Medicine Label Research Articles

Analysis of Patient Benefit Information on the Labels of Non-Prescription Medicines in India

Self-medication, a rampant reality in developing countries such as India, requires attention to ensure safe use of medicines by patients. It is not always possible to visit a health care provider and not always needed also. Self-medication with non-prescription medicines is a common and accepted practice all over the world. It is therefore essential that adequate information is present on the label of non-prescription medicines so that the consumers can take appropriate decisions to self-medicate rationally. In our study, we analyzed 300 labels of non-prescription allopathic medicines in India, and checked for the presence, organization and ease of location of various important information for the benefit of the patient to make a right choice to consume the medicine. We found that in most of the labels, the information was not presented in an organized, easy to find manner. Further, a lot of information related to warnings, indications, purpose, dosing information, as is mandatory on the labels of non-prescription medicines of various other countries was not present on the labels. The non-availability of the correct information that guides the consumer to use these medicines rationally and responsibly is in a way denial of right to health. It is important therefore that necessary regulations and guidelines be put in place in India to ensure that the labels of non-prescription medicines should contain the necessary important information which is easy to locate, in the best interest of the patient.

МАРКЕТИНГОВЫЙ АНАЛИЗ УСТОЙЧИВОСТИ ЦЕПИ ПОСТАВОК РОССИЙСКОЙ ФАРМАЦЕВТИЧЕСКОЙ ОТРАСЛИ В УСЛОВИЯХ ВНЕШНИХ ШОКОВ

The article reveals the results of an analysis of resilience of the supply chain at the stage of distribution of finished pharmaceutical products in the Russian pharmaceutical industry against an ag-gressive external marketing environment. The key destabilizing factors for the external environment of the pharmaceutical market are identified and characterized: the Covid-19 epidemic, introduction of man-datory labeling of medicines, overstocking of the pharmaceutical market with the stabilization of the pandemic situation, a sharp increase in geopolitical tensions, and an increase in the sanctions pressure. The decrease in the supply chain resilience at the distribution stage in the Russian pharmaceutical indus-try is proven on the example of the non-prescription drugs segment under the influence of external shocks to the industry. The stability of this trend has been revealed against the background of deepening geopolitical tensions, tightening of the sanctions restrictions, transformation of the Russian advertising market, and the decrease in the purchasing power of the population. The authors have substantiated the need for pharmaceutical companies to adapt to the described situation through developing the automa-tion and digitalization of business, increasing the role of tactical marketing planning, and digitalization of sales and changing the composition of analytical departments.

OLDER ADULT PREFERENCES FOR THE FORMAT AND CONTENT OF PRESCRIPTION MEDICATION LABELS

Abstract The risk of misinterpreting prescription medicine labels (PMLs) is higher among older adults. Given the limited space on PMLs, their format and content should cater to older adults’ medication information and legibility needs. We established the ranking of seven medication-related content variables (indication, precautions, interaction or paired medicines, food instructions, side effects, expiry date, and missed dose action; provision of these content is currently not legally mandated) to be prioritised on PMLs using best-worst scaling (BWS), and determined the relative utilities of five format attributes (presentation of dose-frequency instructions, font size, presentation of dose, presentation and colour of precautions) when incorporated onto PMLs using discrete choice experiment (DCE), from the perspective of older Singaporeans. The variables and attributes were informed by our prior qualitative study and best practices guidelines for PMLs. We recruited 280 older adults (mean age: 68.8±5.4 years). A BWS object case was used to evaluate the relative importance of medication-related content variables (range: 0 to 1). A mixed logit model estimated the relative utilities of attribute levels, which enabled calculation of importance scores for ranking the format attributes (range: 0% to 100%). The three most-preferred content variables were indication (1.000), precautions (0.853) and interaction or paired medicines (0.845). The top three format preferences were tabular presentation of dose-frequency instructions (43.7%), large font size (22.3%) and precautions in red colour (13.6%). The findings inform an actionable way to improve the content and format of PMLs in the real-world, which is aligned with the stated priorities of older adults.

The relevance of real-world data for the evaluation of neuropathic pain treatments.

Treatment of neuropathic pain (NP) is challenging. Interest in real-world evidence (RWE) for benefit-risk assessments of NP treatments increases given the paucity of drugs showing efficacy in randomized controlled trialsand restricted labels of available medicines. To provide further context, a literature review regarding regulatory use of RWE and a clinical trial registry search for randomized controlled trials over the last 10 years was carried out. Taken together, and especially for available NP treatments, there is increasing support to consider RWE when evaluating their benefit-risk profile. Examples are provided in which RWE could be used effectively for updating the product label and informing treatment recommendations. Collected and analyzed according to state-of-the-art standards, RWE can inform treatment recommendations and product label decisions.

Compliance of Private Primary Health Care Facilities Towards Requirements of Labelling of Dispensed Medicine in Sarawak.

Compliance towards the requirements of labelling of dispensed medicine (LDM) among private primary health care facilities ensures appropriate use of medicines. This study aimed to examine the rate of compliance towards the requirements of LDM among retail pharmacies (RPs) and private medical clinics (PMCs). A cross-sectional study was conducted from April 2019 to January 2020 across all inspected premises in Sarawak. Publics who attended RPs and PMCs and have medicines dispensed have their medicine labels examined for compliance with the requirements of LDM upon exiting the premises. Their verbal consents were obtained and the compliance score was recorded into self- -developed data collection forms. The compliance rate was the percentage of requirements on the examined medicine labels that fulfill the requirements under Regulation 12 of Poisons Regulations 1952. A total of 414 LDM were examined, with 135 from RPs and 279 from PMCs. The full compliance towards the requirements of LDM among RPs and PMCs were 23.7% and 41.6%, respectively. The median compliance score of PMCs (0.83) was significantly higher (P<0.001) than RPs (0.67). The requirements of LDM with the lowest compliance were name of medicine (53.1%), followed by name of patient (31.9%) and date of dispensing (25.6%). The full compliance rate on the requirements of LDM among RPs and PMCs were low. More stringent enforcement and public education on their rights for fully compliant medicine labels could improve the compliance.

Comparing comprehensibility of standard and enhanced prescription medicine labels: a randomized simulation.

The objective of this study is to develop and user-test the comparative effectiveness of two enhanced label designs to improve comprehension of patients with low English proficiency versus a standard label representative of the pharmacist-affixed medicine labels currently used in practice. Using a randomized two-group study design, 66 participants from Sydney, Australia were allocated to view a set of standard labels followed by a set of enhanced labels named 'linguistically enhanced labels' or 'linguistically and graphically enhanced labels'. Each set of labels depicted medicine directions of three levels of complexity, which participants viewed consecutively. The 'enhanced labels' incorporated several features documented in the literature as improving understanding of low-health-literate/linguistically compromised individuals such as translated directions in a language the person is more proficient in, numeric presentations of numbers/counts, carriage returns and graphic depiction of directions. A user-testing questionnaire relating to comprehensibility was conducted after each label was viewed. Differences in comprehensibility were assessed using a generalized linear model, Cochran-Mantel-Haenszel test for trend and a chi-square test. Results indicated significant improvements in comprehensibility with both types of enhanced labels compared with standard labels (P < 0.0001). The 'linguistically and graphically enhanced label' improved comprehensibility of the most complex directions to a greater extent than the 'linguistically enhanced label' (P < 0.0001). This study has highlighted the scope for improvement of existing pharmacist-affixed prescription medicine labels to ensure better understanding by individuals with low English proficiency. The enhanced labels trialled presented a means with which this may be achieved through the incorporation of key design elements, such as simpler, translated and graphically supported directions.

Regulatory requirements and labeling of commercially available prescription (oral) medicines in Sri Lanka: there is room for improvement

BackgroundThe consistency and the quality of medicine labels are sought through the regulatory frameworks. This study aims at investigating the secondary labels of medicines based on the labeling regulations and guidelines issued by the National Medicines Regulatory Authority (NMRA), Sri Lanka.MethodsA descriptive cross-sectional study was conducted on 53 commonly used prescription-only oral medicines selected using the price regulations published for most commonly used drugs. High-resolution images of 216 brands/branded generics/generic products’ secondary labels were collected in April 2021 from six community pharmacies in six districts chosen as a convenience sample. Each label was manually assessed using a checklist prepared based on the regulatory requirements by four trained investigators. The status of registration of each product was assessed using the NMRA website. Descriptive statistics were performed.ResultsThere was a variation observed in labeling regulations and information present on packages. Among the 216 products evaluated, only 148 (68%) products appeared as registered medicines on the NMRA website, and 2.3% of medicines fulfilled all stipulated labeling parameters set out by the NMRA, 3% of products abided by the general labeling requirements, and 76% of the products complied with labeling requirements for API. Major deficiencies were observed in the presentation of registration numbers and the details of the local agent, which were unaccounted for in 210 (97%) and 131 (61%) products, respectively. The highest consistency (100%) of information was noted with the dosage form, date of manufacture, date of expiry, and batch numbers. Among the restricted information, attractive pictures (2%), web addresses (6%), and over-stickers (34%) were found.ConclusionsThe results highlighted a gap between regulatory requirements and practice in medicine labeling information. Regular post-market examination of medicinal labels is highly advised in a country that relies largely on imports. Similarly, careful adherence to the labeling regulations is required. Furthermore, suppliers and local agents should be held accountable for ensuring accurate medicine labeling through increased awareness, education, and sanctions.

The Pattern of Medicine Use in Ethiopia Using the WHO Core Drug Use Indicators.

Introduction Rational medicine use is an appropriate prescribing, dispensing, and patient use of medicines for the diagnosis, prevention, and treatment of diseases. It is affected by several factors. Irrational use of medicine is a widespread problem at all levels of care. This review is aimed at assessing the medicine use pattern in health facilities of Ethiopia using the medicine use pattern developed by WHO/INRUD. Methods Relevant literature was searched from Google Scholar, PubMed, Hinari, Web of Science, and Scopus using inclusion and exclusion criteria. A systematic review was used to summarize the medicine use pattern in health facilities of Ethiopia, and that WHO core drug use indicators were employed. Result From 188 searched studies, 30 literatures were reviewed. The average number of drugs per encounter was 2.11. The percentage of encounters with antibiotics and injection was 57.16% and 22.39%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 91.56% and 90.19%, respectively. On average, patients spent 5.14 minutes for consultation and 106.52 seconds for dispensing. From prescribed drugs, 67.79% were dispensed, while only 32.25% were labeled adequately. The availability of key essential medicines was 64.87%. The index of rational drug use value was 7.26. Moreover, the index of rational drug prescribing, index of rational patient-care drug use, and index of rational facility-specific drug use were 3.74, 2.51, and 1.01, respectively. Conclusion Ethiopian health facilities were faced with antibiotic overprescribing, short consultation, and dispensing times, poor labeling of medicines, poor availability of key drugs, and nonadherence to the essential drug list. Routine, multidisciplinary awareness creation, and regulation should be implemented to promote rational medicine use at a national level.

Legal Basis for Remote Sale of Medicines in the Russian Federation

The topic of the article is very relevant, first of all, due to the fact that today the development of the information and telecommunication services market involves almost all areas of people’s life in the field of e-commerce. Until April 2020, it was not possible to purchase a medicinal product online on the territory of the Russian Federation due to the lack of a regulatory legal framework regulating such a mechanism. However, at the moment, the relevant legislation has entered into force, regulating in detail the sale of medicines in a remote format. Taking into account the presented circumstances, it seems to us that the issue of studying new legislative acts in the field of remote sale of medicines on the territory of the Russian Federation is largely being updated. The subject of the article is the mechanism of legal regulation of remote sale of medicines in Russia. The purpose of the study is to identify the problems of legal regulation of the process of remote sale of medicines in the Russian Federation at the present stage. This research is based on a combination of groups of classical general scientific methods (induction, deduction, analysis, synthesis) and a number of special methods of scientific cognition applied directly within the framework of legal science (formal legal, comparative legal and others). Within the framework of the presented article, the authors carried out a conceptual analysis of the features of the legal regulation of the sale of medicines using remote technologies, taking into account the latest changes in legislation. The specifics of remote trade in prescription and over-the-counter drugs, as well as the peculiarities of labeling of medicines on the territory of the Russian Federation, are analyzed. As a result of a comprehensive study of current trends in regulatory regulation and justification of possible methods for improving the systems for issuing electronic prescriptions, as well as mandatory labeling of medicines, a conclusion is made about the possibility of further development of remote trade in medicines in the Russian Federation.

A retrospective study on the evaluation of the appropriateness of oral anticoagulant therapy for patients with atrial fibrillation.

The incidence of atrial fibrillation (AF) is increasing, and effective anticoagulation therapy can prevent adverse events. Selecting the appropriate OAC based on patient characteristics has become a challenge. Interventions are going to be a potential area of focus. To explore the discrepancies between clinician prescriptions and recommended guidelines of oral anticoagulants (OACs) for patients with atrial fibrillation (AF), and to provide direction for improving anticoagulation strategies for treating patients with AF. Data were collected from the electronic medical record system of Fuwai Yunnan Cardiovascular Hospital between July 2019 and January 2020. The suitability of prescribed OACs for patients with AF was assessed according to the Rules for Avoiding Prescription Inappropriateness, the prescribed medicine label, and any relevant antithrombotic guidelines for treating patients with AF. A total of 460 patients met the inclusion criteria. Of these, 53.7% received an appropriate prescription and 46.3% received an inappropriate prescription. Of the patients who received inappropriate prescriptions, 15.4% were prescribed without the presenting appropriate indicators, 1.3% were prescribed inappropriate drug selection, and 29.6% were prescribed inappropriate drug doses. For patients prescribed without providing appropriate indicators, 2.2% had no indication for medication and 13.3% had an indication for medication, but not a specific OAC. For patients with inappropriate drug selection, 1, 5 patients were on rivaroxaban, dabigatran respectively. The distribution of NOAC doses was as follows: dabigatran standard dose (45.2%), the low dose (54.8%). Rivaroxaban standard dose (58.9%), low dose (36.8%), high dose (4.3%). A total of 44 patients (9.6%) experienced bleeding events, 12 patients (2.6%) experienced embolic events, and 7 patients experienced other adverse events after dosing. In clinical practice, it is common for patients with AF to receive inappropriate prescriptions of OACs. Therefore there is a need to enhance anticoagulation management in patients with AF to improve the appropriate use of OACs.

Drug use pattern using WHO core drug use indicators in public health centers of Dessie, North-East Ethiopia

BackgroundRational drug use requires that patients receive and take medication appropriately. Though the process of diagnosis and pharmaceutical care is complex, World Health Organization (WHO)/international network for rational use of drugs (INRUD) core drug use indicators investigate drug use to minimize the hazardous effect of the drug and enhance the wise use of scares resources. This study assessed drug use patterns in health centers of Dessie town using WHO/INRUD indicators.MethodsA cross-sectional study was conducted in public health centers of Dessie town. Data were retrospectively collected from 1500 prescriptions dispensed from January 1, 2018, to December 31, 2018 using WHO data collection tool to assess prescribing indicators. For patient care and health facility indicators, 600 patients and 3 health centers were prospectively reviewed. Systematic random sampling was used to select samples. Data were analyzed using the Statistical Package for the Social Sciences version 20.ResultsThe average number of drugs per encounter was 2.1. The percentage of encounters with antibiotics and injection was 44% and 13.9%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 98% and 100%, respectively. On average, patients spent 4.7 min for consultation and 105 s for dispensing. From 1305 prescribed drugs, 92% were dispensed, while only 4% were labeled adequately. More than half (54.8%) of patients had adequate knowledge of their medication. None of the health centers had an essential drug list. The availability of key essential medicines was 64.10%.ConclusionThis study demonstrated irrational drug use practices in all healthcare facilities. Polypharmacy, antibiotics over-prescribing, short consultation and dispensing times, inadequate labeling of medicines, inadequate level of patients' knowledge about prescribed medicines, and unavailability of key drugs in stock were found to be the major problems. Continuous refreshment trainings on rational use of drugs and WHO recommendations should be given for prescribers and pharmacists. Further, we recommend studies involving large number of facilities to estimate overall prescribing practices.

Developing and user testing new pharmacy label formats-A study to inform labelling standards.

BackgroundDispensed prescription medicine labels (prescription labels) are important information sources supporting safe and appropriate medicines use.ObjectiveTo develop and user test patient‐centred prescription label formats.MethodsFive stages: developing 12 labels for four fictitious medicines of varying dosage forms; diagnostic user testing of labels (Round 1) with 40 consumers (each testing three labels); iterative label revision, and development of Round 2 labels (n = 7); user testing of labels (Round 2) with 20 consumers (each testing four labels); labelling recommendations. Evaluated labels stated the active ingredient and brand name, using various design features (eg upper case and bold). Dosing was expressed differently across labels: frequency of doses/day, approximate times of day (eg morning), explicit times (eg 7 to 9 AM), and/or explicit dosing interval. Participants’ ability to find and understand medicines information and plan a dosing schedule were assessed.ResultsParticipants demonstrated satisfactory ability to find and understand the dosage for all label formats. Excluding active ingredient and dosing schedule, 14/19 labels (8/12 in Round 1; 6/7 in Round 2) met industry standard on performance. Participants’ ability to correctly identify the active ingredient varied, with clear medicine name sign‐posting enabling all participants evaluating these labels to find and understand the active ingredient. When planning a dosing schedule, doses were correctly spaced if the label stated a dosing interval, or frequency of doses/day. Two‐thirds planned appropriate dosing schedules using a dosing table.ConclusionsEffective prescription label formatting and sign‐posting of active ingredient improved communication of information on labels, potentially supporting safe medicines use.Patient and Public InvolvementConsumers actively contributed to the development of dispensed prescription medicine labels. Feedback from consumers following the first round was incorporated in revisions of the labels for the next round. Patient and public involvement in this study was critical to the development of readable and understandable dispensed prescription medicine labels.

Characterization of VigiBase reports on tinnitus associated with bisoprolol—An exploratory and descriptive study

The aim of this descriptive and explorative study was to assess individual case safety reports of bisoprolol associated with tinnitus and investigate their added value in information about adverse drug reactions (ADRs) in relation to information provided in medicine labels. The global reports from VigiBase, the WHO database of individual case safety reports, as of May 3, 2020, were analyzed for information about bisoprolol associated with tinnitus as an ADR affecting the quality of life of the patients. There were 123 reports of the ADR tinnitus reported with intake of bisoprolol in VigiBase. These described experiences of tinnitus and how this impacted on patients’ daily life, for example, it could be long‐lasting and may have negative impact on sleeping, and even ability to work and keep a job. There were also reports describing the management of the reaction, for example, recovery upon stopping the treatment, and improvement of the symptoms following a decreased dose or change of medicine batch. Based on reports in VigiBase, the ADR tinnitus associated with bisoprolol suggests vigilance for the onset of the event and that, if it occurs, a dose reduction or stopping the treatment could be necessary. The information provided in the reports shows the value of individual case safety reports collected post marketing, in providing descriptive information of the experience and management of the ADR.

The effectiveness of using text and pictograms on oral rehydration, dry-mixture sachet labels.

BackgroundMedication labels are often the only information available to patients after obtaining medication from a healthcare practitioner. Pictograms are graphic symbols that have shown to increase understanding of medicine use instructions.AimTo compare the accuracy of the interpretation of medicine use instructions from two different oral rehydration (OR) dry-mixture sachet labels – the control ‘routine textonly’ label and an experimental label with ‘text-and-pictograms’.SettingParticipants were recruited from waiting rooms in public primary health care (PHC) facilities in Cape Town.MethodEach participant was required to answer six questions about OR preparation. Response accuracy was determined by comparing the participant’s answer to the actual information written on the relevant label. Afterwards, participants could offer their opinion about the label and ways to improve their understanding.ResultsOf the 132 participants who were recruited, 67 were allocated to the experimental group and 65 to the control group. Only the significant difference between the experimental and control groups for the six questions regarding the label, was recorded for the answer that could be read from a single pictogram (p = 0.00) on the experimental group’s label. When asked about this question, more control participants (15/65) found the dosing instruction difficult to understand when compared to the experimental group (1/67). A third of the control participants (22/65) indicated that they could not see or locate instructions on the label.ConclusionText and pictograms on written medicine labels may be an effective tool to aid understanding of medicine use instructions amongst patients attending PHC facilities.

A questionnaire based cross sectional study to assess the knowledge and perceptions regarding concept of rational use of medicines among second year medical students

Background: The main goal of teaching clinical pharmacology, concept of rational usage of medicines to medical students is to imbibe the knowledge, skills so that in future as a clinicians they will be able to weigh the potential benefits versus risks of a treatment along with its cost-effectiveness. Objective: To assess the knowledge, attitude and perceptions about rational use of medicines in second year medical students. Materials and Methods: This was a questionnaire -based, cross-sectional study. The study participants were second year medical students (152). The questionnaire was designed to assess the knowledge, perceptions about rational usage of medicines. Results: Were expressed as counts and percentages. Majority of respondents were aware about over the counter medicines (72%), importance of reading medicine label (86%). Majority of the students 84% purchased all medicines written in prescription. Conclusion: Majority of the students were aware about the concept of rational usage of medicines which seems to be a positive finding. Keywords: Rational use of medicines, Knowledge, Perceptions.

Perceptions, Attitudes and Use of Pharmacy Customers to Medicine Labels

Background. The safe use of medicines largely relies on consumers reading the labeling and packaging carefully and accurately, and being able to comprehend and act on the information presented. We aimed to conduct local study on consumers’ perceptions, attitudes and use of written drug information. Methods. A survey included 200 adults of the public in 13 community pharmacies and one main hospital (the University Hospital) in Tripoli city of Libya, using a structured interview technique. Results. The results showed that 73% of participants read drug labels with variation from always (39.72 %) to rarely (10.95%). About 42.46% of pharmacy customers read the Patients Package Inserts (PPIs) routinely, however; 53.42% of them faced difficulties in understanding the labelling. Foreign languages and small font sizes of written information were the most barriers to participants` comprehensibility (44.69 %, 34%) respectively. The findings indicated that 59 % of the respondents were used to obtain information from pharmacists. Despite the relatively high rate of reading to drug labels among pharmacy customers; more than half of them were unable to interpret information correctly. Conclusion. The study demonstrated the need for the implementation of educational and awareness programs for patients by pharmacists to improve the health literacy of medication labels. Steps must be taken to ensure that medicines in Libyan market are supplied with bilingual and non-technical language labels.

Quality of Drug in Health Facilities: A Cross-sectional Study.

Poor quality drugs result minor to detrimental effect on human health. The drug should be of standard quality and should be used appropriately in order to meet its therapeutic efficacy. This study aims to assess the quality of drug in Nepal. A cross sectional study was conducted in randomly selected 88 health facilities in Nepal from 10th April to 30th June 2016. Selective medicines were collected from both private licensed pharmacies and selected public health facilities. Face to face interview with health facility in-charge of selected health facilities was carried out along with the direct observation of the medicine storage room. The collected medicine samples were dispatched to two laboratories for in-vitro analysis. The labels of the collected medicine were analyzed. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft excel 2007 and analyzed in SPSS version 20. Out of 172 brands, nine brands of medicines were found substandard. Information regarding storage conditions, direction for use and category of the drug were lacking in the label of some brands of medicines. Some selected health facilities were found not meeting major requirements for drug storage: protection from sunlight, moisture, heat, well ventilation and proper sanitation. Few drugs were found to be substandard in Nepalese market from both public and private sectors. Adequate labeling and proper storage condition of medicines in health facilities were lacking.

Relationship of pH and the viscosity of five different iron supplements with the absorption of iron ions and enamel discoloration in the anterior primary teeth (an in vitro study)

Various iron drops are prescribed to children to prevent iron-deficiency anemia. The current study aimed to evaluate and compare the physicochemical profile of iron drops and the effect of these medicines on the color of primary teeth. On the commencement of this experimental study, the pH and viscosity of five types of iron drops were measured. For the purpose of the current study, sixty healthy anterior deciduous teeth were provided; thereafter, they were assigned to five groups and then exposed to iron drops. The color and color difference of each specimen were measured by VİTA Easyshade Compact after 2 weeks. The amount of absorbed iron was determined by atomic absorption. The data were analyzed using two-way ANOVA and Tukey's test (P < 0.05). As evidenced by the obtained results, all medications demonstrated acidic pH and discoloration. The viscosity values of iron drops were reported to be within the range of 2.07-33.58 cP. Based on the results of Pearson's correlation coefficient test, discoloration showed a correlation with pH and atomic absorption (P < 0.05). Analyzed iron drops displayed low pH and discoloration higher than 3.3 which can be easily distinguished with naked eyes. Medicine labels should include warning statements on the feasibility of dental discoloration and erosion.

Evaluation of Community Pharmacists' Professional Practice and Management of Patient's Respiratory Conditions.

Objectives:We assessed the extent of community pharmacists managing respiratory conditions and their ability to make differential diagnoses between the common cold and allergic rhinitis.Methods:A simulated patient technique was used to achieve the study objectives. Thirty community pharmacies were randomized to be visited by a patient with allergic rhinitis symptoms, followed by a patient with common cold symptoms, and vice versa. One simulated patient visited the 15 pharmacies assigned to allergic rhinitis. Then, after 3–4 days, the pharmacies were revisited by a second simulated patient using the same symptoms; likewise, a simulated patient visited the other 15 pharmacies with common cold symptoms. Then, these pharmacies were revisited by the other simulated patient with the common cold symptoms. Descriptive statistics and correlation analyses were carried out using SPSS at alpha 0.05.Results:Fifteen pharmacies were used for the common cold scenario and 15 for the allergic rhinitis scenario (a total of 30 visits per scenario). Pharmacists showed overall poor skills in asking questions for differential diagnosis between the two conditions. No significant difference was found in the overall differential diagnosis score between the two groups (P = 0.744). The overall adherence to the labeling standard score was low, with an average of 2.38 (standard deviation [SD] = 2.50) out of 11, with no significant difference between the two scenarios (P = 0.332). The overall adherence score to the counseling standard was low, with an average of 2.93 (SD = 3.74) out of 15, with no significant difference between the two scenarios (P = 0.586).Conclusion:The simulated patient technique approach revealed a lack of ability of pharmacists in Amman, Jordan, to make differential diagnoses between the common cold and allergic rhinitis. In addition, pharmacists lacked the ability to carry out their role with respect to the management of the common cold and allergic rhinitis, including treatment recommendations, adherence to medicine labeling standards, and adherence to the counseling standard.

Evaluation of use, comprehensibility and clarity of over-the-counter medicine labels: Consumers' perspectives and needs in Taiwan.

An estimate of one third of preventable medication errors occurred annually due to patients' misunderstanding of use instructions. To safeguard consumers' over-the-counter (OTC) medicine use and to develop future initiatives, this study evaluated the use, comprehensibility and clarity of the information labels on OTC packages from consumers' perspectives in Taiwan. This cross-sectional study was conducted at 29 community pharmacies; 50 pharmacy clerkship students helped participant enrolment from June to September 2017. Participants (n=470) were 20years old or above, Mandarin speaking, and with specific OTC purchases. A face-to-face survey was administered to investigate the degree to which participants read the package labels and their comprehension of correct medicine use. An 11-item survey was used to measure participants' specific OTC purchases (3 items), the use (2 items), comprehensibility (1 item) and clarity (2 items) of OTC package labels, in addition to the sociodemographic information (3 items). Participants were also solicited to provide opinions regarding package label redesign. Descriptive statistics and logistic regressions were applied for analyses. Findings show that most (84.0%) participants read instruction labels before use, with indications (79.4%), drug names (64.5%) and dosage and administration (59.8%) being the top reads. Only 30.0% of the participants fully understood how to take the medicines correctly. Younger (OR=1.033, p<.001) and female participants (OR=1.965, p=.014) with a higher level of education (OR=1.940, p=.034) tended to read package label information prior to purchase or use. Younger participants (OR=1.030, p<.001) and those who read OTC medicine labels before use (OR=2.317, p=.004) were more likely to correctly understand medicine use. The findings indicate that older, male adults with a lower level of education should be targeted to ensure their correct understanding of OTC labels. Pharmacists should recite pertinent label information and, concomitantly, ensure consumers' understanding when providing medicine counselling.