“A Disconnect in the Process and Understanding of Prescription Medications”

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About the Author

Matthew White is currently an undergraduate in the Biochemistry Department at Saint Mary’s College of California. He is an aspiring physician with interests in both clinical medicine and biomedical research.

Contents

Introduction

Literature Review

Methodology

Results

Conclusion

References

Results

The survey and think-aloud protocol session data indicate that both the physician-patient interaction and the way in which patients engage the medication guide contribute to an insufficient understanding of patients’ prescribed medication.  This incomplete understanding is a result of four issues in particular: skimming the medication guide, difficult terminology in the guide, varying awareness of the risk and effects, and differing levels of communication with the physician.

Obtaining Information: Skimming the Medication Guide

“Every time I’m prescribed a new medication or a change occurs.” -- Research Participant, on how often they read the medication guide that comes with their prescribed medication.

With the medication guide being an essential aspect to understanding one’s prescription medication, it is necessary to determine if individuals read them as common practice.  Although the excerpt above provides an example of an individual who regularly reads these package inserts, there were varying answers in response to this question.  According to the think-aloud protocols, approximately 58% of the participants said they read these medication guides occasionally or as they see fit, while the remaining 42% of participants responded by saying they never read them.  Furthermore, when asked if they read the entire medication guide that was given to them during the study, more than 90% of the participants responded by saying they skimmed through it. 

This decision to skim is most likely due to the length and the amount of information within the guide.  When analyzing the genre of medication guides, I found that length was a common theme across the majority of these text types.  Often times these medication guides are about 10 pages in length and are full of information, which may cause the reader to feel the need to skim through the guide rather than read it thoroughly.

In addition, patients may feel encouraged to skim through these medication guides due to their typical structure and formatting.  In a think-aloud protocol session, participants made several remarks about the formatting, such as “The formatting is good” and “Bullet points are nice, and short, simple phrases make it easy to read and understand.”  Through analysis of the genre of medication guides as a whole, along with the responses from the study, it is justifiable to state that these guides have a primary purpose of informing the patient and are formatted and structured in such a way that makes it easy for the patient to understand.  Brief statements in the active voice allow the patient to quickly identify the most important information: “Use 2 inhalations of ADVAIR HFA 2 times each day” (Center for Drug Evaluation and Research).  These commonalities in the text were also identified by Grabowski, who determined that keywords and phrases became more simplified within the medication guides, most likely for purposes of aiding the patient in their ability to understand the material (27).  Together, these results show that the length and formatting often encourage patients to skim, not read, the medication guide.

Specialized Terminology: Issues in Understanding Medication Guides

“Partially, it used words/phrases I did not know such as the acronyms and the pharmaceutical terminology.” -- Research Participant, on if they found the language and terminology understandable

Despite the fact that the majority of these medication guides are relatively understandable, specialized terminology is a predominant issue that is interfering with patients’ understanding of the information.  More than 60% of the participants in the study responded negatively to the language and terminology being understandable by referring to the acronyms and other specialized terminology that was used in the text.  For individuals in the study, the pharmacological and chemical content may have been difficult to read because the majority, if not all, of the individuals participating in the research lack the knowledge necessary to be able to properly interpret this kind of terminology.  Similar evidence was found in prior research, which stated that patients have difficulty understanding these information guides due to their complex terminology (Prescription Labels – Consumer Reports Health).  This type of terminology is exemplified in the medication guide that was reviewed in the study: “ADVAIR HFA combines the inhaled corticosteroid (ICS) medicine fluticasone propionate and the LABA medicine salmeterol” (Center for Drug Evaluation and Research).  For example, this excerpt's utilization of words such as "fluticasone propionate," "LABA," and "salmeterol" leaves most readers baffled. In addition, analysis of the genre shows that the majority of these medication guides contain this specialized terminology, which suggests that they are somewhat exclusive to members of pharmaceutical or medical discourse communities.  This results in an overlying issue of a large majority of individuals who read these guides being unable to interpret certain aspects of the text that are potentially important.

Risks and Effects: Critical Aspects of Prescription Medications 

In terms of the medication in general, one of the most crucial aspects to consider are the potential risks and effects of the drug.  With that being said, it is no surprise that medication guides place so much importance on conveying these risks in a clear and concise manner.  Through analysis of these medication guides, it was evident that the most important aspect was the part that discussed the side effects or risks that may come with taking the drug and information on what to do in case of emergency.  For example, this section consisted of many bolded words, bullet points, and simple phrases that direct the reader’s attention.  When looking at the medication guide during the think-aloud protocols, every participant stated that the potential risks and effects of the drug were clear and understandable.

However, despite the clarity of the risks and effects of the drug in the medication guide, there were many mixed responses from individuals regarding their awareness of the risks of their own prescription medications.  For example, one participant responded, “yes, but I wasn’t told about them; I experienced the effects as they were happening but didn’t really care because the medication was a benefit to my health.”  Another participant responded by saying, “common side effects, yes; other harmful risks/serious side effects, no.”  These responses point to two possible issues: the first reverts to the earlier discussion regarding the patient’s inclination to skim the medication guide, and the second associates with a lack of communication with the physician.  These excerpts demonstrate that it is likely that neither individual read the medication guide thoroughly, but the amount of communication with the physician did vary between the two.  While the first response proposes that the individual did not have a conversation regarding the risks and effects of the prescribed medication with the physician, the second response conveys the idea that a discussion was had but it still left the patient without knowledge of the more serious risks and effects.

Regardless of the individual’s awareness of the risks and effects of their prescribed medication, data from the study shows that 70% of the participants have never refused to take a medication due to its risks.  Many individuals may feel that the medication will benefit them, and therefore they begin to disregard any risks or effects conveyed to them through the medication guide or by the physician.  This data correlates to the responses found in the group discussions, when participants were asked at what point they thought the risks conveyed in the medication guide, or in general, outweighed the benefit of the medication. One individual stated: “In general, if it is fatal, life-threatening, or may cause other serious problems.  I am usually willing to try medication but if it may affect my daily life then no.”  Another participant responded by saying, “When the risks are fatal or extensively debilitating.”

In addition to most individuals never refusing to take a medication due to its risks, from the data it is evident that the majority of people only begin to feel concerned about the risks and effects of medication if they are potentially life-threatening or inhibiting their daily life. With a large amount of the data pointing to the idea of individuals feeling relatively unconcerned by the common risks and effects addressed by these medication guides, it is necessary to look at the genre as a whole.  Through analysis of various medication guides, which all addressed both the common and serious risks and side effects of their respective medications, the reasoning behind the pharmaceutical company’s need to address them is questionable. Do they address these serious risks and effects for liability purposes, or have these effects been seen in research trials that were conducted prior to the medication being put on the market for patients? 

Discussing Medications: Communication with the Physician

After concluding the surveys, it was evident that 80% of the participants understood the reasoning behind why they were prescribed a medication due to the physician’s explanation during consultation.  This relates back to the earlier discussion surrounding skimming the medication guides.  For example, when I asked a group how often they read the medication guide, multiple individuals responded by saying, as I paraphrase, I usually never do, because I trust the medication the doctor prescribes.  This feeling of “trust” that is cited by the patient is most likely the result of the physician effectively communicating with the patient.  With proper communication from the physician that would normally include not only the reasoning behind the prescription, but also brief information on the medication, the patient may feel at ease regarding the medication they are being prescribed leading them to feel less inclined to read the medication guide.

Nevertheless, effective communication with the physician was uncommon.  Similar to the data found in this study, prior research determined that even when a patient expresses their opinions or preferences on medication, the extent to which it manipulates the prescription the physician writes is questionable (Britten et al. 1502).  As found in the participant surveys, 70% of individuals felt that their opinion regarding their openness to take certain kinds of prescription medications is neither communicated with the physician nor taken into account if it is in fact communicated.  For example, one individual responded by saying, “No, I often feel like my opinion is not considered.” Another responded, “No, I don’t think my opinion is taken into account.”  While these responses may be much different with improved communication between the physician and patient, prior research has identified that patients feel less inclined to convey their concerns or opinions of medications because they think it will infringe on the social interaction with their physician (1502).  This presents a predominant issue within physician-patient interaction that must be improved and maintained so that both the physician and patient convey their opinions effectively.  Improved communication with the physician may eliminate potential confusion and dissatisfaction that the patient would otherwise have to overcome.