The patients role in medicine taking
Despite protracted effort invested in drug development, pharma leaves what happens once its product reaches the patient to chance, says Theo Raynor, professor of pharmacy practice at the University of Leeds and executive chairman of LUTO Research.
By on Aug 11, 2009Despite protracted effort invested in drug development, pharma leaves what happens once its product reaches the patient to chance, says Theo Raynor, professor of pharmacy practice at the University of Leeds and executive chairman of LUTO Research.
Raynor was a featured speaker at eyeforpharmas recent Pharma Relationship Marketing and Adherence 2009 conference.
A medicines effectiveness and safety cannot be maximized unless patients understand their role in the medicine taking process, Raynor told conference delegates. And it is clear, he notes, that effective spoken and written communication is crucial to the success of treatments. But, more often than not, pharma communicates this information badly and patients health literacy is lacking when it comes to understanding what they do receive, he says.
Most medicines depend on good understanding by patients of how to take the drug effectively and safely. But addressing health literacy is a two-way street, Raynor says, that includes not only helping people better comprehend health information, but working to make the information they are given as accessible and understandable as possible.
Patient focus groups, when surveyed by Raynor and his colleagues a few years ago, said patient leaflets were meant to be thrown away, were uninspiring, dont contain the information patients want or in the order they seek it and should be written by those who suffer with a given condition.
In the past, the implications of health literacy have focused on the deficiencies of the patients, Raynor says. That makes the assumption that the information available to patients was understandable. We need to help people improve their skills to understand information, but also to ensure that the spoken and written information pharma gives them is as simple and easy to understand as possible. We must meet patients halfway.
What patients want
What patients dont want when it comes to information about the medicines they take is almost as important as what they do want. Most patients, Raynor says, do not value the written information they receive and do not want that information to be a substitute for spoken information from their doctor, the prescriber.
People are desperate for someone to talk to them about their medications, but they dont get that even from their pharmacist, he says.
While patients value the idea of information, it must be tailored and set in the context of their particular disease, Raynor explains, and it must contain a healthy balance of benefit and harm information in sufficient detail to meet their needs. Patients, he says, like written information to help with decision-making both initially when deciding whether to take a medicine or not, as well as for medication management and interpretation of symptoms.
Effective communication
Ideally, medicine information materials, Raynor says, should use short, familiar words and short sentences, as well as concise headlines that stand out. Leaflets also should sport large type, abundant white space and bulleted lists for ease of reading. Using a conversational tone and the active voice, puts patients at ease and gets them involved whats being presented, he says. Other tips include using non-justified text and bold lower case type for emphasis. Last, pictures and graphs dont necessarily tell a better story, Raynor says.
While pictures are good in theory, they are difficult in practice for such communications, he says. Pictograms require a rigorous design process that includes testing just as should be undertaken for words.
Regulators and producers of written medication information should involve patients at all stages of information development, Raynor says. And companies must use findings on information design and content to improve the quality and usefulness of their products. And because spoken information remains the priority, pharmacists and other professionals should ensure that written information is not used as a substitute for discussion.
Research conducted in the UK by Raynor and his colleagues in three separate studies found that although 97% of patients noticed the medication information leaflet and 71% of first time users of product read at least some of the material, 60% of repeat users rarely or never look at the leaflets after their first prescription of the drug. In a 2003 study in the US, he says, more than one-third of patients found the medication information leaflet difficult to read and reported that it contained only 50%, on average, of the information patients expected.
Getting it right
Its not enough to simply provide information, Raynor says. Pharma also must get what it delivers right. For example, while side effect information is extremely important to patients, it should not be conveyed using complicated descriptions, little indication of how they are likely to happen or scant guidance on what to do when side effects occur.
Raynor says medication information should avoid ambiguous and hollow words such as occasionally, common and rarely. And people have trouble understanding percentages, he says. Frequency statements, such as four out of every ten patients, are easier to understand.
Consumer medication information can be analyzed with content based testing, but that only tells companies if the right information is present, not whether it meets patients needs, Raynor says. On the other hand, performance based testing is based on how a leaflet performs, not what it contains. This kind of testing, he says, allows companies to assess if information can be found and understood by patients.
Package leaflet information should reflect the results of consultations with target patient groups to ensure that it is legible, clear and easy to use, Raynor explains. And testing should be an iterative process that tests, identifies problems, rectifies those issues and re-tests.
Packaging and labeling of medications is a crucial link between the maker of a medicine and the taker or patient. Raynor believes pharma can maximize health literacy in the future by including more benefit information in its product materials and by utilizing headlined sections in leaflets.
We must strike a balance between benefit and risk information and highlight the most important information in the headline section where key points are presented prominently and a few key messages for safe and effective use are summarized, he says. People have not valued previous labeling and leaflets. They want easy to read and well laid out information, but the bottom line is that spoken information remains the priority and cant be replaced even by the most well thought out written communication.