Amy J. Keenum

Suitability and readability of consumer medical information accompanying prescription medication samples.

OBJECTIVE To examine readability and formatting characteristics of consumer medication information (CMI) accompanying prescription medication samples. METHODS We collected the most commonly used prescription medication samples (n=100) from four out-patient clinics at a large teaching hospital in the Southeastern US. Seventeen percent of samples were not pills/tablets and of such diverse nature (e.g., injections, drops, and creams) that there were not enough in any category to draw conclusions. Therefore, our analyses were limited to 83pill/tablet samples, belonging to 11 drug classes (e.g., cardiovascular, and psychiatric). We noted if CMI was present, and if so we assessed it for how instructions were presented, reading level, text size, format/layout, and comprehensibility. RESULTS No CMI was present in 39 (46.9%) samples. In 19 (22.9%), CMI was contained in a package insert and in 25 (30.2%) it was printed on the medication package. Average reading difficulty of CMI was at the 10th grade level (range=6-15) using the Fry formula, and text point size was small (mean 9.9+/-2.2 on package inserts and 9.4+/-2.6 when printed on packages). CONCLUSIONS Almost half of samples did not include any type of CMI. For those that had CMI, it was often written at a reading difficulty level higher than the average reading skills of American adults, and the format of most CMI was not optimal for comprehensibility. It is likely that many patients do not understand the instructions accompanying medication samples they receive from clinicians. PRACTICE IMPLICATIONS Clinicians should be cognizant of the shortcomings of CMI accompanying medication samples and thereby, distribute them to patients with caution. Manufacturers too should consider revising CMI to comply with low-literacy guidelines.

Patients' attitudes regarding physical characteristics of family practice physicians.

Background This study examined patient perceptions and attitudes toward various aspects of the male and female physician’s professional appearance in the family practice setting. Methods Four hundred ninety-six patients from two family practice clinics in Knoxville, Tennessee, completed a valid and reliable questionnaire. Questionnaires were offered to all patients on registering at their respective clinic during a 2-week period. Results Most patients had no preference regarding the age or sex of their medical care provider. A nametag, white coat, and visible stethoscope were the most desirable characteristics, whereas sandals, clogs, and tennis shoes were the least desirable items. Younger patients were generally more accepting of casual attire than were older patients. Office clinic location was the most important predictor of preferences in six of the significant characteristics. Conclusion Our findings support the results of both studies published two decades earlier and more recently. Patients prefer a traditionally dressed physician as opposed to one who is dressed more casually.

Generic medications for you, but brand-name medications for me

BACKGROUND Because generic medications are less expensive than brand-name medications, government and private insurers have encouraged and/or mandated the use of generics. OBJECTIVE This study aimed at evaluating perceptions about generic medications among English-speaking women of childbearing age currently enrolled in U.S. TennCare (Medicaid). METHODS We recruited a convenience sample of patients from the waiting room of a primary care/gynecology health clinic, with 80% recruitment rate among those approached. We orally administered a 25-item questionnaire to gather sociodemographic information and to assess beliefs regarding the efficacy, safety, cost, and preferences for personal use of generic medications. RESULTS The average age of the women (n=172) was 28.8 ± 6.4 years, and most were white (82.0%) and currently married (58.1%). Nearly one-fifth (19.2%) had not completed high school. Most women believed that generic medications were less expensive (97.6%) and better value (60.5%) than brand-name medications, but only 45.3% preferred to take generics themselves. About a quarter (23.3%) believed that brand-name medications were more effective than generics, whereas 13.4% believed that generics caused more side effects. Few women reported that their doctor (29.7%) and/or pharmacist (35.5%) had ever talked to them about taking generics. CONCLUSION Awareness of the benefits of generics did not equal preferences for personal use of generics among this sample of women enrolled in U.S. TennCare. Furthermore, women reported that providers-both physicians and pharmacists-infrequently discussed generic substitution with them.

Evaluation of Consumer Medical Information and Oral Liquid Measuring Devices Accompanying Pediatric Prescriptions

OBJECTIVES The aim of this study was to assess supplementary materials accompanying 2 commonly prescribed pediatric medications, including the following: 1) readability and layout characteristics of pharmacy-generated consumer medical information(CMI); and 2) types and features of oral liquid measuring devices(OLMDs) provided. METHODS We filled the same two prescriptions (prednisolone and amoxicillin) at 20 pharmacies (national grocery store chain [n = 1], regional grocery store chains [n = 4], national pharmacy chains [n = 3], national superstore chains [n = 3], and independently owned [n = 9]) across three states (Colorado,Georgia, and Tennessee). We evaluated readability, using both the Flesch-Kincaid (FK) formula and McLaughlins Simplified Measure of Gobbledygook (SMOG), and text point size of pharmacy-generated CMI. We also assessed whether an OLMD(oral syringe, dropper, or cylindrical spoon) was included with each prescription and recorded the largest marked dose (in mL). RESULTS Three pharmacies did not provide any type of CMI for either medication. Therefore, CMI was reviewed for 34 prescriptions. Reading grade levels of CMI averaged 9.6 1.9 (range, 5.3-11.7) using the FK and 11.2 2.6 (range, 6-14) based on the SMOG. Average text font size of CMI was 9.8 1.9 (range, 6-12). Although 32 (80%) prescriptions included an OLMD (oral syringe [n = 20], cylindrical spoon [n = 7], and dropper [n = 5]), close to one third (31.3%) would require multiple measurements to attain prescribed dosages. CONCLUSIONS Many of the supplemental materials accompanying the prescriptions filled in this study were suboptimal;CMI was written at reading levels exceeding that of many parents,and the largest marked dose on each OLMD varied substantially. Physicians should be cognizant of the shortcomings of supplemental materials included with many medications, whereas pharmacies should strive to provide understandable CMI (ie, written at or below sixth-grade reading level) and suitable OLMDs (ie,requiring only one measurement of medication) to promote proper medication use.

Effects of naltrexone on repressive coping and disclosure of emotional material: A test of the opioid-peptide hypothesis of repression and hypertension

Objective: The present study was designed to assess the role of endogenous opioids in the relationship of hypertension to repressive coping. Methods: Ten hypertensive and 8 normotensive males were given either the opioid antagonist naltrexone or placebo in a randomized, double-blind fashion over the course of four laboratory sessions. Measures of repression and disclosure were completed and blood pressure was assessed during a laboratory stressor protocol. Results: Opioid antagonism reduced repression and increased disclosure only in the hypertensive group. Also, opioid antagonism increased stress-related systolic blood pressure only in the hypertensive group. Conclusion: The results support the hypothesis that endogenous opioid dysregulation underlies both hypertension and repressive phenomena. DBP = diastolic blood pressure; SBP = systolic blood pressure; POMS = Profile of Mood States; LCC = Life Concerns Checklist; MAS = Taylor Manifest Anxiety Scale; MCSDS = Social Desirability Scale; TAS = Toronto Alexithymia Scale.

Using a home blood pressure monitor: do accompanying instructional materials meet low literacy guidelines?

To evaluate the readability and related features of English language Quick Reference Guides (QRGs) and User Manuals (UMs) accompanying home blood pressure monitors (HBPMs). We evaluated QRGs and UMs for 22 HBPMs [arm (n=12); wrist (n=10)]. Using established criteria, we evaluated reading grade level, language availability, dimensions, text point size, use of illustrations, layout/formatting characteristics, and emphasis of key points of English-language patient instructions accompanying HBPMs. Readability was calculated using McLaughlins Simplified Measure of Gobbledygoop. Items from the Suitability of Materials Assessment and User-Friendliness Tool were used to assess various layout features. Simplified Measure of Gobbledygoop scores of both QRGs (mean±SD=9.1±0.8) and UMs (9.3±0.8) ranged from 8th to 10th grade. QRGs and UMs presented steps in chronological order, used active voice throughout, avoided use of specialty fonts, focused on need to know, and used realistic illustrations. Seven sets of instructions included all seven key points related to proper HPBM use, whereas three sets of instructions included less than or equal to three key points (mean=4.8±1.9). Although most QRGs and UMs met at least some recommended low-literacy formatting guidelines, all instructional materials should be developed and tested to meet the needs of the patient population at large. Key points related to proper HBPM use should not only be included within these instructions, but highlighted to emphasize their importance.

Nutrition in Chronic Disease Management in the Elderly

Older Americans experience chronic disease at rates well above other segments of our society. Rates of health services use are also 2 to 3 times that of younger age groups. The most rapidly growing segments of Americas aging population are also its most nutritionally vulnerable-women, minorities, and those 85 years of age and older. The routine incorporation of nutrition screening and intervention into chronic disease management protocols will lower healthcare services usage, decrease healthcare costs, help relieve the burden of human suffering experienced by older Americans with chronic disease, and improve quality of life for our nations elders.

Do Medication Samples Jeopardize Patient Safety

BACKGROUND Medication samples are commonly dispensed by prescribers. Written consumer medication information (CMI) provided with sample packaging is an important source of patient information. Although one-third of Americans have health literacy deficiencies, previous studies have found that CMI is often too complex for many patients to understand. This may prevent patients from using these medications appropriately. OBJECTIVE To evaluate readability and formatting characteristics of CMI included with nonsolid (ie, topical cream/lotion, inhalation, transdermal) drug samples. METHODS We collected a convenience sample of nonsolid dosage sample medications (N = 55) from several different private and university-affiliated primary care and specialty physician practices at a large academic medical center in the southeastern US. We noted whether CMI was present and, if it was, we assessed it for instruction presentation, reading level, text size, format/layout, and comprehensibility. RESULTS Most (43 of 55) products included CMI, either as a separate leaflet or directly on the packaging. Reading level of CMI leaflets ranged from the 6th- to 14th-grade level, with just 4 (16.0%) written at the recommended 6th-grade level. Text font point size was 9.48 ± 2.14 (mean ± SD; range 5–12). Text printed directly on sample packaging averaged 6.61 point ± 2.62 (4–11) font size. Ninety-two percent of CMI leaflets included a combination of text and pictures; only 11.1% of CMI printed directly on the packaging used pictorial aids. CONCLUSIONS Most CMI accompanying nonsolid medication samples is written at a reading level that exceeds that of many consumers and does not meet recommended standards for readability and comprehensibility of patient education material.

Terminology Matters: Patient Understanding of “Opioids” and “Narcotics”

Background:  The terms “opioid” and “narcotic” are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding “narcotics” vs. “opioids.”