A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

Michael S. Wolf*, Terry C. Davis, Laura M. Curtis, Stacy Cooper Bailey, Jo Ann Pearson Knox, Ashley Bergeron, Mercedes Abbet, William H. Shrank, Ruth M. Parker, Alastair J.J. Wood

*Corresponding author for this work

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Background: Patient misunderstanding of prescription drug label instructions is a common cause of unintentional misuse of medication and adverse health outcomes. Those with limited literacy and English proficiency are at greater risk. Objective: To test the effectiveness of a patient-centered drug label strategy, including a Universal Medication Schedule (UMS), to improve proper regimen use and adherence compared to a current standard. Design: Two-arm, multi-site patient-randomized pragmatic trial. Participants: English- and Spanish-speaking patients from eight community health centers in northern Virginia who received prescriptions from a central-fill pharmacy and who were 1) ≥30 years of age, 2) diagnosed with type 2 diabetes and/or hypertension, and 3) taking ≥2 oral medications. Intervention: A patient-centered label (PCL) strategy that incorporated evidence-based practices for format and content, including prioritized information, larger font size, and increased white space. Most notably, instructions were conveyed with the UMS, which uses standard intervals for expressing when to take medicine (morning, noon, evening, bedtime). Main Measures: Demonstrated proper use of a multi-drug regimen; medication adherence measured by self-report and pill count at 3 and 9 months. Key Results: A total of 845 patients participated in the study (85.6 % cooperation rate). Patients receiving the PCL demonstrated slightly better proper use of their drug regimens at first exposure (76.9 % vs. 70.1 %, p = 0.06) and at 9 months (85.9 % vs. 77.4 %, p = 0.03). The effect of the PCL was significant for English-speaking patients (OR 2.21, 95 % CI 1.13–4.31) but not for Spanish speakers (OR 1.19, 95 % CI 0.63–2.24). Overall, the intervention did not improve medication adherence. However, significant benefits from the PCL were found among patients with limited literacy (OR 5.08, 95 % CI 1.15–22.37) and for those with medications to be taken ≥2 times a day (OR 2.77, 95 % CI 1.17–6.53). Conclusions: A simple modification to pharmacy-generated labeling, with minimal investment required, can offer modest improvements to regimen use and adherence, mostly among patients with limited literacy and more complex regimens. Trial Registration (ClinicalTrials.gov): NCT00973180, NCT01200849

Original languageEnglish (US)
Pages (from-to)1482-1489
Number of pages8
JournalJournal of general internal medicine
Volume31
Issue number12
DOIs
StatePublished - Dec 1 2016

Keywords

  • adherence
  • clinical trial
  • health literacy
  • label
  • medication
  • pharmacy
  • prescription
  • understanding

ASJC Scopus subject areas

  • Internal Medicine

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