Improving Patient Understanding of Prescription Drug Label Instructions
- 917 Downloads
Patient misunderstanding of instructions on prescription drug labels is common and a likely cause of medication error and less effective treatment.
To test whether the use of more explicit language to describe dose and frequency of use for prescribed drugs could improve comprehension, especially among patients with limited literacy.
Cross-sectional study using in-person, structured interviews.
Three hundred and fifty-nine adults waiting for an appointment in two hospital-based primary care clinics and one federally qualified health center in Shreveport, Louisiana; Chicago, Illinois; and New York, New York, respectively.
Correct understanding of each of ten label instructions as determined by a blinded panel review of patients’ verbatim responses.
Patient understanding of prescription label instructions ranged from 53% for the least understood to 89% for the most commonly understood label. Patients were significantly more likely to understand instructions with explicit times periods (i.e., morning) or precise times of day compared to instructions stating times per day (i.e., twice) or hourly intervals (89%, 77%, 61%, and 53%, respectively, p < 0.001). In multivariate analyses, dosage instructions with specific times or time periods were significantly more likely to be understood compared to instructions stating times per day (time periods — adjusted relative risk ratio (ARR) 0.42, 95% Confidence Interval (CI) 0.34–0.52; specific times — ARR 0.60, 95% CI 0.49–0.74). Low and marginal literacy remained statistically significant independent predictors of misinterpreting instructions (low - ARR 2.70, 95% CI 1.81–4.03; marginal -ARR 1.66, 95% CI 1.18–2.32).
Use of precise wording on prescription drug label instructions can improve patient comprehension. However, patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language.
Key Wordsliteracy health literacy drugs prescription medications labels patient safety medication regimens
The authors are grateful to Mary Bocchini, Kat Davis, Sumati Jain, Jennifer Webb, Jessica Salazar and Silvia Skripkauskas. The study was supported in part by internal funding from the Health Literacy and Learning Program at Northwestern University.
Conflict Of Interest
- 1.Institute of Medicine. In: Kohn L, Corrigan J, Donaldson M, eds. To err is human: Building a safer health system. Washington, D.C.: National Academy Press; 2000.Google Scholar
- 3.Institute of Medicine. In: Aspden P, Wolcott J, Bootman L, Cronenwett LR, eds. Preventing Medication Errors. Washington D.C.: National Academy Press; 2006.Google Scholar
- 5.Henry J. Kaiser Family Foundation. Prescription Drug Trends: A Chartbook Update. November 2001; http://www.kff.org. Accessed September 2008.
- 6.Medical Expenditure Panel Survey [on-line]. Available at http://www.meps.ahrq.gov. Accessed September, 2008.
- 13.Park DC, Jones TR. Medication adherence and aging. In: Fisk AD, Rogers WA, eds. Handbook of Human Factors and the Older Adult. San Diego, CA: Academic Press; 1997:257–87.Google Scholar
- 14.Morrow DG, Leirer VO, Sheikh J. Adherence and medication instructions: review and recommendations. J Am Geriatric Soc. 1988;36:1147–60.Google Scholar
- 18.Davis TC, Kennen EM, Gazmararian JA, Williams MV. Literacy testing in health care research. In: Schwartzberg JG, VanGeest JB, Wang CC, eds. Understanding health literacy: Implications for medicine and public health. Chicago, IL: AMA Press; 2004:157–79.Google Scholar
- 21.Davis CS. Statistical Methods for the Analysis of Repeated Measurements. New York: Springer; 2002.Google Scholar
- 23.Rice GE, Okun MA. Older readers’ processing of medical information that contradicts their beliefs. J Gerontol: Psych Sci. 1994;49:119–28.Google Scholar
- 24.Gien L, Anderson JA. Medication and the elderly: a review. J Geriatric Drug Ther. 1989;4:59–89.Google Scholar
- 25.U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health, 2nd edition. Washington, DC: U.S. Government Printing Office; 2000.Google Scholar
- 30.American Pharmaceutical Association. Committee Policy Report on Health Literacy 2001–2002.Google Scholar
- 31.Park DC, Gutchess AH, Meade ML, Stine-Morrow EA. Improving cognitive function in older adults: nontraditional approaches. J Gerontol. 2007;62B:45–52.Google Scholar