Study Finds Many Patients Don't Understand Prescription Medicine Labels

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Study Finds Many Patients Don't Understand Prescription Medicine

Labels

http://www.sciencedaily.com/releases/2006/11/061129093308.htm

When Wolf paged though dusty, yellowing pharmacists' logs

from the 1890s at the sonian National Museum of American

History, he found the following entry about a druggist's encounter

with a confused patient: " Shake well, " a patient apparently read out

loud to the pharmacist from his prescription bottle label. " Does

that mean I shake myself " ?

It sounds like the punch line of a bad joke, but it wasn't. And the

confusion experienced by that patient more than a century ago hasn't

changed much.

Many people still don't fully understand the seemingly simple label

instructions on their prescription medication, according to a new

study of low-income patients by Wolf, Ph.D., assistant professor of

medicine at Northwestern University's Feinberg School of Medicine.

The study was published Nov. 29 online in ls of Internal

Medicine. Wolf is presenting a position piece on how to improve

those labels Nov. 29 at the American College of Physicians

Foundation conference in Washington, D.C.

Wolf found that nearly half of the patients in the study

misinterpreted at least one or more out of the five prescription

labels they were shown. Patients with low literacy made the most

mistakes and frequently were unable to grasp four out of five label

instructions. But even people with a high-school education and

higher had problems.

" We came at this from a health literacy perspective, but we found it

was a problem with many people in general, " said Wolf, director of

Northwestern's new Health Literacy and Learning Program, which aims

to improve patients' ability to understand and act on health

information. " It was surprising how prevalent mistakes were

regardless of an individual's literacy level. Just being able to

read the label doesn't mean you'll be able to interpret it. "

Wolf believes the main culprit is awkward wording. " Why are we not

phrasing things properly on bottles " " he asked.

Recent studies have shown that many patients don't take their

medicine properly at home. Wolf's research with co-lead author Terry

, professor at Louisiana State University, is the first to show

why the errors occur. Ruth , professor at Emory University,

was senior author on the study.

Their research follows Wolf's widely publicized June, 2006 study,

which found patients with low literacy skills had trouble

understanding prescription drug warning labels.

Addressing medication error is a high priority within the health

care system. In July, the Institute of Medicine reported 1.5 million

patients are injured each year by medication errors, of which more

than one-third occur at home.

The potential for patient mistakes rises as Americans' countertops

fill with ever more bottles of prescription medicines. The average

adult took six or seven medicines a year in 2002 compared to four or

five medicines a decade ago. Not only are there more opportunities

for mistakes, Wolf's study showed that the more medications a

patient takes, the more likely he or she will misunderstand the

labels.

The most common mistake made by patients in the study was

misinterpreting dosage instructions (a tablespoon versus a teaspoon)

followed by misunderstanding the dose frequency.

" Just being able to read the label doesn't mean you'll be able to

interpret it. Patients reading at a sixth-grade level or below could

read it back. But if you ask them what it means to take two tablets

twice daily, only one-third of the patients with limited literacy

skills got that correct, " Wolf said.

" What is twice daily " " he asked in what sounded like an opening to a

Carlin comedy routine. " Do you take two at 8 a.m. or two at

noon " "

" The most common misinterpretation was to take two pills a day. It's

not that they couldn't figure out two plus two equals four. Rather,

it's the way the instructions were written. It's awkward wording, "

Wolf said, noting the wording is chosen by the individual pharmacist

filling the prescription.

The more numbers included in the dosage, the more likely patients in

the study got it wrong. The hardest label to understand: Take 1

teaspoon 3 times a day for 7 days. " It's possible people read this

quickly because they perceive it as simple. They get the numbers

flipped. They confuse and misread them, " Wolf said.

The gap between reading and actually understanding the dose means

that the current " teach back " technique, in which patients are asked

to repeat back instructions to a health care provider, may be

inadequate to prevent patient mistakes.

The 395 patients participating in the study ranged from 18 through

mid-70s and were from primary care clinics serving indigent

populations in Chicago; Shreveport, La.; and , Mich. Wolf

said the study purposely focused on low-income patients because they

are disproportionately affected by poor health. A patient was shown

each commonly used medicine individually and asked how he or she

would take it.

In his Northwestern office, Wolf pulled out giant plastic bags

filled with the offending prescription bottles. Family members,

friends and colleagues send him their used bottles, which he

stockpiles at home. " My wife hates that, " he admitted with a smile.

He also has a flourishing collection of pharmacy bags stapled with

patient education material.

Another study led by Wolf published in September in Patient

Education and Counseling showed those FDA-approved education

materials aren't useful to patients, especially those with low

literacy skills. " There's too much information on them, " Wolf

complained.

Wolf proposes a complete redesign and standardization of the text

and format of prescription medication labels. The challenge is how

to best use the limited " real estate " of the plastic cylinders to

clearly instruct patients. He is working with study authors

and as part of an American College of Physicians Foundation

initiative to design a better label design for prescription bottles.

They expect to unveil the new label soon.

He also has a grant from Target Corp. to redesign the warning icons

and usage instructions on its medication bottles. " There are 120

possible warnings and instruction stickers. There is little evidence

for a lot of these warnings. There is no process to say what

warnings should be on the label and which should not, " he said.

Wolf's research is funded by a career development award through

Centers for Disease Control and Prevention.