BACKGROUND: The clarity of prescription drug instructions is a health literacy and medication safety concern. OBJECTIVE: To assess the variability of pharmacy interpretations of physician prescriptions. DESIGN: Identically written prescriptions for 4 common medications (atorvastatin, alendronate, trimethoprim/sulfamethoxazole, ibuprofen) were filled in 6 pharmacies (2 largest chains, 2 grocery stores, 2 independents) in 4 cities (Boston, Chicago, Los Angeles, Austin). MEASUREMENT: Components of the instruction were coded as dose, frequency, administration route, timing, indication, and auxiliary instructions. RESULTS: In all, 85 labels were evaluated. Dose frequency was omitted on 6% of instructions ("take 1 tablet for cholesterol"). Timing was explicitly stated on 2% of instructions ("in the morning"). All prescriptions included indications; pharmacies transcribed these onto 38% of labels. The prescription for alendronate stated not to lie down for at least 30 minutes after taking; this was transcribed with 50% of instructions. Reading difficulty was above recommended levels for 46% of instructions; with 14% greater than a high school level. CONCLUSIONS: Efforts are needed to ensure patients receive clear, consistent information supporting safe medication use.
Wolf, Michael SShekelle, PaulChoudhry, Niteesh KAgnew-Blais, JessicaParker, Ruth MShrank, William HK01 EH000067-01/EH/NCEH CDC HHS/United StatesK23 HL090505-02/HL/NHLBI NIH HHS/United StatesEvaluation StudiesResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, P.H.S.United StatesMedical careMed Care. 2009 Mar;47(3):370-3.