Improving Patient Understanding of Prescription Drug Label Instructions
Improving Patient Understanding of Prescription Drug Label Instructions
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DOI：
10.1007/s11606-008-0833-4
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发表时间：
2009-01-01
影响因子：
5.7
通讯作者：
Wolf, Michael S.
中科院分区：
文献类型：
--
作者：
Davis, Terry C.;Federman, Alex D.;Wolf, Michael S.
患者对处方药标签上说明的误解是很常见的，这可能是用药错误和治疗效果不佳的一个原因。为了测试使用更明确的语言来描述处方药的剂量和使用频率是否可以提高理解，特别是在文盲有限的患者中。采用面对面、结构化访谈的横断面研究。在路易斯安那州什里夫波特、伊利诺伊州芝加哥和伊利诺伊州芝加哥的两家以医院为基础的初级保健诊所和一家具有联邦资格的医疗中心，359名成年人等待预约。通过对患者逐字回答的盲目小组审查确定对十个标签说明中的每一个的正确理解。对处方标签说明的患者理解程度从最不理解的53%到最常理解的89%不等。与每天两次或每小时间隔(分别为89%、77%、61%和53%，p<；0.001)相比，患者更有可能理解具有明确时间段(即上午)或一天中准确时间段的说明。在多变量分析中，具有特定时间或时间段的剂量说明比每天说明次数(时间段调整后的相对风险比(ARR)0.42，95%可信区间(CI)0.34-0.52；特定时间-ARR 0.60，95%CI 0.49-0.74)更容易被理解。低识字率和边际识字率仍然是误译说明书的独立预测因素(低ARR2.70，95%可信区间1.81-4.03；边际识字率1.66，95%可信区间1.18-2.32)。在处方药标签说明书上使用精确的措辞可以提高患者的理解能力。然而，尽管使用了更露骨的语言，识字能力有限的患者更有可能曲解说明。
Patient misunderstanding of instructions on prescription drug labels is common and a likely cause of medication error and less effective treatment.To test whether the use of more explicit language to describe dose and frequency of use for prescribed drugs could improve comprehension, especially among patients with limited literacy.Cross-sectional study using in-person, structured interviews.Three hundred and fifty-nine adults waiting for an appointment in two hospital-based primary care clinics and one federally qualified health center in Shreveport, Louisiana; Chicago, Illinois; and New York, New York, respectively.Correct understanding of each of ten label instructions as determined by a blinded panel review of patients' verbatim responses.Patient understanding of prescription label instructions ranged from 53% for the least understood to 89% for the most commonly understood label. Patients were significantly more likely to understand instructions with explicit times periods (i.e., morning) or precise times of day compared to instructions stating times per day (i.e., twice) or hourly intervals (89%, 77%, 61%, and 53%, respectively, p < 0.001). In multivariate analyses, dosage instructions with specific times or time periods were significantly more likely to be understood compared to instructions stating times per day (time periods - adjusted relative risk ratio (ARR) 0.42, 95% Confidence Interval (CI) 0.34-0.52; specific times - ARR 0.60, 95% CI 0.49-0.74). Low and marginal literacy remained statistically significant independent predictors of misinterpreting instructions (low - ARR 2.70, 95% CI 1.81-4.03; marginal -ARR 1.66, 95% CI 1.18-2.32).Use of precise wording on prescription drug label instructions can improve patient comprehension. However, patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language.