Study Finds Many Patients Misunderstand Prescription Drug Labels

You know you can't assume your patients will follow the prescription medication regimen you prescribe. But you also should know that if they don't, it might not be for lack of trying. Research in the December Annals of Internal Medicine shows that even the most compliant patients may misunderstand -- and thus fail to follow -- the instructions printed on their medication bottles.

According to the article "Literacy and Misunderstanding Prescription Drug Labels," researchers found as many as 48 percent of patients may not understand how to take their prescription medications, even if they can read the words on the label.

Researchers asked 395 patients to read and interpret the prescription labels for five commonly prescribed medications -- amoxicillin, trimethoprim, guaifenesin, felodipine and furosemide. Of the 1,975 responses obtained for the five labels, 374 were "incorrect," and "almost half (46.3 percent) of patients misunderstood one or more of the prescription label instructions," the researchers write.

Specifically, "correct" scores were given only if the patient's verbatim response to the question, "How would you take this medication?" included all elements of the label's instructions: dosage, timing of doses and, if applicable, duration. The error rate was 37.7 percent among patients with adequate literacy, 51.3 percent among those with marginal literacy and 62.7 percent for those with low literacy.

Moreover, a patient's ability to read the words on a prescription label did not guarantee he or she knew how to take the medication, write the two primary authors for the article, Terry Davis, Ph.D., professor at the Louisiana State University Health Science Center, Shreveport, and Michael Wolf, Ph.D., M.P.H., assistant professor of medicine in the Institute for Healthcare Studies at Northwestern University, Chicago.

Among people with adequate literacy, 89.4 percent could read the label instructions accurately, but only 80.2 percent could demonstrate the correct number of pills to be taken. Likewise, 84.1 percent of patients with marginal literacy could read the label, but only 62.8 percent could show how many pills to take a day, and 70.7 percent people with low literacy could read the instructions, but only 34.7 percent could demonstrate the correct number of pills to take.

What does that mean for you?

"For the practitioner, (the research) confirms that detailed medication reconciliation -- ensuring that the patient knows which medications have been prescribed and can demonstrate how to correctly use all of them -- must be part of routine practice," writes Dean Schillinger, M.D., associate professor of clinical medicine at the University of California, San Francisco, in an accompanying editorial.

Davis, Wolf and their co-authors agree. "A system approach in which someone (pharmacist, nurse, clinic assistant, or physician) verifies that patients can accurately demonstrate or articulate specific correct medication taking behaviors is important to ensure quality care," they write.