superior understanding of the syndrome. STUDY DESIGN This was a randomized controlled trial in which 120 women were assigned to (1) a newly developed preeclampsia educational tool, (2) a standard pamphlet addressing preeclampsia that had been created by the American College of Obstetricians and Gynecologists, or (3) no additional information. Preeclampsia knowledge was assessed with the use of a previously validated questionnaire. RESULTS There were no demographic differences among the groups. Patients who received the tool scored significantly better on the preeclampsia questionnaire than those who received the American College of Obstetricians and Gynecologists pamphlet or no additional information (71%, 63%, 49%, respectively; P < .05). This improved understanding was evident equally among women with and without adequate health literacy (interaction: P > .05). CONCLUSION Patients who were exposed to a graphics-based educational tool demonstrated superior preeclampsia-related knowledge, compared with those patients who were exposed to standard materials or no education.
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Affiliation(s)
- Whitney B You
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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