A graduate student here at Auburn is studying optimal methods to deliver information to patients about the medications they are taking. When we began looking into this topic, we were quickly reminded what a confusing mash of terminology is used in this space, including medication guides, patient package inserts, patient medication information, and consumer medication information. These names generally represent documents with a common purpose — to educate patients — but important distinctions are found with each. The Food and Drug Administration plays a major role in regulating the information patients receive (except for consumer medication information). Pharmaceutical manufacturers also play a role in developing some of the information. Other players who influence that patient’s experience include knowledge vendors like First DataBank and your pharmacy information system vendor. With so many forces of influence, it’s not surprising that consistency is the exception instead of the rule.
Read more on the topic in Brent Fox’s Blog
This got us to thinking about the ideal situation. If we had endless resources of time, funds, and personnel, what would we want in the perfect information source for patients about their medications? This question can be addressed from two perspectives: that of the patient and that of the pharmacy staff. We are going to approach the opportunity for an ideal situation from both perspectives. Some of the desired features described below may be present in your system; others may not be present in any system currently available. Our approach is to think about the patient information features we want right now.
The most obvious feature (that is, we hope, present in your current system) is accuracy. This is the baseline. Regardless of the number of features detailed below that are included in your system, if the information they provide is inaccurate, the opportunity for negative outcomes increases. When we think about accuracy, we think about mistakes that occur in the creation of information. This can be a transposition of numbers in a dose; an indication to take a medication with food when it should say to not take it with food; and other similar mistakes. We also think about inaccuracy due to information that is not timely, such as the absence of information about a new, significant adverse reaction or drug-drug interaction. In either circumstance, corrections to the drug information database should be pushed to the pharmacy database immediately. This, or something similar, is probably happening in your pharmacy. We wonder, though, if your system goes to the next step and can notify all patients with active prescriptions for the medication in question that a significant change has occurred. Or is pharmacy staff notified by the management system vendor, so they can then notify patients? We think at least one of these ways of handling critical updates is necessary.
Once we are confident that the information we are providing to patients is accurate, we want to make sure it is accessible. Accessibility means a number of things to us. It needs to be in the patient’s preferred language and appropriate literacy level. Your system likely already does this. If not, there are options to provide this information in a variety of languages. The font needs to be legible. Have you recently looked at the size of the font in the printed information you provide to patients? We have seen printouts that should have been thrown directly in the trash (or not printed at all) because the font is simply too small, especially for the older segment of the population. Sure, paper costs are important, but printed information that is too small to read is really of no use to the patient. Depending on the type of information, there may be requirements for minimum font size set by the FDA. In this case, our ideal information document would be customizable to allow patients to specify if they need a larger font through a setting on their profile. Reading level is the second accessibility factor that, depending on the type of information, the FDA may have specified.
What about the actual content? Certainly we would start with the minimum information that should be included according to law. What about additional information? Can you think of patients who are highly engaged in their healthcare and would like to know more about their medications than is minimally required by law? Thinking about the PatientsLikeMe.com model, we can see a scenario where a patient wants to connect with others who take the medication to discuss side effects, cost issues, etc. Of course, we are not proposing to provide patient names and contact information, but what about a live link to an online community for the medication in question? This ideal feature is complex, would require close coordination with patients to identify desired additional features, and would be highly difficult, if not impossible in a paperbased scenario. But what if it isn’t paper based? Is this an option to consider?
What if patients were given the option to choose how they receive their medication information? Obviously, there are legal requirements that would have to change, but we already granted ourselves a set of hypothetical, unlimited resources above, so we are going to run with it. We envision giving patients the opportunity to choose between hard-copy paper, electronic paper version, audio only, video, or some combination of these. Through an initial consultation with pharmacy staff, patient preferences are recorded that direct future provision of medication information to the patient. That segment of the population — like us — that learns best through visual means would be able to select video. Maybe a patient is a commuter or simply really likes podcasts. An audio version of the medication information would best fit his or her lifestyle. An additional benefit of all of the electronic versions is that they could be cloud based, making them highly portable, accessible anywhere there is a network connection, and less likely to get thrown away or lost with other papers.
Lastly, we think about the ideal scenario to provide medication information to patients. We believe there is an opportunity for interactivity. Currently, patients receive a paper handout, leave the pharmacy, and maybe call to ask follow-up questions when they get home or on their next visit. What if patients could annotate the information with their own notes (yes, they can do this on paper now) and share those annotations with pharmacists, especially when the annotation is a question? We envision this happening in one of the electronic formats described above. Again, it would be a significant undertaking. The primary challenge we see to this feature being successful is pharmacy’s ability to respond to questions. If we tell patients to submit their thoughts through their medication information resource, we’d better be there to answer their questions.
Yes, we are describing scenarios that likely make your heart rate increase. Yes, we acknowledge there are serious changes in medication distribution workflow that would be needed, including from the patient’s perspective. But this is an exercise in “If you could have anything, what would it be?” Visit our blog at www.pharmacyinformatics.com to tell us the features you would like to see. CT
Brent I. Fox, Pharm.D., Ph.D., is an associate professor, and Bill G. Felkey, M.S., is professor emeritus in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University. They can be reached at email@example.com and firstname.lastname@example.org.