Davis Terry C, Federman Alex D, Bass Pat F, Jackson Robert H, Middlebrooks Mark, Parker Ruth M, Wolf Michael S
Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
J Gen Intern Med. 2009 Jan;24(1):57-62. doi: 10.1007/s11606-008-0833-4. Epub 2008 Nov 1.
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.
患者对处方药标签说明的误解很常见，这可能是用药错误和治疗效果不佳的原因。
测试使用更明确的语言描述处方药的剂量和使用频率是否能提高理解度，尤其是在识字能力有限的患者中。
采用面对面结构化访谈的横断面研究。
分别来自路易斯安那州什里夫波特、伊利诺伊州芝加哥和纽约市的两家医院基层医疗诊所和一家联邦合格健康中心，共359名等待预约的成年人。
通过对患者逐字回答进行盲法小组审查来确定对十条标签说明中每条的正确理解。
患者对处方标签说明的理解程度从理解最少的53%到理解最普遍的89%不等。与每天几次（如两次）或每小时间隔的说明相比，患者对有明确时间段（如早晨）或一天中精确时间的说明理解的可能性显著更高（分别为89%、77%、61%和53%，p<0.001）。在多变量分析中，与每天几次的说明相比，有特定时间或时间段的剂量说明被理解的可能性显著更高（时间段——调整后的相对风险比（ARR）0.42，95%置信区间（CI）0.34 - 0.52；特定时间——ARR 0.60，95% CI 0.49 - 0.74）。低识字能力和边缘识字能力仍然是误解说明的统计学上显著的独立预测因素（低——ARR 2.70，95% CI 1.81 - 4.03；边缘——ARR 1.66，95% CI 1.18 - 2.32）。
在处方药标签说明中使用精确措辞可以提高患者的理解度。然而，尽管使用了更明确的语言，识字能力有限的患者误解说明的可能性更大。
