Written Drug Information Research Articles

Factors Influencing Consumer Use of Written Drug Information

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. 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. 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. 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. 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). 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.

Designing an Information Leaflet: using consumer-oriented research to inform the development of a drug resource for children

This project was commissioned to develop a written drug information resource for children and from this to develop a model of good practice. The article focuses on the way the resource was designed using a consumer-oriented approach. The research was undertaken in three stages: ” Stage one: listening . Identification of the mindset of the children and needs assessment of both children and parents and teachers. This also included a review of the literature. ” Stage two: interpreting . Development and design of resources based on the findings of the first stage, the literature review and the views of parents and professionals. ” Stage three: evaluation . Piloting the material and obtaining feedback from children, teachers and parents. The results from stage one resulted in a decision to focus on drug use and skill enhancement as opposed to the provision of factual information about drugs. The study attempted to consult and keep in touch with consumers with the aim of producing effective and innovative communication. The resulting resource allowed children to establish their own position in relation to drug use and was therefore capable of meeting the differing needs of different groups of children.

Knowledge of and attitudes to pharmacotherapy in medical inpatients.

To analyze different aspects of patients' knowledge and attitudes to pharmacotherapy in medical inpatients. 183 patients hospitalized in the Department of Medicine of University Hospital "Merkur", Zagreb, Croatia were investigated. A questionnaire was designed to investigate patients' knowledge of drugs they were taking before admission to the hospital and drugs they are receiving during hospitalization. Patients were asked to give drug names, dosage and reasons for their prescription. Patients' rating of the importance of some drug characteristics (dosage, indication, precautions, side-effects, mode of action) was evaluated. A representative group of patients (mean age 55.5 years, range 17-86, SD 16.1; 89 men, 94 women; 50 hematological, 44 cardiological, 50 gastroenterological and 39 nephrological patients) showed a significantly better (p < 0.000001) overall knowledge of drugs taken prior to admission compared to the knowledge of drugs that they were receiving during hospitalization. Overall drug knowledge did not differ significantly between groups of patients stratified according to gender, ward, number of drugs they were taking or duration of treatment. In older patients (p < 0.0001) and in those with lower education (p < 0.001) a significantly worse overall knowledge was observed. On a 1-5 semiquantitative scale patients rated dosage as the most important and mode of action as the least important drug characteristic (average 3.62 and 2.08, respectively). Of all patients, 94.5% pointed out physicians as one of their sources of drug information, written drug information followed in 40.4% and pharmacists in only 11.5% of patients. Our results agree with the results of the few similar studies published to date. A need for better health education of patients is underlined and possible ways of providing drug information for patients are discussed. The need for improvement of physician-patient transfer of drug information as well as the need for written drug information tailored according to patients' needs is underlined.

在宅要介護高齢者の薬剤知識と服薬コンプライアンス 文書による薬剤情報提供の効果

Pursuant to the revision of the Pharmacists' Law in April, 1997, we pharmacists have the responsibility to provide information to patients about medications. However, it is uncertain as to wheter written information is effective enough for the elderly living in our community.Our research focused on the results of providing written drug information to 161 elderly homecare recipients aged 65 and older. Medication use was observed by pharmacistconducted interviews during home visits. Compliance was estimated by comparing the prescribed regimens with medications actually being taken at home. Knowledge about medications was also analyzed. Our results showed that the elderly home-care recipients knew only 2.4% of the names, 34.2% of the purposes, 66.0% of the dosages, 2.0% of the side effects, and 0.06% of the interactions of their prescribed medications.We found that written drug information significantly increased the patients' knowledge of the name of the diseases, the purposes of the drugs, and the side effects. However, such knowledge did not improve the compliance among the elderly. Medication knowledge was also not affected by written drug information when the elderly patient had a hearing or visual impaiment. Nevertheless, we found that there was significant inverse association between knowledge of the name of the drug and compliance among those elderly patients who had a visual impairment without any written drug information.It is therefore crucial that pharmacists provide elderly home-care recipients with not only verbal but also written information about their medications.

患者用説明書とくに副作用情報によるコミュニケーション効果

患者用説明書とくに副作用情報によるコミュニケーション効果

Attitude of physicians toward patient package inserts for medication information in Belgium.

In Belgium, the distribution of medications to outpatients in community pharmacies is almost exclusively by branded unit-of-use packages, with a package insert inside every package. At the time of the study (spring 1990), the implementation of legislation that mandated a shift from highly technical documents to patient package inserts (PPIs), understandable by the lay person, had begun. This study explores the attitude of practising physicians toward written medication information for patients. A mail questionnaire was sent to 1500 (8% random sample) Belgian general practitioners and to 500 (22% random sample) internal medicine specialists. A total of 543 usable questionnaires were returned (27.5% return rate). Ninety-two percent of the physicians stated that their patients seldom or never requested additional information on drug efficacy or side effects, during routine consultation; 30% estimated that more than half of their patients read the PPI; 75% expect that a patient would experience side effects after reading about them in the PPI; 59% agreed that the PPI could help the patient react more adequately in unforeseen situations. It was possible to cluster the respondents in a stable segmentation of three clusters: moderately positive physicians (20%), ambiguous to neutral physicians (44%), physicians overtly negative to written drug information (36%). The low response rate to this extensive postal questionnaire limits the conclusions to a qualitative description of relevant clusters of respondents. In contrast with the opinion of physicians about patient readership, results from other studies indicate that the vast majority of patients read the package inserts.

The Impact of a Drug Information Sheet on the Understanding and Attitude of Patients About Drugs

A proposed Food and Drug Administration program to require written information with prescription drugs could cost $500 million annually; the American Medical Association has implemented a similar, voluntary program costing more than $3 million. However, the educational impact of written drug information has not been studied. We evaluated one-page drug information sheets using an objective examination. The baseline score of 71 patients was 3.9 of 6.0. Patients tested before and one day after receiving the drug sheet improved their score by +1.4. In the second phase, patients randomized to receive the drug sheet improved their score after one month by +1.1; those not given the sheet had no improvement. Changes in attitudes and incidence of reported adverse effects seemed to be random and unrelated to the information sheet. Thus, a drug information sheet may be a useful adjunct to patient education.

Evaluating Performance in Writing Drug Information Consultations

A form for evaluating written drug information consultations was used to measure the performance of pharmacy students in a drug information service clerkship; the reliability of the evaluation process was also assessed. Drug consultations were written by 74 clerks during a four- or five-week rotation. A total of 147 consultations were written: Nine clerks wrote one consultation, 57 clerks wrote two, and eight clerks wrote three. The consultations were evaluated on 11 criteria by 18 different preceptors using an evaluation form. Performance on each criterion was rated on a four-level scale. Clerk improvement over time, reliability of the instrument, and inter-rater reliability for preceptors were analyzed statistically. The overall mean score for all consultations was 84 7%. Some improvement was observed between the first and second consultations completed by clerks, but the difference was not significant. Reliability of the evaluation process was good (coefficient of alpha = 0.666). There as no significant difference among preceptors. The authors concluded that the written drug information consultation evaluation form was a valid and reliable method for measuring individual and program competence.

Consumer reactions to the tone of written drug information

Emotional and cognitive reactions to four different patient package inserts (PPIs) describing flurazepam were tested. All documents contained the same basic information. However, this information was presented in a frank manner to half the subjects and in a reassuring manner to the other half. In addition, in both cases, drug side effects were presented either as a list or in paragraph form. Study subjects--456 members of a college community--each read one of the PPIs and then completed a self-administered questionnaire that had 10 multiple-choice questions about flurazepam and 19 scaled questions focusing on semantics. The frank version was judged clearer, more interesting, longer, and more appropriate for an adult audience. Tone also affected which items of information in the PPI were remembered best, possibly because it helped to establish which information was considered most important. Caution should be observed in generalizing the study conclusions until they are corroborated by research on a wider patient population.

Consumer reactions to differing amounts of written drug information.

Four prototype patient package inserts (PPIs) for erythromycin were tested in an analog study using 325 individuals drawn from a college community. There was no difference in the total amount of knowledge communicated by the different PPIs, but results for individual test items suggest (1) that more explicit information may be better recalled, and (2) that longer PPIs may aid in information integration, whereas shorter PPIs may aid in pure recall of facts. PPIs containing elaboration on why drug effects occur were rated by the subjects as more "accurate." Subjects tended to rate PPIs that provided behavioral instructions on what to do if certain drug effects occurred as designed to promote better care.

Patient comprehension of written drug information

The effect of the readability level of patient drug information materials on patient comprehension of and attitude toward the information was studied. The reading level of 108 outpatients at a Veterans Administration hospital who could read English, read type of normal size, and who were not receiving warfarin sodium was measured. Patients then were given, on a random basis, a warfarin drug monograph written on either the 5th- or 10th-grade level. To test comprehension, all subjects took a true-false test of recall written at the 5th-grade level. A significant relationship was found between comprehension and reading ability (p less than 0.001). Patients receiving the 5th-grade level monograph exhibited significantly better comprehension than those receiving the 10th-grade level material (p less than 0.001). As compared with those getting 10th-grade material, the group receiving the 5th-grade material had a more favorable perception of the level of difficulty, understandability, and clarity of the material. The study indicates that comprehension of written patient drug information can be improved by adjusting the readability of informational materials to the reading level of the patients.

Effects of written drug information on patient knowledge and compliance: a literature review.

The prospect of patient-oriented prescription drug labeling has focused increased attention on the effectiveness of written information for the consumer. Studies which have evaluated the effects of written prescription drug information in a patient population are reviewed. Several studies indicate that written information can be effective in improving patient compliance with regimens for antibiotic therapy. However, for drugs used on a long-term basis, written information as a sole intervention has not been shown to be sufficient for improving patient compliance. Patient knowledge of less commonly known information, such as precautions, side effects, or special directions is frequently improved by written information. Listing a drug's side effects has not been shown to increase the reported experience of side effects; however, one study suggests that patients may be more willing to report side effects to a health professional if they are listed in the written information. The trend for recent studies has been to focus on the "milieu" in which written information is provided or to systematically vary structural features of the information in order to improve the quality of drug communications.

Patient Attitudes About Two Forms of Printed Oral Contraceptive Information

The desired form and style of written drug information for patients were assessed in a national survey of oral contraceptive (OC) users. These women were queried about two forms of OC information: a short insert included with dispensed drugs and a longer brochure delivered by the physician upon patient request. Longer and more detailed information, especially concerning drug dangers and directions for use, was strongly preferred. Younger and more educated women were more likely to report receiving the OC brochure and to desire more comprehensive information. Most respondents found information in both the insert and the brochure clear and useful, and felt it was important to include written information with other prescription drugs. The longer brochure was preferred over the shorter insert as a model of drug information to be included with additional drugs.

Laymens' knowledge on the correct use of drugs

SEVERAL investigations have shown that patients use drugs improperly, including abundant self medication and neglect of directions of pre scribed drugs (Dunnel et al, 1972; Haggerty et al, 1972; Marston, 1970; Murray, 1972; Stewart et al, 1972; Stimson, 1974; Office of Health Economics, 1968). The reasons for this have been sought mainly by ex amining characteristics of the patients. The patients' know ledge on drugs has not been related to the habits of using drugs. This study surveys the extent of knowledge on drugs among people living in the countryside. It also reports data on whether written drug information given in con nection with a health ex amination increases know ledge on drugs.