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Prescription Instructions Confuse Even Educated Patients

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   March 02, 2011

Even for highly educated patients, following instructions to take multiple  medications a day is a daunting task that can lead to missed or incorrectly administered doses, according to an experiment published Monday in the Archives of Internal Medicine.

The 464 volunteers were asked to organize taking seven hypothetical prescription medications  – 21 fake pills in all – by placing them in a box with 24 compartments representing hours of the day.

While all the pills could be consolidated into just four time slots, 8 a.m., noon, 6 p.m. and bedtime, most of patients largely couldn't see that because of the confusing way the prescription labels were worded. Instead of four slots, many of the patients organized the 21 fake pills in as many as 14 time slots, from 5 a.m. to 11 p.m.

Only 15% of the participants got it right.

For example, even though instructions for taking two of the drugs were identical – "take one tablet by mouth three times daily" – nearly one third of the volunteers put those drugs in separate time slots.

The failure to follow the instructions and correctly group the times when the pills should be taken was also associated with scoring low on a literacy assessment test known as the "Newest Vital Sign," a six-item quiz that measures reading skills based on the participant's comprehension of a food nutrition label.

The study, by Michael Wolf of Northwestern's Health Literacy and Learning Program at Feinberg School of Medicine and colleagues, supports a move to a new UMS or Universal Medication Scheduling system to standardize the way physicians and pharmacists recommend dosages.

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