Effect of information organization on recall of medication instructions

A preliminary investigation of the interactions between UK and US community pharmacists and their prescription clients

Similar periods of time were spent recording pharmacist-client interactions in each of five pharmacies in North Carolina, United States, and South Wales, United Kingdom. All interactions involving prescription medicines were transcribed and analysed, 63 from the UK pharmacies and 60 from the US. The mean time spent by the US pharmacists counselling their clients (122.7 seconds) was almost twice as long as that spent by UK pharmacists (69.1 seconds). Pharmacists in the US offered significantly more items of information to their clients (11.2 items per interaction) than their UK counterparts (6.5 items per interaction). Although pharmacists from both countries asked their clients similar numbers of questions, UK pharmacists asked significantly more leading questions. Over 95 per cent of questions asked by pharmacists from both the UK and the US were the closed type. Although US pharmacists have been shown to offer more advice to their clients than those in the UK, the study did not assess the quality of advice given nor ascertain the opinion of those who received this advice.

Written information about individual medicines for consumers

BACKGROUND

Medicines are the most common intervention in most health services. As with all treatments, those taking medicines need sufficient information: to enable them to take and use the medicines effectively, to understand the potential harms and benefits, and to allow them to make an informed decision about taking them. Written medicines information, such as a leaflet or provided via the Internet, is an intervention that may meet these purposes.

OBJECTIVES

To assess the effects of providing written information about individual medicines on relevant patient outcomes (knowledge, attitudes, behaviours and health outcomes) in relation to prescribed and over-the-counter medicines.

SEARCH STRATEGY

We searched MEDLINE, EMBASE, CINAHL, The Cochrane Library, PsycINFO and other databases to March 2007. We handsearched five journals' tables of contents, and the reference lists of included studies, and contacted experts in the field.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of medicine users, comparing written medicines information with no written medicines information; or trials that compared two or more styles of written medicines information. We only included trials that measured a knowledge, attitudinal or behavioural outcome. There were no language restrictions.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data relating to the interventions, methods of the trials, and outcome measures; and reconciled differences by discussion. Heterogeneity of interventions and outcomes measured meant that data synthesis was not possible. The results are presented in narrative and tabular format.

MAIN RESULTS

We included 25 RCTs involving 4788 participants. Six of twelve trials showed that written information significantly improved knowledge about a medicine, compared with no written information. The inability to combine results means we cannot conclude whether written information was effective for increasing knowledge. The results for attitudinal and behavioural outcomes were mixed. No studies showed an adverse effect of medicines information.

AUTHORS' CONCLUSIONS

The combined evidence was not strong enough to say whether written medicines information is effective in changing knowledge, attitudes and behaviours related to medicine taking. There is some evidence that written information can improve knowledge. The trials were generally of poor quality, which reduces confidence in the results. Trials examining the effects of written information need to be better designed and use consistent and validated outcome measures. Trials should evaluate internet-based medicines information. It is imperative that written medicines information be based on best practice for its information design and content, which could improve its effectiveness in helping people to use medicines appropriately.

Audio-taping the oncology treatment consultation: a literature review

An increased amount of research has been conducted to evaluate interventions for improving the quality of communication between cancer patients and health care providers. One of these interventions involves providing patients with audiotapes of their consultations with oncologists. Given that effective patient-physician communication has been linked to beneficial health outcomes, an examination of studies that have evaluated the effects of audiotape provision appears warranted. This article provides a critical review of this literature. The audiotape intervention has been examined in uncontrolled studies and randomized trials, and the primary outcome variables have included psychological well-being, information recall, and patient satisfaction. The empirical literature is unclear as to the efficacy of providing patients with taped recordings of cancer consultations. Overall, the findings suggest that the majority of patients benefit from receiving the audiotape, but the utility of this intervention in improving patient-physician communication requires further examination. Replication studies and well-controlled experimental designs applied to a variety of health care providers in diverse oncology settings are needed to confirm the validity of the empirical findings to date, and to facilitate further development of interventions aimed at enhancing patient-physician communication.

Social pharmacology: unresolved critical issues

This article describes and analyzes decision-making by patients, physicians, and drug information providers about registered medical drugs. Based on a cognitive psychology perspective, cognitive variables (the individual's mediating system) are assumed to be critical factors determining both patient and physician behavior. The individual's psychological functioning is seen as a continuous reciprocal interaction between behavioral, cognitive, and environmental influences; i.e., an interactional paradigm is applied. The importance of research models including cognitive and situation variables to guide the search for appropriate research methods is stressed. An intensive research strategy with a small sample of respondents will often be necessary. Also, respondents should be asked to describe their reactions to specific medical situations. The drug information sender has to select a set of goals for disseminating information to patients. Among the goals most often selected are: message comprehension, receiver satisfaction, changes in knowledge, attitudes, and drug behavior, as well as health effects. More research is needed on how the patient's mediating system, the actual situation, and the perceived situation steer his search for the use of new drug information. A different set of factors influence the patient's decision to start a medicinal or drug treatment than the factors that influence his decision to continue a treatment. The latter factors include forgetfulness, misunderstandings, and the patient's interpretation of physiological signs. More cognitive-oriented research about drug compliance must be undertaken. In such studies the mediating systems of a group of patients could be considered before and after intervention. There are a great number of types of inappropriate (irrational) prescribing. However, a physician may prescribe rationally in one area but irrationally in another. Face-to-face education of physicians has been shown to be effective in reducing inappropriate prescribing in a number of studies. "Overprescribing" of benzodiazepine has been an issue of intensive professional debate during the last decades. The two groups who criticize and defend the existing use of benzodiazepines build their views on different assumptions about the interaction between mind and brain as well as making different value assumptions regarding the use of a psychotropic drug. There is a need for prescription studies where a cognitive and interactional perspective is combined with an information-processing and a normative perspective. The benzodiazepines dependency problem has provoked lively discussion among professionals and the general public. Long-term benzodiazepine use and personality disorders increase the risk of the patient becoming dependent. A great number of research models have been suggested for the analysis of prescription drug dependency and as guides to the treatment of dependency.(ABSTRACT TRUNCATED AT 400 WORDS)