Medication-related Knowledge Research Articles

Effects of a Web-Based Patient Decision Aid on Biologic and Small-Molecule Agents for Rheumatoid Arthritis: Results From a Proof-of-Concept Study.

To assess the extent to which ANSWER-2, an interactive online patient decision aid, reduces patients' decisional conflict and improves their medication-related knowledge and self-management capacity. We used a pre-post study design. Eligible participants had a diagnosis of rheumatoid arthritis (RA), had been recommended to start using a biologic agent or small-molecule agent or to switch to a new one, and had internet access. Access to ANSWER-2 was provided immediately after enrollment. Outcome measures included 1) the Decisional Conflict Scale (DCS), 2) the Medication Education Impact Questionnaire (MeiQ), and 3) the Partners in Health Scale (PIHS). A paired t-test was used to assess differences pre- and postintervention. The majority of the 50 participants were women (n = 40), and the mean ± SD age of participants was 49.6 ± 12.2 years. The median disease duration was 5 years (25th, 75th percentile: 2, 10 years). The mean ± SD DCS score was 45.9 ± 25.1 preintervention and 25.1 ± 21.8 postintervention (mean change of -21.2 of 100 [95% confidence interval (95% CI) -28.1, -14.4], P < 0.001). Before using ANSWER-2, 20% of participants had a DCS score of <25, compared to 52% of participants after the intervention. Similar results were observed in the PIHS (mean ± SD 25.3 ± 14.8 preintervention and 20.4 ± 13.0 postintervention; mean change of -3.7 of 88 [95% CI -6.3, -1.0], P = 0.009). Findings from the MeiQ were mixed, with statistically significant differences found only in the self-management subscales. Patients' decisional conflict decreased and perceived self-management capacity improved after using ANSWER-2. Future research comparing the effectiveness of ANSWER-2 with that of educational material on biologic agents will provide further insight into its value in RA management.

Assessment of patients’ knowledge and practices regarding their medication use and risks in Lebanon

Background Patients' knowledge of their medications play a pivotal role in their disease management. Objective Assess the knowledge and practices of Lebanese outpatients regarding their own medication use and risks. Setting Four hundred and sixty community pharmacies across Lebanon. Method It was a cross-sectional study performed from March through May 2016 among Lebanese outpatients, using a self-administered questionnaire. Descriptive statistics were used to calculate all participants' responses. The association between categorical variables were evaluated using Pearson χ2 test or Fisher's exact test. Binary logistic regressions were performed to identify factors associated with medication patients' knowledge and interest. Main outcome measure Ability of the patients to identify own medications' elements: name, strength, dosage regimen, indication, and adverse drug reactions. Results Our study comprised 921 patients, with around 16% taking ≥5medications/day. Around 56% of our patients showed sub-optimal medication knowledge. Patients' higher educational level, number of chronic diseases, and patient physician interaction were associated with higher medication knowledge. Many patients admitted not discussing their medications each time they visit their physicians (38.7%); not reading the leaflet of each medication they take (61.2%); and not regularly asking their pharmacist about the potential interactions of OTC drugs with prescribed medications (53.9%). Conclusion This study showed suboptimal medication-related knowledge, and suboptimal patient's interactions with primary care givers. Our findings serve as a platform for healthcare providers to understand patients' needs and educate them about medication use and risks.

Non-adherence to medication regimens among older African-American adults

BackgroundDespite concerns about racial differences on adherence to prescribed medication rigimens among older adults, current information about nonadherence among underserved elderly African Americans with co-morbidities is limited. This study examines the association between adherence to drug regimens and an array of medication-related factors, including polypharmacy, medication regimen complexity, use of Potentially Inappropriate Medications (PIM), and knowledge about the therapeutic purpose and instructions of medication use.MethodsFour-hundred African Americans, aged 65 years and older, were recruited from South Los Angeles. Structured, face-to-face interviews and visual inspection of participants’ medications were conducted. From the medication container labels, information including strength of the drug, expiration date, instructions, and special warnings were recorded. The Medication Regimen Complexity Index (MRCI) was measured to quantify multiple features of drug regimen complexity. The Beers Criteria was used to measure the PIM use.ResultsParticipants reported taking an average of 5.7 prescription drugs. Over 56% could not identify the purpose of at least one of their medications. Only two-thirds knew dosage regimen of their medications. Thirty-five percent of participants indicated that they purposely had skipped taking at least one of their medications within last three days. Only 8% of participants admitted that they forgot to take their medications. The results of multivariate analysis showed that co-payment for drugs, memory deficits, MRCI, and medication-related knowledge were all associated with adherence to dosage regimen of medications. Participants with a higher level of knowledge about therapeutic purpose and knowledge about dosage regimen of their medications were seven times (CI: 4.2–10.8) more likely to adhere to frequency and dose of medications. Participants with a low complexity index were two times (CI: 1.1–3.9) more likely to adhere to the dosage regimen of their medications, compared with participants with high drug regimen complexity index.ConclusionsWhile other studies have documented that non-adherence remains an important issue among older adults, our study shows that for underserved elderly African Americans, these issues are particularly striking. A periodic comprehensive assessment of all medications that they use remains a critical initial step to identify medication related issues. Assessment of their disease and medication related knowledge (e.g., therapeutic purposes, side-effects, special instructions, etc.) and their ability to follow complicated medication regimens and modification of their drug regimens requires inter-professional collaboration.

Evaluation of Medication-related Self-care Skills in Patients With Cystic Fibrosis.

BACKGROUND: As the life expectancy of patients with cystic fibrosis (CF) increases, the focus on ensuring success with medication therapies is increasingly important. The ability of patients to autonomously manage medications and related therapies is poorly described in the literature. OBJECTIVE: The goal of this project was to assess the level of medication-related knowledge and self-care skills in patients with CF. METHODS: This project took place in a Cystic Fibrosis Foundation accredited affiliate center. Eighty-nine patients between the ages of 6 and 60 were eligible to participate based on inclusion and exclusion criteria. Pharmacists administered a 16-item questionnaire and detailed medication history during clinic visits from January through May 2014. RESULTS: Forty-five patients 6 to 41 years old participated in the study. The skills most often performed independently were preparing nebulizer treatments (85%) and telling someone if they feel their medicines are causing a problem (89%). Skills least often performed were carrying a medication list (82%) and bringing a medication list to appointments (76%). In respondents 21 years of age and older, less than 75% of respondents were involved with obtaining financial resources, maintaining equipment, carrying a medication list, or rinsing their mouth after using inhaled medicines. Participants were able to provide drug name, dose, and frequency of use for pancreatic enzymes and azithromycin 37% and 24% of the time, respectively. CONCLUSIONS: In the population surveyed, many medication-related skills had not been acquired by early adulthood. Assessing and providing education for medication-related self-care skills at all ages are needed.

Causes and Issues of High-risk Intravenous Medication Safety among Nurses

This survey study systematically investigated issues associated with medication-related procedures and elucidated the issues regarding high-risk intravenous medication safety among nurses. The results indicated that for nurses, high-risk intravenous medication safety issues included a lack of knowledge about administered medicines, patient confirmation negligence, inappropriate medicine management, inappropriate storage, lack of awareness about high-risk medicines, frequent verbal prescriptions, and confusion regarding packages and containers. This study therefore will contribute to improvements in nurses’ work satisfaction, patient safety, and medication-related knowledge and performance in terms of the safety of high-risk medicines requiring caution.

Drug administration via enteral feeding tube in residential care facilities for individuals with intellectual disability: A focus group study on guideline implementation.

People with profound intellectual disabilities often receive medication through enteral feeding tube (EFT). In a previous study, we found that current guidelines concerning medication preparation and administration through EFT are often not followed in residential care facilities (RCFs) for individuals with intellectual disabilities. The present qualitative study aimed to identify barriers and facilitators experienced by RCF staff members to following guidelines on medication administration via EFT, by conducting focus group interviews. Time constraints, lack of knowledge, lack of clear administration instructions, lack of necessary materials, and limited gastric fluid tolerance in certain residents were identified as barriers to following guidelines. Other influencing factors were the number of staff members, residents, and medications; habits; and the residents' comfort and well-being. To optimize care for this vulnerable patient population with EFT, an intervention can be set up focusing on improving staff members' medication-related knowledge and providing clear administration instructions and the necessary materials.

Education is critical for medication adherence in patients with coronary heart disease

Background Although non-adherence to medications is associated with increased cardiovascular risks, very little information is focused on the relationship between knowledge and medication adherence among patients with coronary heart disease (CHD).Aim The purposes were to assess the relationship between medication adherence and medication- or disease-related knowledge in patients with CHD, and to investigate whether educating patients would alter their medication adherence behaviour.Methods This study was carried out at the outpatient clinic of a public university teaching hospital in China. The primary outcome was the ability of patients to follow medication instructions, which was assessed by the Morisky Medication Adherence Scale (MMSA-8c). The Medication- or Disease- Related Knowledge Test (MDRKT) was used to assess patients’ medication-related knowledge. We also explored patients#x2019; preferences for receiving education about medications and whether it is necessary for pharmacists to provide education.Results Among the 159 patients who completed the survey, approximately 38.4% were considered non-adherent (MMAS-8c score < 6). Medicationor disease-related knowledge and concerns about adverse drug events were signifi cantly associated with non-adherence. The MDRKT revealed that most participants had very little knowledge about their drug treatment. Specifi cally, 22 participants said that pharmacists were their primary source of information. Subsequently, 95.0% of participants expressed an interest in activities related to medication education.Conclusions Knowledgeable patients with CHD are more likely to adhere to medication instructions. Many patients have diffi culty acquiring medication information; thus, patients need increased access to education about their medication. Pharmacist services may be required to provide such information.

Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings.

Communication problems contribute enormously to medication errors and adverse events. Encouraging patient engagement can help to facilitate effective medication management. To examine barriers and enablers affecting how patients engage with managing their medications in specialty hospital settings. An exploratory qualitative design was used involving in-depth interviews with doctors, nurses, pharmacists, patients and family members. An Australian public, metropolitan teaching hospital was the study site and five specialty hospital settings were used, including cardiac care, emergency care, intensive care, oncology care and perioperative care. In all, 21 health professionals, 11 patients and 12 family members participated in the study (n = 44). Barriers and enablers involved intrapersonal, interpersonal and environmental aspects, and differences in perceptions and experiences were found between the various settings. Health professionals had preconceived notions of what was appropriate behaviour in conveying information about medications. Many health professionals stated that they deliberately chose not to provide medication-related knowledge. Different barriers for patient engagement existed in various settings - in emergency care, patients could only stay for 4 h; in intensive care, medication changes regularly happened; in cardiac care, patients were discharged prematurely due to urgent need of beds; in oncology, there was lack of availability of oncology consultants; while in perioperative care, surgeons and anaesthetists were available just before surgery. Complex barriers and enablers are associated with patient engagement in specialty clinical settings. By developing an understanding of these barriers and enablers, health professionals can help patients to understand and participate in their medication management.

EPA-1388 – Mental health service needs of patients with depression in general hospital - a qualitative interview

Object To know the treatment experiences of patients with depression in general hospital, and their suggestion on the present mental health services. To provides theoretical support for optimizing the mental health services model in general hospital. Methods Qualitative interviews were given to 10 patients diagnosed as depressive disorder from department of psychiatry, Renmin Hospital of Wuhan University. Questions were asked from following aspects: the process of seeking medical help before hospitalization in psychiatry department(when, where, who, referral), evaluation of drug treatment (efficacy, side effects, doctors) and psychotherapy, satisfaction and suggestions on medical services(including hospital environment, medical staff and etc.), social rehabilitation (stigma, social functional recovery, survival / quality of life etc.), socioeconomic factors (health insurance coverage, financial resources, social support resources). Answers referred to above factors were conducted to statistical analysis. Results showed departments of neurology, gastroenterology, endocrinology, Chinese traditional medicine, obstetrics and gynecology are the first medical choice of depressive patients; the average number of departments before they get psychiatric treatment is five, the average number of referral is 2. Medication side effects are the most concerned problems. Enough and reasonable information given from doctor about drug's name, efficacy, side effects, and length of treatment can improve patient's compliance, even can predict recurrence rate. Discrimination medical personnel can reduce compliance of patients: contempt, pessimism, avoidance, activity limitations, and impolite language and behavior. Psychotherapy can shorten the hospital stay. Health insurance coverage, job, social support can predict social functional recovery. Conclusions Doctors in general hospital should improve their ability in recognizing depression to ensure referral patients timely; Education of depression, medication-related knowledge should offered by psychiatrists to improve patients’ treatment compliance, and reduce relapse rate; psychological therapy should be incorporated into psychiatric conventional treatment; Medical personnel should be conscious of using positive affirmation, respectful words and actions; effective communication with families is necessary for promoting patients’ social rehabilitation.

Pharmacology in undergraduate nursing education: Innovative strategies for enhancing medication related knowledge, attitudes, skills and behaviours

Medications are commonly used interventions in healthcare. As our population ages and the prevalence of chronic health challenges increases, medication management has become increasingly complex. Although medication management is a collaborative team effort among health care providers, nurses have a major role in the clinical assessment and monitoring of patients. Nurses are also responsible for medication administration and related drug dosage calculations in the care of patients. There is a growing body of literature that highlights gaps in knowledge and applied skills of nursing students and practicing nurses in pharmacology content and drug dosage calculations. Teaching pharmacology, drug dosage calculations, and medication administration techniques requires innovative strategies to promote student learning, achievement of outcomes, and life-long learning principles in undergraduate nursing education. We present evidence-informed, innovative strategies and techniques from classroom and Clinical Learning and Simulation Centre experiences that were employed in order to improve student learning and success in an undergraduate pharmacology course. The most notable of course outcomes is that of students’ enhanced abilities to exercise clinical reasoning with regard to application of the medication related knowledge and skills.

Knowledge and perspectives of Dutch home healthcare nurses regarding medication frequently used by older people

Home healthcare nurses in their roles as caregivers, educators and administrators of medications are particularly well positioned to act on a preventive way to be alert of adverse drug reactions. However, knowledge about medication and a professional attitude is required. To describe medication-related knowledge and perspectives of Dutch home healthcare nurses regarding frequent used medication by older people. A cross-sectional study was conducted among home healthcare nurses (n=146) in the Netherlands based on the ten most frequently used drugs by older people. The mean score for total medication knowledge was 76.2% of the maximum score. Most home healthcare nurses (80.3%) felt responsible for improving older patients' medication use. Three-quarters of the home healthcare nurses agreed with the statement: "By taking appropriate action at the right time, I am able to prevent a medication-related hospital admission". Although most home healthcare nurses felt responsible for their older patients' proper medication use and agreed with the statement that they played a role in preventing older patients' medication-related hospital admissions, their knowledge regarding medications could be improved. Home healthcare nurses should profit as a professional from gaining more knowledge of medication frequently used by older people.

Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience

BackgroundWhile the home is the most common setting for the provision of palliative care in Australia, a common problem encountered here is the inability of patient/carers to manage medications, which can lead to misadventure and hospitalisation. This can be averted through detection and resolution of drug related problems (DRPs) by a pharmacist; however, they are rarely included as members of the palliative care team. The aim of this study was to pilot a model of care that supports the role of a pharmacist in a community palliative care team. A component of the study was to develop a cost-effective model for continuing the inclusion of a pharmacist within a community palliative care service.MethodsThe study was undertaken (February March 2009-June 2010) in three phases. Development (Phase 1) involved a literature review; scoping the pharmacist's role; creating tools for recording DRPs and interventions, a communication and education strategy, a care pathway and evidence based patient information. These were then implemented in Phase 2. Evaluation (Phase 3) of the impact of the pharmacist's role from the perspectives of team members was undertaken using an online survey and focus group. Impact on clinical outcomes was determined by the number of patients screened to assess their risk of medication misadventure, as well as the number of medication reviews and interventions performed to resolve DRPs.ResultsThe pharmacist screened most patients (88.4%, 373/422) referred to the palliative care service to assess their risk of medication misadventure, and undertook 52 home visits. Medication reviews were commonly conducted at the majority of home visits (88%, 46/52), and a variety of DRPs (113) were detected at this point, the most common being "patient requests drug information" (25%, 28/113) and "condition not adequately treated" (22%, 25/113). The pharmacist made 120 recommendations in relation to her interventions.Fifty percent of online survey respondents (10/20) had interacted 10 or more times with the pharmacist for advice. All felt that the pharmacist's role was helpful, improving their knowledge of the different medications used in palliative care. The six team members who participated in the focus group indicated that there were several benefits of the pharmacist's contributions towards medication screening and review.ConclusionsThe inclusion of a pharmacist in a community palliative care team lead to an increase in the medication-related knowledge and skills of its members, improved patients' medication management, and minimised related errors. The model of care created can potentially be duplicated by other palliative care services, although its cost-effectiveness was unable to be accurately tested within the study.

Physician–patient and pharmacist–patient communication: Geriatrics’ perceptions and opinions

Objective Earlier research examined the perceptions of the pharmacist–patient relationship quality using data from a systematic random sample of non-institutionalized elderly in the United States. The purposes of this study were to determine: (1) how the findings of this study, conducted in a culturally diverse urban area in Queens, New York, compare with the earlier study; (2) how community-dwelling elderly patients in a metropolitan area perceive their relationship with the pharmacist compared to the physician; and (3) the extent to which their perceived relationship quality predicts medication-related knowledge, medication-related outcomes, and self-efficacy for medication management. Methods One hundred and twenty-one elderly individuals aged 65 and over who took at least one prescription medication, selected from three senior centers, participated in the study. Of the total responses, 102 were useable. Results Our sample demonstrated significantly lower levels of perceived quality of relationship with their pharmacist compared to earlier research. In contrast, the participants in this study perceived a better quality of relationship with their physicians than pharmacists. Further, the quality of relationship with physician predicted medication-related knowledge, medication-related outcome expectations, and self-efficacy for medication management. Conclusion The findings of this study suggest that pharmacists still have a way to go to fully meet patients’ healthcare needs, particularly in culturally diverse urban settings. Practice implications Further research is needed to examine ways to improve pharmacist–patient interactions and, therefore, patients’ perceptions of pharmacists.

The medication role of informal carers

A qualitative study was undertaken to determine the role that informal carers perform with respect to dependants' medication. The objectives of the study were to understand the nature of medication-related assistance provided by informal carers and to identify any problems they encounter with this role. Face-to-face interviews were conducted with 20 informal carers who were known to provide medication-related assistance. Three group discussions were held with informal carers attending a local selfhelp group. Results from the study indicate that informal carers often provide support with all aspects of medication management including obtaining supplies, administering medication and monitoring effects. Other informal carers keep an eye on their dependant's medication but are not involved in the day-to-day management. The amount of support provided is influenced by the carer's and dependant's physical and mental ability. Furthermore, carers' commitments, such as family and work, and their relationship with the dependant will also affect the level of support they provide. A lack of medication-related knowledge, and an inability to access some of the pharmaceutical and medical services available, result in carers experiencing additional difficulties in fulfilling their role. More attention should be paid to the practicalities of managing medication. Furthermore, the needs of carers should be considered alongside those of the patient when developing pharmaceutical services. Such a philosophy would be in line with the provision of Community Care which advocates the development of services which are sensitive to carers as well as to dependants.

Using Commercial Knowledge Bases for Clinical Decision Support: Opportunities, Hurdles, and Recommendations

The quality and safety of health care leaves much to be desired.1,2 Automated clinical decision support (CDS) tools embedded in clinical information systems (CISs) such as computer provider order entry (CPOE) and electronic health records (EHR) applications have the potential to improve care and should be part of any comprehensive approach to improve quality.3,4,5,6 Medication prescribing is a component of health care with well documented quality and safety problems that can be improved by CDS.7,8,9 Medication-related CDS requires that pharmaceutical knowledge be represented in a computable, explicit and unambiguous form. Creating an automated representation of medical knowledge often is the most time consuming step in the development of a CDS system and is known as the “knowledge acquisition bottleneck.”10 For a time, it was hoped that the move toward explicit guidelines in medicine would decrease the knowledge acquisition effort,11 but that has not happened.12 Experiments on data sharing from over a decade ago have not progressed.13 As a result, just a few organizations, primarily academic medical centers, are creating rules and benefiting from CDS,14 but most health care organizations do not have the expertise or resources to create such knowledge bases themselves. One potential solution to the problem of access to automated medication-related knowledge is the set of commercial vendors that supply medication-related knowledge bases for pharmacy and prescribing applications. These vendors' products contain such knowledge as drug-drug and drug-disease interactions, minimum and maximum dosing suggestions, drug-allergy cross-sensitivity groupings, and groupings of medications by therapeutic class. Developers of CISs (either vendor-based or “homegrown”), with appropriate licensing, can incorporate commercial knowledge bases into their products. The knowledge base vendor receives a licensing fee for each CIS implementation and can amortize the …

Optimizing Pharmacists’ Effectiveness as Medication Therapy Managers Through a Segmentation Approach

To determine whether older persons could be segmented into meaningful subgroups that shared similar patterns in terms of self-assessments of medication-related knowledge, beliefs, and perceived abilities. Secondary analysis of data previously collected from a cross-sectional, descriptive study. United States. A total of 500 community-dwelling older persons, 65 years and older, using at least one prescription medication. Mail survey. Older persons' self-assessments of medication-related knowledge, beliefs, and perceived abilities, as well as perceptions of pharmacist-patient relationships. The data set contained usable responses from 330 respondents out of 496 surveys presumably delivered (66.5%). Cluster analysis revealed three groups of older persons who showed differences in terms of medication-related beliefs and perceived abilities. Older persons in group 1 reported worse health, used the most prescription medications, sought the most advice from pharmacists, and had the lowest perceived abilities. Older persons in group 2 reported good health, took the fewest medications, sought pharmacists' advice least frequently, and had the lowest beliefs and high perceived abilities. Older persons in group 3 reported the best health, had the highest beliefs, high perceived abilities, and the highest perceptions of pharmacist participative behavior, patient-centeredness, relationship quality, and commitment. Pharmacists can use a segmentation approach to target those older persons who are most in need of medication therapy management.

Construct identification and measure development for investigating pharmacist–patient relationships

To investigate older adults’ perceptions of pharmacist–patient relationships, we identified meaningful constructs, developed measures to use in this domain, and explored associations between pairs of constructs. Data were collected via mailed survey to a systematic random sample of 500 non-institutionalized adults in the United States, aged 65 years and older, taking at least one prescription medication. The useable response rate was 66.5% (330/496). Older adults’ perceptions that the pharmacist is participating in the relationship and the relationship is patient-centered had the strongest association with perceived pharmacist–patient relationship quality. Older adults’ perceptions of relationship quality had a stronger association with medication-related outcome expectations and self-efficacy for medication management, as compared to older adults’ perceptions of pharmacist participative behavior/patient-centeredness, patient participative behavior and pharmacist–patient interpersonal communication. Older adults’ perceptions of medication-related knowledge were moderately associated with self-efficacy for medication management perceptions. These findings have important pharmacy practice implications.

Nurses' confidence and pharmacological knowledge: a study.

The introduction of nurse prescribing will assist the government to deliver its agenda of providing patients with faster access to advice and health services. This study evaluated the knowledge base, self-rated knowledge and confidence, for a prescribing role, in a group of community nurses in Essex. A questionnaire was distributed to 183 community nurses recruited using a random, stratified method, and 110 nurses returned completed forms. Nurse prescribers in the sample were more confident and rated their knowledge more highly when compared with non-prescribing nurses. However, prescribers' actual medication-related knowledge, relative to their high levels of confidence, was not confirmed with performance on case scenarios. In responses to the case scenarios, prescribers did not perform as well as non-prescribers on all five analysed scenarios. The overall assessment of the nurses' response to the OTC case scenarios showed a poor performance when compared with prescription cases. There is a need to improve community nurses' levels of confidence and their abilities in coping with medication-related issues at pre-registration and post-registration level.

Uncovering a multitude of sins: medication management in the home post acute hospitalisation among the chronically ill.

Sub-optimal use of prescribed medication is often associated with unplanned hospitalisation among the chronically ill. To examine the extent of sub-optimal use of prescribed medication in a 'high risk' patient cohort recently discharged from acute hospital care. Chronically ill patients discharged from acute hospital care (n = 342) were studied. At one week post discharge a home visit was performed by a nurse and a pharmacist during which medication management (including compliance and medication-related knowledge) was assessed. During the majority of home visits at least one medication-related problem was detected: approximately half of the cohort subject to a 'reliable' pill-count were found to be mal-compliant and almost all demonstrated inadequate medication-related knowledge. Mal-compliance was correlated with > or = five prescribed medications (Odds ratio [OR] 2.6: p < 0.002). Comparatively, lower medication-related knowledge was correlated with age > 75 years (OR 2.2: p < 0.001), exacerbation of a pre-existing chronic illness (OR 2.7: p = 0.044) and < or = six years formal education (OR 1.9: p = 0.004). Neither were modulated by extent of in-hospital counselling. Other previously unknown problems detected during the home visit included hoarding of previously prescribed medication (35%) and reducing medication intake to minimise costs (21%). Management of prescribed medications among chronically ill patients recently discharged from acute hospital care is often sub-optimal. Assessment of medication management in the home provides an invaluable opportunity to detect and address problems likely to result in poorer health outcomes.

Facilitating Information Acquisition for Over-the-Counter Drugs using Supplemental Labels

This study examined the effect of the presence and color of a supplemental cap label on medication information acquisition and container preference. Participants were 75 elders from a retirement community who were asked to examine one of five manipulated labels on a fictitious but realistic-appearing over-the-counter (OTC) pharmaceutical product container and then to respond to questions concerning their knowledge about the medication. Later they were shown all five manipulated bottle labels and asked which they preferred in effectively communicating medication information. The five bottles differed in the use of labeled surface area and color. Two bottles, displaying labels only on the body of the bottle, served as controls. One control had only a front label, and the other control was conventionally labeled with printed information on the front, back and sides of the bottle. The three other bottles were identical to the conventionally labeled control bottle except they included a supplemental cap label that reprinted the most critical product-use information in large type on three different colored backgrounds. The results showed greater medication-related knowledge for the bottles with supplemental cap labels compared to bottles without the supplemental cap label, with no significant difference among the different colored caps. Participants indicated a strong preference for the bottles with supplemental cap labels over the two control bottles. A distinctive cap color (different from the main label color) was most preferred. Making use of extended surface areas on medication containers to print important information in a more noticeable, legible form benefits elders' knowledge about proper use and hazards.