Louis A. Morris

A survey of patients' receipt of prescription drug information

A nationwide telephone survey of 1,223 individuals investigated the nature and source of information provided to patients regarding prescription drugs. About half of the respondents said that they had received information from their doctor about the purpose and directions for use for their most recent prescription. Only a few people (11 per cent) said that they had been informed about the drugs side effects, and 19 per cent said that they had been told nothing by their doctor. Most (72 per cent) related that nothing had been said to them at the pharmacy. Written information (stickers on the medicine container, leaflets or brochures) was said to be infrequently provided at the pharmacy. About 12 per cent of the respondents said they had expected they might get a drug side effect, but only 9 per cent said that they had experienced one. The most frequently cited action in response to side effects was to consult the physician (40 per cent); however, a sizable percentage of people stopped the medicine completely or temporarily (36 per cent) or kept on taking the drug as prescribed (32 per cent).

A segmentational analysis of prescription drug information seeking.

Drug information-seeking proclivities were examined using data from a telephone survey of 835 individuals who had obtained new outpatient prescriptions within the previous 4 weeks. Factor analytic and clustering techniques were used to segment patients based on the source and nature of drug information received in conjunction with the prescription. A four-cluster solution appeared to represent the most stable, distinct, yet homogeneous solution for the data. The groups were named “physician reliant” (40%), “pharmacist reliant” (19%), “questioners” (7%), and “uninformed” (34%). The four groups were compared for demographic, situational, and attitudinal differences. The physician-reliant group appeared most satisfied with the direct counseling of the doctor. Although this group may have sought additional information, the information appeared to reinforce the physicians directions. The pharmacistreliant group often obtained prescriptions at independent pharmacies and tended not to rely on magazines or reference books for additional information. The questioners were often taking multiple medications. This group tended to seek out reference information from nonprofessional sources and reported several barriers to seeking information from professionals. The uninformed group was the oldest, tended to receive little information, and was more likely than the other groups to agree that one need not ask questions if one trusts the doctor. Different types of patient education programs were recommended as appropriate for each of the four groups. Motivational messages directed to the uninformed segment appeared to be the largest unmet need in patient-oriented prescription drug education.

Longitudinal study of awareness, recall, and acceptance of alcohol warning labels

This research reports the results of a 5-year (1989–1993) longitudinal study on consumer awareness of warning messages on alcoholic beverage containers. Adjusting for false positives, about one-third of respondents in the 1993 survey were “very likely” or “somewhat likely” to believe that alcoholic beverages containers contain warning messages. However, reported awareness has shown only a small increase since 1991. Respondents were also asked to indicate the content of the warning message. Adjusting for false positives, about one-quarter of respondents mentioned either the birth defects or driving warnings. Recall of the birth defects message has shown steady growth, while recall of the driving message has failed to increase since 1991. The rate of learning about alcohol warnings varied by education level; more educated respondents learned about the warnings more quickly than did less educated respondents. Recall was greatest among young and “heavy” consumption segments; about 40 percent of respondents in these two segments recalled at least one of the warning messages.

Patient attitudes about two forms of printed oral contraceptive information.

The desired form and style of written drug information for patients were assessed in a national survey of oral contraceptive (OC) users. These women were queried about two forms of OC information: a short insert included with dispensed drugs and a longer brochure delivered by the physician upon patient request. Longer and more detailed information, especially concerning drug dangers and directions for use, was strongly preferred. Younger and more educated women were more likely to report receiving the OC brochure and to desire more comprehensive information. Most respondents found information in both the insert and the brochure clear and useful, and felt it was important to include written information with other prescription drugs. The longer brochure was preferred over the shorter insert as a model of drug information to be included with additional drugs.

Patients’ Medical Judgments

Weighing risks and benefits to form a decision about the desirability of a therapy is inherent in the physician’s role as prescriber. However, as discussed previously, the patient’s desire to know risk information may reflect a need for anticipatory coping as well as meaningful participation in the therapeutic selection process. It is no wonder that many health professionals view the conveyance of risk information as an undesirable legal intrusion that interferes with the practice of medicine (Taylor and Kelner, 1987). When the patient is faced with the possibility of severe consequences from a disease or a therapy, it is natural for health professionals to assume that reassurance is necessary rather than the accurate transmission of risk information.

Mass Media Risk Communication

We have examined the communication of risk information primarily as it flows from health professional to patient. Interpersonal relationships modify risk communication, changing meanings and interpretations, and understanding these relationships is essential to understanding risk communication. However, patients receive risk information from other non-personal sources as well. The health education movement has fostered the growth of numerous print and audio-visual patient education materials (Green, Kreuter, Deeds and Partridge, 1980).

Patient Information Processing

The verbal or written disclosure of risk information is dependent upon the health professional. However, the patient cannot be totally passive. To be successfully communicated, not only does risk information need to be disclosed, but it needs to be attended, understood, integrated, remembered, and ultimately put to proper use when decisions are made and behaviors undertaken. Even if emphasized by a physician, the patient must be able to fully process risk information for it to be of value.

Learning About Therapy

Modern medicine has blessed us with a number of highly effective treatments. We can control, cure, prevent, or alleviate a wide variety of conditions and diseases. Infectious diseases that were once the major cause of mortality have been controlled or eradicated by vaccines and antibiotic drugs. We can treat myocardial blockages with surgery and replace worn out or broken body parts with human or mechanical ones. Specific and useful therapies have been developed for cardiovascular disease, cancer, diabetes, arthritis, ulcers, and many neurological and psychological problems.

Effects of Risk Communication

In a perfect world, once physicians explain the benefits, risks, and directions for how to use a therapy, patients merely utilize the treatment, get better, and remain satisfied with the physician, the treatment, and their condition. Unfortunately, the world is far from perfect and the anticipation that problems may result from improper risk communication is a driving force that influences the flow of information between doctor and patient. In Boyle’s (1983) survey, physicians were asked how frequently patients had problems with drug therapy. The great majority of physicians (95%) said that patients frequently or occasionally terminated taking medication prematurely, 89% said that patients frequently or occasionally neglected the proper dosage schedule, 72% said that patients frequently or occasionally suffered suggestion-induced side effects, and 69% said that patients frequently or occasionally resisted drug therapy.

Physician’s Risk Disclosure

As described in chapter two, for the majority of patients who receive therapeutic risk information, the physician is the primary source and additional sources are supplementary. Therefore, an examination of the nature and extent of physician delivered communications is essential to understand how patients learn about their therapies. Studies that have sought to measure the flow of information from doctor to patient have used a variety of methods. Unfortunately, measurement of this complex and dynamic interaction provides only limited insights that are correlated with the particular data gathering technique (Gerbert and Hargreaves, 1986).