Comparative evaluation of patient information leaflets by pharmacists, doctors and the general public

Utility of medicines information leaflets in hypertensive care in a setting with low health literacy: A cross-sectional study

Introduction:

Higher levels of health literacy improve utilization of health information, medication adherence and outcomes. Few studies evaluate the utility of medicines information in hypertensive care in settings with low health literacy.

Aim:

To determine the level of health literacy and utility of medicines information leaflets (MILs) among hypertensive patients in public health care in Namibia.

Methods:

A hospital-based survey among hypertensive patients receiving care at a referral hospital in Namibia from the 8 June 2018 to 29 June 2018. Patient’s health literacy and utility of MIL were assessed using three literacy tools and a survey questionnaire. Quantitative data were analysed using descriptive statistics and qualitative thematic content analysis for factors associate with the utility of the MIL.

Results:

Of the 139 patients, 63% were female and the mean age was 45.7 (range: 19.0–84.0) years. Over 85.6% had of low literacy skills (Rapid Estimate of Literacy in Medicine (REALM) score <44, that is, unable to read simple health materials), 38.8% had positive Single Item Literacy Screener (SILS) scores (⩾2, require help to read medicines information) and 66.9% had inadequate skills for comprehension, appraisal and decision-making with regard to health information (Health Literacy Skills Instrument-Short Form (HLSI-SF) score <70%). The level of access to and utility of MIL were low, 32.4% and 34.6%, respectively. The main factors associated with poor utility of the MIL were low patient health literacy, lack of guidelines on the use of MIL and MIL written in non-native languages.

Conclusion:

Low rates of health literacy and utility of MIL were observed among hypertensive patients in Namibia. The integration of health literacy programmes, and MIL guidelines are needed to promote utility of medicine information and improve medication adherence.

Patients’ views of general practitioners’ provision of medicine information leaflets

ABSTRACT INTRODUCTIONGiving patients medicine information leaflets with oral information could help improve patient understanding about their medicines. Some health professionals believe patients do not want to receive leaflets or find them too difficult to understand so do not provide them. AIMTo investigate Dunedin general practitioners’ (GPs) provision of medicine information leaflets from patients’ reports and to examine patient views about the leaflets provided. METHODSPatients collecting prescriptions from community pharmacies in Dunedin, New Zealand, between December 2016 and February 2017 were asked to complete a survey. Responses were entered into SurveyMonkey and data were exported into Excel for analysis. RESULTSOf the 151 survey respondents, over three-quarters (79%) did not receive a medicine information leaflet from their GP in the last 6 months, although most believed it important to receive one. Many participants felt that leaflets improved their knowledge and helped them take their medication correctly. Most participants liked the leaflets they received, although over half (60%) would like a short summary leaflet. Patients did not commonly search for more information than their GP provided. DISCUSSIONSome patients may not seek further information about their medicines other than during consultation. Although rarely given, most participants who received leaflets from their GP appreciated them. Most participants read and understood leaflets they were provided, although ready access to a one- to two-page summary leaflet may be preferable. Technology could enable GPs to easily provide leaflets to patients in their care.

Readability and Comprehensibility of Patient Information Leaflets for Antidiabetic Medications in Qatar

Background:The readability and comprehensibility of the patient information leaflets (PILs) provided with antidiabetic medications are of questionable standards; this issue negatively affects adherence to drug therapy, especially in patients with limited literacy skills. Objective: To evaluate the readability and comprehensibility of PILs supplied with medications used for the treatment of type 2 diabetes mellitus in Qatar. Methods: All PILs of the antidiabetic medications in Qatar were evaluated using the Flesch Reading Ease (FRE) score for readability. The Flesch-Kincaid Grade Level, Gunning-Fog Index, and SMOG Grading were used to estimate the comprehensibility of PILs in terms of school grade levels. Results: A total of 45 PILs were evaluated: 32 (71.1%) PILs of brand-name products and 13 (28.9%) for generics. Nine (20%) of the PILs were in English only; 8 (17.8%) were in English, Arabic, and French; and 28 (62.2%) were in English and Arabic. The mean FRE score was 37.71 (±15.85), and the most readable PIL had FRE score of 62. The mean scores for the comprehensibility evaluations were 10.96 (±2.67), 15.02 (±2.52), and 11.41 (±1.6) for the Flesch-Kincaid Grade Level, Gunning-Fog Index, and SMOG Grading, respectively. The most commonly used antidiabetic medication was metformin with 1372.9 (±552.9) as PILs' mean number of words. Conclusion: Only 2.2% of PILs had acceptable readability scores. All PILs could be comprehended by at least an 11th grade student, which exceeds the recommended grade level for health-related materials. Approximately 20% of these PILs were in English only and were not readable by most patients.

It's for your benefit: exploring patients' opinions about the inclusion of textual and numerical benefit information in medicine leaflets

Objectives

To explore consumers' beliefs and preferences for benefit information in medicine leaflets and examine their understanding and reaction to treatment benefits.

Methods

Forty-five participants were recruited to eight focus groups, run concurrently in Australia (23 participants in four groups) and the UK (22 participants in four groups). Participants were provided with amended leaflets based on the medicine clopidogrel, containing textual and numerical benefit information presented using numbers needed to treat (NNT). A topic guide which explored use of leaflets, preferences and opinions was used to direct discussion. Focus group discussions were recorded, transcribed verbatim and content analysed using adapted cross-case study analysis.

Key findings

The consensus was that the inclusion of benefit information was a positive factor. Many participants felt that textual benefit information offered an incentive to take a medicine, although some Australian participants had concerns that included benefit information could create anxiety. The presentation of numerical benefit information provoked strong feelings of disbelief and shock. Participants were surprised that so few people would benefit. Some participants struggled to understand and interpret the NNT and others found it difficult to comprehend the magnitude of the benefit information, instead operating on initial and often crude assumptions of what the data meant. In both countries the provision of numerical benefit information appeared to shake participants' faith in drug treatments. Participants were concerned about how this might affect the ‘less-informed’ patient. However, in the UK, participants stated that their adherence to treatment was also reinforced by their doctor's advice.

Conclusions

Participants wanted to receive information about the benefits of their medicines. However, they may misinterpret the numerical information provided.

Consumer opinions on medicines information and factors affecting its use — an Australian experience

Background

Consumer Medicine Information (CMI) is brand-specific, written drug information produced by pharmaceutical companies and intended for consumers in Australia. The content of CMI is defined in legal regulations.

Objectives

This exploratory study investigated: (a) consumers' awareness, perceptions and modes of CMI use, (b) the impact of CMI on consumers, and (c) possible factors affecting CMI use.

Methods

Six focus groups (n=57 consumers) were conducted. Discussions were tape-recorded, transcribed verbatim and thematically analysed.

Setting

Metropolitan Sydney, New South Wales, Australia.

Key findings

Most participants were aware of written information about prescription medications but were unfamiliar with the term “CMI”. Few had experienced a health care professional providing or discussing CMI but most had read it and found it useful. There were many suggestions for improvements to the format and content of CMI to increase its “user-friendliness”. CMI had caused anxiety in some participants but increased awareness of their medications in others. Several factors appeared to increase the likelihood of CMI use: information-oriented coping mechanism, severe disease, internal locus of control, appropriate timing of information provision, and care-giver role. Conversely, difficulty in reading and understanding CMI, confidence in health care professionals and perceived “problem-free” therapies appeared to reduce CMI use.

Conclusions

Although consumers were aware of and read written drug information, there was limited interaction with a health professional when written information was provided.

Sources of drug information for patients with chronic conditions in Alexandria, Egypt

Objectives

This study sought to identify patients' perceived drug knowledge, need for more information and drug information sources, and how they varied by patient characteristics, particularly education level.

Methods

A convenience sample of 366 adult patients was interviewed when leaving 20 Egyptian pharmacies after collecting a dispensed prescription. Patients were asked about their (1) perceived knowledge of their drugs' purpose, (2) use of package inserts (PIs) to learn about side effects, contraindications and drug interactions, (3) perceived need to know more about their drugs and (4) general sources of drug information beyond healthcare providers.

Key findings

More than 30% of the patients reported that they did not know the purpose of at least one of their drugs and only read PIs selectively. Whereas 36% read about drug interactions, more reported reading about side effects (65%) and contraindications (60%) in PIs. Sixty-nine per cent of patients reported that they needed more information about their drugs. This was true for 86.8% of patients with limited education compared to 48.5% of university graduates. University graduates reported using PI topics, newspapers, internet, TV and family and friends as sources of drug information at significantly higher rates than did patients with lower levels of education.

Conclusion

There is a need for healthcare professionals to evaluate patient comprehension and needs for drug information, especially for patients with less schooling. Healthcare providers should also consider other information sources that a patient is using.

The benefits of providing benefit information in a patient information leaflet

Objective

To examine the effects of providing two different types of written information about medicine benefits in a patient information leaflet (PIL).

Setting

Participants were 358 adult volunteers from the general population recruited from a London railway station and central Reading.

Method

The study used a controlled empirical methodology in which people were given a hypothetical, but realistic, scenario about visiting their doctor and being prescribed medication. They then read an information leaflet about the medicine that contained neither, one, or both benefit statements, and finally completed a number of Likert rating scales. Outcome measures included perceived satisfaction and helpfulness of the information, effectiveness and appropriateness of the medicine, benefit and risk to health, and intention to comply.

Key findings

Both types of benefit information led to significantly higher ratings on all of the measures taken.

Conclusions

Provision of a relatively short ‘benefit’ statement can significantly improve people's judgements and intention to take a medicine. The findings are important and timely as the European Union is currently considering reviewing their regulations to allow for the inclusion of limited non-promotional benefit information in PILs.

Consumer use of the internet for medicines information

Objective

To explore consumer opinion of the internet as a source of medicines information, the reasons consumers use this information, and the impact of this information on their use of medicines.

Method

Focus groups (n=6) were conducted in metropolitan Sydney, Australia during March to May 2003 with consumers (n=46) who had used the internet for medicines information.

Key findings

Although participants expressed some concerns about the quality of internet-based medicines information (IBMI), the convenience of access to this information outweighed these reservations. Attitudes were thus positive overall. Participants used IBMI when preparing for doctors' visits, for second opinions and additional information, for information on current issues, when deciding whether to use a medicine, for comparative information on brands and generics, and when written information was not supplied by health professionals. Most participants felt empowered by the information they found and used it to play a more active role in decision making about their therapy.

Conclusion

This study describes various issues associated with consumer use of IBMI and highlights the possible role of pharmacists to support their patients' efforts to access and interpret medicines information.

Implementation of an Oral Care Protocol and Its Effects on Oral Mucositis

Oral complications are commonly seen in pediatric oncology patients. Induced by chemotherapy or radiation, oral mucositis is a debilitating side effect that has much clinical significance. Oral mucositis may decrease the effectiveness of treatment as well as decrease the quality of life in the pediatric oncology patient. Therefore, it is our responsibility as health care professionals to reduce the incidence and/or severity of mucositis as much as possible. One intervention that has been proven to be successful is basic oral hygiene implemented through an oral care protocol. It is important that nurses are educated on the significance of adequate dental hygiene and the process and need for institutional change of protocols. Nurses and other health care professionals can positively influence patient care by incorporating the evidence-based practice of an oral care protocol— improving consistency of care while promoting an intervention of proven benefit against oral mucositis.

Comparative analysis of patient package inserts of local and imported anti-infective agents in palestine

BACKGROUND AND OBJECTIVE

The patient package insert is an important source of drug information. The aim of this study was to evaluate and compare the PPI of the anti-infective agents manufactured in Palestine with the imported equivalents.

METHOD

The selection criteria generated 15 different anti-infective agents available as 36 locally manufactured products and 15 imported equivalents. The design of the patient package insert was evaluated in terms of the number of words used in eight main headings and the presence or absence of certain information regarding nine statements.

RESULTS

Inserts of locally manufactured products have significantly fewer words than those of imported products with respect to warnings, dosage and administration, and side effects. The most significant difference was found in the warnings. Moreover, differences were found between inserts of local and imported products in terms of the presence of the nine informative statements. Locally manufactured products did not mention inactive ingredients, clinical pharmacology or date of last revision, but all of them provided information on the use of the drug during pregnancy and lactation and on the duration of therapy. However, in general they provided less information than the imported equivalents.

CONCLUSION

Palestinian authorities and local manufacturers should implement appropriate measures to regulate the quality and quantity of information in the patient package insert of locally produced anti-infective agents. PPI improvement will better direct health practices to the benefit of the patients.

Depressed patients' preferences for education about medications by pharmacists in Kuwait

OBJECTIVE

To assess patients' opinion toward receiving written or specialized verbal pharmacists' interventions and to determine the effect of these interventions on patients' medication knowledge.

METHODS

150 newly diagnosed patients with unipolar depression and initiated with a single antidepressant were randomized into 3 groups: control, leaflet and counselling, and interviewed at initiation and after 6-8 weeks of treatment at the outpatient department of the Psychiatric Hospital in Kuwait.

RESULTS

50% of respondents asserted that clinicians did not give them sufficient information while 90% favoured the idea of receiving further information about therapy. Forty seven percent of participants failed to return for the second follow-up appointment. The drop-out rate was 66% in the control, 42% in the Leaflet and only 34% in the counselling groups (P=0.004). A broad support for receiving leaflets and drug counselling (97%) was found among attendees. Moreover, 94% of the counselling and 79% of the leaflets group affirmed that they received adequate information compared to 47% of the control (P=0.001). Counselling was found to be significantly associated with a much higher recall of medicine name (OR=9.6, P=0.01), how to manage missed doses (OR=8.9, P=0.007), and correct use of medication (OR=31.3, P<0.001). Leaflet use was less strongly associated than counselling and was statistically significant for recall regarding correct use of medication (OR=8.4, P=0.009).

CONCLUSION

Pharmacists in a psychiatric institution can play an important role in satisfying patient demands for specialized information about their medications. Patients with depression appear very eager to receive additional drug information with modest difference between the written and the verbal counselling interventions. Patients looked at the two interventions in a very positive manner and no difference was observed between patients in the leaflets and in the counselling group with regards to how helpful, sufficient, supportive and reassuring was the educational material. However, both interventions were more informative than the control in conveying elemental drug information to patients.

PRACTICE IMPLICATIONS

In contrast with the lack of enthusiasm that some clinicians express, the affirmativeness that was expressed by patients towards receiving written or verbal specialized educational interventions by pharmacists may support the psychiatric hospital pharmacists' stands in providing them for all patients which may aid in improving patients compliance and probably treatment outcome.

Changes in attitudes among Japanese patients after Pharmacist Law revision

OBJECTIVE

To assess changes in patients' perception of their medications and their adherence to regimens after enactment of the Japanese Pharmacist Law revision of 1997, which stipulated provision of drug information to patients as one of the principal duties of pharmacists. Setting A university hospital in Japan.

METHOD

Comparison of cross sectional analyses between two time periods: shortly after enactment of the Pharmacist Law revision and about a half-decade later.

MAIN OUTCOME MEASURE

Patient's knowledge of the medications, anxiety level, individual beliefs regarding taking medications without anxiety, and adherence to the medication regimens.

RESULTS

There were 141 and 151 patients who participated during each period, respectively. The proportion of non-adherent patients significantly decreased from 68.8 to 53.6% (P = 0.008). Multiple logistic regression analysis indicated that the features of the intentionally non-adherent patients have changed; they have switched from persons who lack general comprehension about the medications (P = 0.01), ones who place an importance on knowing the side effects (P = 0.04), or who place no value on mutual reliance on their doctors (P = 0.03) into persons who place no value on understanding the purpose of taking their medications (P = 0.04) or who place value on multiple items to take medications without anxiety (P = 0.03), i.e., supposedly people who prefer thinking about their drug therapy from their own point of view based on comprehension of their disease and medications.

CONCLUSIONS

The rapid progression of drug information disclosure after enactment of the Pharmacist Law revision has likely resulted in drastic changes in patients' perception of their medications and led to improvements in medication adherence.

The role and value of written information for patients about individual medicines: a systematic review

OBJECTIVE

To review research on the role and value of written medicines information for patients from the perspective of patients and health professionals.

CONTEXT

Providing written information to patients about their medicines is acknowledged as a priority but there is poor understanding of how best to meet patients' needs.

METHOD

A sensitive search strategy was developed to maximize the identification of relevant studies. We used a data extraction form designed to appraise qualitative research. Findings were synthesized into a narrative account.

MAIN RESULTS

There were three broad categories of study: those which related to policy initiatives; those where the aim was to increase compliance; and those concerned with using information to support decision-making ('informed patient' studies). While the policy initiative and compliance studies reported that, mostly, patients were positive about written information, the 'informed patient' studies showed a more complex picture. Patients valued medicines information tailored to their condition. They did not want it to be a substitute for spoken information from their doctor. Not everyone wanted written information but those who did wanted sufficient detail to meet their need. Need varied over time and between patients. The small number of studies relating to health professionals showed widespread ambivalence towards using written information. Some thought it should be brief and simple, only partially disclose side-effects and saw its main role as being to increase compliance.

CONCLUSION

The different perspectives of patients and health professionals, and the diverse and changing information needs of patients pose a challenge to providers of written medicines information.

Information processing in the context of genetic risk: implications for genetic-risk communication

Communicating genetic-risk information is fraught with difficulties, and there are no universally accepted guidelines for clinical practice. In this paper, we suggest that information-processing models may offer some guidance for the communication of genetic risk. The paper reviews selected literature from health and social psychology, including defensive reactions to threatening health information, the Extended Parallel Process Model (EPPM) and Self Affirmation Theory. Ultimately, it presents the Heuristic-Systematic Model (HSM) of information processing as a useful perspective from which to view genetic-risk communication. Through our review of this literature, we identify some of the variables found to influence the systematic or heuristic processing of risk information and note their relevance to genetic counseling contexts. We suggest that systematic information processing is conducive to informed decision-making, as well as improved understanding of risk information. Clinical practice implications derived from our review of these literatures are noted.

Expressing medicine side effects: assessing the effectiveness of absolute risk, relative risk, and number needed to harm, and the provision of baseline risk information

OBJECTIVE

To assess the effectiveness of absolute risk, relative risk, and number needed to harm formats for medicine side effects, with and without the provision of baseline risk information.

METHODS

A two factor, risk increase format (relative, absolute and NNH)xbaseline (present/absent) between participants design was used. A sample of 268 women was given a scenario about increase in side effect risk with third generation oral contraceptives, and were required to answer written questions to assess their understanding, satisfaction, and likelihood of continuing to take the drug.

RESULTS

Provision of baseline information significantly improved risk estimates and increased satisfaction, although the estimates were still considerably higher than the actual risk. No differences between presentation formats were observed when baseline information was presented. Without baseline information, absolute risk led to the most accurate performance.

CONCLUSION

The findings support the importance of informing people about baseline level of risk when describing risk increases. In contrast, they offer no support for using number needed to harm.

PRACTICE IMPLICATIONS

Health professionals should provide baseline risk information when presenting information about risk increases or decreases. More research is needed before numbers needed to harm (or treat) should be given to members of the general populations.

Assessment of prescribing information for generic drugs manufactured in the Middle East and marketed in Saudi Arabia

BACKGROUND

Little research has assessed the quality of manufacturer-provided prescribing information or documented differences in key aspects of drug information among different marketed generic products of the same drug, particularly in the Middle East and Arabian Gulf. We assessed the quality of written prescribing information for selected generic drugs marketed in Saudi Arabia and manufactured in various countries of the Middle East.

METHODS

We assessed the correctness and completeness of information pertaining to indications, dosage, cautions/contraindications, side effects and drug interactions in 37 package inserts for generic products registered in Saudi Arabia and manufactured in the Middle East, including atenolol (6 inserts), fluoxetine (4 inserts), ciprofloxacin (11 inserts), metformin (7 inserts), and omeprazole (9 inserts). We also described deficiencies in the quality and quantity of manufacturer-provided information that could be misleading to patients and prescribers.

RESULTS

We found substantial disagreement in information between generic package inserts versus the British National Formulary and the package insert of the brand product marketed in Saudi Arabia. A cumulative average of 63 +/- 16% of drug information indicators were in agreement with these standard references. Section headings with the least conformity with study references were those related to dosage (57 +/- 28%) and side effects (54 +/- 30%).

CONCLUSION

Our results indicate that national authorities should implement appropriate measures aimed at removing misleading and incorrect information in generic package inserts and incorporating crucial prescribing information that is missing. National authorities in the Middle East and Arabian Gulf should strengthen collaboration and information interchange among each other and with international agencies to maintain common quality standards for delivering information through package inserts.

Patients' Preferences for Methods of Counselling about Glaucoma

Objective:

To investigate patients' preference for two counselling methods related to glaucoma therapies.

Design:

Nineteen volunteers with glaucoma received counselling about an eye drop medication in two sessions, one involving verbal presentation of information accompanied by a computer-generated information leaflet and the other involving verbal presentation of information supported by images. To the extent possible, the drug-related content of each session was the same. The setting was the EduLab facility of the College of Pharmacy and Nutrition at the University of Saskatchewan.

Results:

An equal number of subjects expressed an outright preference for each method, but results suggested that the order of presentation of the methods might be important. Most participants indicated that if a pharmacist used pictures while advising on medications, print information would still be welcomed.

Conclusion:

Patients were satisfied with both methods, with no clear overall preference evident within the study sample.

Pharmacists' discussions of medication side effects: a descriptive study

To improve efforts to assist patients in making informed decisions regarding medications, current methods of providing information, such as patient counseling by pharmacists, must be examined. This will require attention not only to what content is delivered, but also how it is phrased by this group. Ten community pharmacists were videotaped while providing their customary patient counseling to two standardized patients receiving new prescriptions within staged scenarios. All of the pharmacists discussed side effects and management strategies. Vague, verbal descriptors of frequency--rather than numerical indicators--were used which may inhibit accurate risk assessment by patients. Additionally, pharmacists focused on safety aspects of using medications and spent far less time discussing potential therapeutic benefits. Patient decision-making regarding medication may be affected by how pharmacists communicate such benefits and risks, meriting further investigation into patients' interpretations of information received.

A survey of current practice with regard to oral care for children being treated for cancer

The aim of the study was to establish current UK oral care practice for children with cancer. A telephone survey of all 22 United Kingdom Children's Cancer Study Group (UKCCSG) centres was undertaken. Nineteen (86%) of the centres reported using guidelines/protocols for mouth care. The use of routine preventive oral care therapies showed the greatest variation between centres. Four centres (18%) did not use any prophylactic oral care therapy other than basic oral hygiene, whereas seven (32%) routinely used a combination of three or more agents. Chlorhexidine was the most frequently administered prophylactic therapy (17/22 centres, 77%), followed by nystatin (11/22 centres, 50%). There was little variation in advice given to parents/patients on basic oral hygiene. Regarding dental check-ups, 9/22 centres (41%) recommended children to attend a hospital-linked dental clinic. Only at 8/22 centres (36%) did children undergo a dental check-up before commencing cancer treatment. The survey identified significant variation in preventive oral care therapies and dental check-ups at the UKCCSG centres. Attention needs to be given to establishing evidence based, effective strategies.

How do consumers search for and appraise information on medicines on the Internet? A qualitative study using focus groups

Background

Many consumers use the Internet to find information about their medicines. It is widely acknowledged that health information on the Internet is of variable quality and therefore the search and appraisal skills of consumers are important for selecting and assessing this information. The way consumers choose and evaluate information on medicines on the Internet is important because it has been shown that written information on medicines can influence consumer attitudes to and use of medicines.

Objective

To explore consumer experiences in searching for and appraising Internet-based information on medicines.

Methods

Six focus groups (N = 46 participants) were conducted in metropolitan Sydney, Australia from March to May 2003 with consumers who had used the Internet for information on medicines. Verbatim transcripts of the group discussions were analyzed using a grounded theory approach.

Results

All participants reported using a search engine to find information on medicines. Choice of search engine was determined by factors such as the workplace or educational environments, or suggestions by family or friends. Some participants found information solely by typing the medicine name (drug or brand name) into the search engine, while others searched using broader terms. Search skills ranged widely from more-advanced (using quotation marks and phrases) to less-than-optimal (such as typing in questions and full sentences). Many participants selected information from the first page of search results by looking for keywords and descriptions in the search results, and by looking for the source of the information as apparent in the URL. Opinions on credible sources of information on medicines varied with some participants regarding information by pharmaceutical companies as the "official" information on a medicine, and others preferring what they considered to be impartial sources such as governments, organizations, and educational institutions. It was clear that although most participants were skeptical of trusting information on the Internet, they had not paid conscious attention to how they selected information on medicines. Despite this, it was evident that participants viewed the Internet as an important source for information on medicines.

Conclusions

The results showed that there was a range of search and appraisal skills among participants, with many reporting a limited awareness of how they found and evaluated Internet-based information on medicines. Poor interpretation of written information on medicines has been shown to lead to anxiety and poor compliance to therapy. This issue is more important for Internet-based information since it is not subject to quality control and standardization as is written information on medicines. Therefore, there is a need for promoting consumer search and appraisal skills when using this information. Educating consumers in how to find and interpret Internet-based information on medicines may help them use their medicines in a safer and more-effective way.

[Communication prostheses and behavioral alignment in hospital leaflets]

Review was made of publications that describe experience with printed material distributed to the lay public in hospital institutions. From the 146 leaflets examined, those aimed at professionals or disabled people, thus leaving 75 papers that illustrate the present pattern for the rationality behind the production, use and evaluation of this type of resource. In a general manner, such leaflets invest in the power of "ideal printed information" to align behavior with the hospital's biomedical agenda. The underlying rationality that permeates them perceives the "perfect information package" as one that efficiently describes its technical content for the purpose of unidirectional persuasion, is up-to-date in relation to readability scales and embellished by graphic design, and emphasizes the priorities defined by the professionals. Such "communication prostheses" should be capable of electronic validation by means of software suitable for proportioning the "doses" to the subject matter. Information as a drug, cognitivism, the lack of research on message reception and the need for communicative action for the deconstruction of systems of closed thinking within the hospital environment have been discussed.

Factors influencing consumer use of written drug information

OBJECTIVE

To provide an overview of the use and impact of written drug information (WDI) on consumers, and to review the literature on the factors influencing the use of WDI by consumers.

DATA SOURCES

Relevant articles published in English since the late 1970s were identified based on searches of on-line databases, texts, and cited references in published articles.

STUDY SELECTION

Articles reporting findings on the origin, use, and impact of WDI were included. Due to limited literature, articles reporting findings on factors influencing the use of written drug as well as disease information were included.

DATA EXTRACTION

Due to the lack of design consistency between studies and the comparatively small volume of work, subjective assessment rather than a criteria-based objective review was deemed more appropriate.

DATA SYNTHESIS

To date, research on WDI has focused on its use and impact. WDI has the potential to increase patients' knowledge, compliance, and satisfaction. However, there is also the potential for anxiety or premature cessation of therapy due to fear of possible adverse effects. Multiple factors may potentially influence the use of WDI by consumers including those associated with the written information document (readability, presentation), the patient (health literacy, role of caregiver, demographic factors, health locus of control, coping style, health belief model), and the environment (timing of provision, experience).

CONCLUSIONS

WDI has the potential to impact consumers positively and negatively. Although not widely investigated, a number of factors can potentially influence the use of WDI by consumers. The findings of this review can form the basis for much needed further research.

Patient information leaflets--helpful guidance or a source of confusion?

BACKGROUND

According to the European Community Directive 92/27, pharmaceutical companies are responsible for working out patient information leaflets (PILs) for all products marketed, and every PIL should comply with the Summary of Product Characteristics (SPC) and be phrased so that it is easily understandable by the patient. However, the volume of information included in the PIL may differ for different brands, and furthermore, the same drug may be registered for different indications. Patients may therefore receive different drug information when they renew prescriptions for the same generic drug.

OBJECTIVES

To examine if PILs on different brands of generically identical drugs contain inconsistent and diverging information that may lead to confusion.

DESIGN

Case-finding among patients who contacted a pharmacy because of problems related to the information retrieved from the PIL.

SETTING

Inquiries to a Danish pharmacy during one year (1 June 2000-31 May 2001).

RESULTS

Different brands of generically identical products included PILs with substantial inconsistencies. Diverging information about indications for drug use, adverse effects, drug-drug interactions and precautions and considerations concerning pregnancy and breastfeeding resulted in inquiries to the pharmacy.

CONCLUSION

Patients may be confused by inconsistent information in PILs from different brands of generically identical drugs. Confusion about drug treatment may lead to reduced compliance and initiatives should be taken to coordinate information in PILs covering the same generic product.