Need to help patients simplify complex prescription regimens

January 01, 0001

Need to help patients simplify complex prescription regimens

There is considerable variability in the manner in which prescriptions are written by physicians and transcribed by pharmacists, resulting in patient misunderstanding of label instructions. A universal medication schedule was recently proposed for standardizing prescribing practices to 4 daily time intervals, thereby helping patients simplify and safely use complex prescription regimens. These US authors investigated whether patients consolidate their medications or whether there is evidence of unnecessary regimen complexity that would support standardization. They conducted structured interviews with 464 adults (age range, 55-74 years). Participants were given a hypothetical, 7-drug medication regimen and asked to demonstrate how and when they would take all of the medications in a 24-hour period.

They found: "Participants on average identified 6 times in 24 hours to take the 7 drugs. One-third of the participants (29.3%) dosed their medications 7 or more times per day, while only 14.9% organized the regimen into 4 or fewer times a day. In multivariable analysis, low literacy was an independent predictor of more times per day for dosing the regimen. Instructions for 2 of the drugs were identical, yet 31.0% of the participants did not take these medications at the same time. Another set of drugs had similar instructions, with the primary exception of 1 drug having the added instruction to take "with food and water." Half of the participants (49.5%) took these medications at different times. When the medications had variable expressions of the same dose frequency (eg, every 12 hours vs twice daily), 79.0% of the participants did not consolidate the medications."

The authors concluded: "Many patients, especially those with limited literacy, do not consolidate prescription regimens in the most efficient manner, which could impede adherence. Standardized instructions proposed with the universal medication schedule and other task-centered strategies could potentially help patients routinely organize and take medication regimens."

This study clearly demonstrates the need for intervention studies to help patients take their medications when the regimens are complex.

For the full abstract, click here.

Arch Intern Med 171(4):300-305, 28 February 2011
© 2011 to the American Medical Association
Helping Patients Simplify and Safely Use Complex Prescription Regimens. Michael S. Wolf, Laura M. Curtis, Katherine Waite, et al. Correspondence to Dr. Wolf:

Category: HSR. Health Services Research. Keywords: prescription medicines, adherence, literacy, survey research, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.