McCarthy Danielle M, Russell Andrea M, Eifler Morgan R, Opsasnick Lauren A, Lyden Abigail E, Gravenor Stephanie J, Montague Enid, Hur Scott I, Cameron Kenzie A, Curtis Laura M, Wolf Michael S
Department of Emergency Medicine, Northwestern University, Chicago, Illinois.
Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, Illinois.
Pharmacoepidemiol Drug Saf. 2019 Sep;28(9):1251-1257. doi: 10.1002/pds.4795. Epub 2019 Jul 9.
Patient-centered labels may improve safe medication use, but implementation challenges limit use. We assessed implementation of a patient-centered "PRN" (as needed) label entitled "Take-Wait-Stop" (TWS) with three deconstructed steps replacing traditional wording.
As part of a larger investigation, patients received TWS prescriptions (eg, Take: 1 pill if you have pain; Wait: at least 4 h before taking again; Stop: do not take more than 6 pills in 24 h). Prescriptions labels recorded at follow-up were classified into three categories: (1) one-step wording (Take 1 pill every 4 h [without daily limits]), (2) two-step wording (Take 1 pill every 4 h; do not exceed 6 pills/day), and (3) three-step wording. There were three subtypes of three-step wording: (3a) three-step, not TWS (three deconstructed steps, not necessarily TWS wording), (3b) TWS format, employing three steps with leading verbs, but "with additions or replacements" (eg, replaced "do not take" with "do not exceed"), and (3c) verbatim TWS.
Two hundred eleven participants completed follow-up. Mean age was 44.3 years (SD 14.3); 44% were male. One-step bottles represented 12% (n = 25) of the sample, whereas 26% (n = 55) had two-step wording. The majority (44%, n = 93) had three-deconstructed steps, not TWS (3a); 16% (n = 34) retained TWS structure, but not verbatim (3b). Only 2% (n = 4) displayed verbatim TWS wording (3c). All category three labels (utilizing deconstructed instructions) were considered adequate implementation (62%).
Exact intervention adherence was not achieved in the majority of cases, limiting impact. Nonetheless, community pharmacies were responsive to new instructions, but higher implementation reliability requires additional supports.
以患者为中心的标签可能会改善药物的安全使用，但实施过程中的挑战限制了其应用。我们评估了一种以患者为中心的“按需服用（PRN）”标签——“服用 - 等待 - 停止（TWS）”的实施情况，该标签通过三个解构步骤取代了传统的表述方式。
作为一项更大规模调查的一部分，患者收到了TWS处方（例如，服用：若疼痛则服用1片药；等待：再次服药前至少间隔4小时；停止：24小时内服用不超过6片药）。随访时记录的处方标签分为三类：（1）一步式表述（每4小时服用1片药[无每日限量]），（2）两步式表述（每4小时服用1片药；每日不超过6片），以及（3）三步式表述。三步式表述有三种亚型：（3a）三步式，非TWS（三个解构步骤，不一定是TWS表述），（3b）TWS格式，采用带有引导性动词的三个步骤，但“有添加或替换”（例如，将“不要服用”替换为“不超过”），以及（3c）逐字逐句的TWS。
211名参与者完成了随访。平均年龄为44.3岁（标准差14.3）；44%为男性。一步式药瓶占样本的12%（n = 25），而两步式表述的占26%（n = 55）。大多数（44%，n = 93）有三个解构步骤，非TWS（3a）；16%（n = 34）保留了TWS结构，但不是逐字逐句的（3b）。只有2%（n = 4）展示了逐字逐句的TWS表述（3c）。所有三类标签（使用解构后的说明）都被认为实施得当（62%）。
大多数情况下未实现对干预措施的完全遵循，限制了其影响。尽管如此，社区药房对新的说明有响应，但更高的实施可靠性需要更多支持。
