I pity the poor prescription label.
For at least the past 20 years researchers in health literacy have pointed out that patients with low health literacy have trouble accurately reading their prescription directions and therefore, show poor medication adherence.
So when I recently read that Wisconsin announced a new project to improve medication taking by “adopting of uniform, patient-centered medication labels” I was, well…feeling a bit like Bill Murray in Groundhog Day.
Because the announcement cites the same troublesome evidence that’s been used for the past 20 years to justify fixing prescription labels – “Misunderstanding and incorrect medication use is linked to non-adherence, which has been associated with a 20 percent greater risk of hospital readmission.”
Full Disclosure: I believe that problems reading prescription labels is insignificant compared to the real reasons people don’t take their medications as prescribed. And we should be addressing those problems.
The Evidence that we’re barking up the wrong tree:
Exhibit #1 A large study done with the new Target retail chain’s new prescription labels (2005) did not translate into better compliance among consumers… at all. In fact researchers found no statistical significance among those using a new, clear Target Prescription Drug Label ( 2009) Journal of General Internal Medicine http://link.springer.com/article/10.1007%2Fs11606-009-0924-x
BTW – Target still promotes its label as a “clear winner”.
Exhibit #2 In 2014 Nang, Terry and McHorney did an extensive lit review of the evidence of a link between medication adherence and health literacy. They found a “weak” relationship between health literacy and medication. And they conclude that there must be other mediators.
Exhibit #3 My dear, intelligent mother takes her Lipitor every other day even though she’s supposed to take it everyday. Why? Because she once heard a commercial on TV warning about possible liver damage. She likes her liver just the way it is. Thank you.
She’s doing a bit of her her own, what I once heard Dr. Ethan Halm call, “homegrown evidence based medicine”. It should come as no surprise that we often don’t take medication as directed.
Exhibit #4 There are many identified reasons why patients don’t take their medications as prescribed. None having to do with reading labels. (See reasons below)
From Gifford AL, Bormann JE, Shively MJ, Wright BC, Richman D, Bozzette SA. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. Journal of Acquired Immune Deficiency Syndrome. 2000;23:386–395.