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Lehnbom EC, Berbakov ME, Hoffins EL, Moon J, Welch L, Chui MA. Elevating Safe Use of Over-The-Counter Medications in Older Adults: A Narrative Review of Pharmacy Involved Interventions and Recommendations for Improvement. Drugs Aging 2023:10.1007/s40266-023-01041-5. [PMID: 37340207 DOI: 10.1007/s40266-023-01041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
Over-the-counter (OTC) medications are products that have been made easily accessible to allow patients to treat common ailments without a prescription and the cost of a doctor's visit. These medications are generally considered safe; however, there is still a potential for these medications to lead to adverse health outcomes. Older adults (ages 50+) are especially susceptible to these adverse health outcomes, due to age-related physiological changes, a higher prevalence of comorbidities, and prescription medication use. Many OTC medications are sold in pharmacies, which provides pharmacists and technicians with the opportunity to help guide safe selection and use for these medications. Therefore, community pharmacies are the ideal setting for OTC medication safety interventions. This narrative review summarizes the findings of pharmacy-involved interventions that promote safe OTC medication use for older adults.
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Affiliation(s)
- Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Maria E Berbakov
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Emily L Hoffins
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Jukrin Moon
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Lauren Welch
- William S. Middleton VA Geriatrics Research Education & Clinical Center, Madison, WI, USA
| | - Michelle A Chui
- Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
- Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
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Using change detection to objectively evaluate whether novel over-the-counter drug labels can increase attention to critical health information among older adults. COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2021; 6:40. [PMID: 34041617 PMCID: PMC8153101 DOI: 10.1186/s41235-021-00307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022]
Abstract
Over-the-counter (OTC) drugs have many benefits but also carry risks, such as adverse drug reactions, which are more prevalent in older adults. Because these products do not require the oversight of a physician or pharmacist, labeling plays a key role in communicating information required for their safe and effective use. Research suggests that current labels are not terribly effective at communicating potential risk. One reason for their lack of effectiveness is that few consumers attend to critical information (active ingredients and warnings) when making purchases. In two experiments, we used a change detection task to objectively evaluate how novel label designs that employ highlighting and a warning label placed on the package’s front impact attention to critical information among older participants (65 and older). The change detection task is a unique form of visual search which allowed us to assess the attentional priority of critical information among participants who were not explicitly instructed to search for this critical information. This unique aspect of the task is important given research suggesting that consumers rarely have the explicit goal of seeking out warnings and active ingredients when making OTC selections. Our results provide empirical support that both highlighting critical information and positioning it on the package’s front increase its attentional prioritization relative to current, commercial practice. Given that attending to the critical information is prerequisite to utilizing that information, strategies that elicit attention in this way are likely to reduce medication errors.
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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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Tong V, Raynor DK, Aslani P. Comparative User Testing of Australian and UK Over-the-Counter Labels and Leaflets for Diclofenac. Ther Innov Regul Sci 2018; 52:38-48. [DOI: 10.1177/2168479017711730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Page AT, Cross AJ, Elliott RA, Pond D, Dooley M, Beanland C, Etherton-Beer CD. Integrate healthcare to provide multidisciplinary consumer-centred medication management: report from a working group formed from the National Stakeholders’ Meeting for the Quality Use of Medicines to Optimise Ageing in Older Australians. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amy T. Page
- Western Australia Centre for Health and Ageing; University of Western Australia; Crawley Australia
| | - Amanda J. Cross
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne Australia
| | - Rohan A. Elliott
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne Australia
- Pharmacy Department; Austin Health; Melbourne Australia
| | - Dimity Pond
- University of Newcastle; Newcastle Australia
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Tong V, Raynor DK, Aslani P. Developing alternative over-the-counter medicine label formats: How do they compare when evaluated by consumers? Res Social Adm Pharm 2018; 14:248-261. [DOI: 10.1016/j.sapharm.2017.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/14/2017] [Accepted: 03/08/2017] [Indexed: 10/20/2022]
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Merks P, Świeczkowski D, Balcerzak M, Drelich E, Białoszewska K, Cwalina N, Krysinski J, Jaguszewski M, Pouliot A, Vaillancourt R. The evaluation of pharmaceutical pictograms among elderly patients in community pharmacy settings - a multicenter pilot study. Patient Prefer Adherence 2018; 12:257-266. [PMID: 29497281 PMCID: PMC5818874 DOI: 10.2147/ppa.s150113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The search for new ways to optimize the use of medications by patients has led the pharmaceutical community to promote the idea of introducing pictograms into routine practice. The main intention of pictograms is to ease patient adherence and to reduce potential risks or errors associated with the use of medications. PURPOSE To evaluate a series of pharmaceutical pictograms for patient comprehension. PATIENTS AND METHODS The study was conducted in community pharmacies within a European Union country that belongs to the professional research network. Structured interviews were used to evaluate the pictograms for patient comprehension. This consisted of an assessment of the following: the transparency and translucency of the pictograms, health literacy, and pictogram recall. Participants were also given the opportunity to provide feedback on how to improve the pictograms. The primary endpoint was pictogram comprehension. Secondary outcomes included recall of the pictograms and pictogram translucency. RESULTS The study included 68 patients with whom face-to-face interviews were performed. Low transparency results (≤25%) and extensive patient feedback in initial interviews led to the withdrawal of certain pictograms (n=15) from the evaluation. Among the pictograms included in the final stage of our research, 22 pictograms (62.8%) obtained an acceptable transparency level ≥66%. All pictograms passed the short-term recall test with positive results. CONCLUSION A majority of the designed and modified pictograms reached satisfactory guess-ability scores. Feedback from patients enabled modification of the pictograms and proved that patients have an important voice in the discussion regarding the design of additional pictograms.
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Affiliation(s)
- Piotr Merks
- Department of Pharmaceutical Technology, Collegium Medicum in Bydgoszcz, Nicolaus University in Torun, Bydgoszcz-Torun, Poland
- Piktorex Sp. z.o.o., Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
- Correspondence: Damian Świeczkowski; Miłosz Jaguszewski, First Department of Cardiology, Medical University of Gdansk, Dębinki 7, 80-952 Gdansk, Poland, Tel +48 73 202 2498, Email ;
| | | | | | | | - Natalia Cwalina
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Jerzy Krysinski
- Department of Pharmaceutical Technology, Collegium Medicum in Bydgoszcz, Nicolaus University in Torun, Bydgoszcz-Torun, Poland
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
- Correspondence: Damian Świeczkowski; Miłosz Jaguszewski, First Department of Cardiology, Medical University of Gdansk, Dębinki 7, 80-952 Gdansk, Poland, Tel +48 73 202 2498, Email ;
| | - Annie Pouliot
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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Tong V, Raynor DK, Aslani P. Receipt and use of spoken and written over-the-counter medicine information: insights into Australian and UK consumers' experiences. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:129-137. [PMID: 28544204 DOI: 10.1111/ijpp.12382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/19/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore Australian and UK consumers' receipt and use of spoken and written medicine information and examine the role of leaflets for consumers of over-the-counter (OTC) medicines. METHODS Semistructured interviews were conducted with 37 Australian and 39 UK consumers to explore information received with their most recent OTC medicine purchase, and how information was used at different times post-purchase. Interviews were audio-recorded, transcribed verbatim and thematically analysed. KEY FINDINGS Similarities were evident between the key themes identified from Australian and UK consumers' experiences. Consumers infrequently sought spoken information and reported that pharmacy staff provided minimal spoken information for OTC medicines. Leaflets were not always received or wanted and had a less salient role as an information source for repeat OTC purchases. Consumers tended not to read OTC labels or leaflets. Product familiarity led to consumers tending not to seek information on labels or leaflets. When labels were consulted, directions for use were commonly read. However, OTC medicine information in general was infrequently revisited. CONCLUSIONS As familiarity is not an infallible proxy for safe and effective medication use, strategies to promote the value and use of these OTC medicine information sources are important and needed. Minimal spoken information provision coupled with limited written information use may adversely impact medication safety in self-management.
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Affiliation(s)
- Vivien Tong
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | | | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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Tong V, Raynor DK, Hamrosi KK, Acharya B, Panchal N, Aslani P. Consumer Opinions on Existing and Proposed Australian Over-the-Counter Medicine Labeling Strategies in Comparison With the Standardized US Drug Facts Label. Ther Innov Regul Sci 2016; 50:427-435. [DOI: 10.1177/2168479016628301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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