Nature and frequency of dosing instructions on prescription labels in primary care

Abstract

Purpose To investigate the nature and frequency of dosing instructions and auxiliary labels on prescription labels in primary care. Methods A retrospective analysis of data on prescription labels of dispensed drugs extracted from the pharmacy information system of community pharmacies in the Netherlands. Dosing instructions were categorized into four types. Results Data were extracted from 123 community pharmacies. All drugs dispensed for a random sample of 10% of patients were selected. In the sample of 938 479 prescriptions, 96% had a predefined dosing instruction and 2995 different coded instructions were used. Ninety‐five percent of all instructions were covered by 354 coded instructions. Most prescriptions were coded with an instruction indicating once daily use (48.4%) or twice or more times daily use (23.8%) without specification of the time (eg, “1 tablet 1 time a day”). A general instruction (“use as directed”) was given for 7.0% of all prescriptions, and for 6.0%, the instruction was to use “as needed.” For most prescriptions (80.6%), one or more auxiliary labels were generated with the warning “may cause drowsiness” (17.9%) being the most frequent one. Conclusions A limited set of instructions covered the majority of the prescriptions. About a quarter of the prescription labels contained nonspecific dosing instructions for use multiple times a day, and 13.0% were general or “use as needed” instructions. These instructions can potentially be made more comprehensible by rewording and specification of the time of day.

Development of Comprehensible Prescription Label Instructions: A Study Protocol for a Mixed-Methods Approach

“…Moreover, research of Borgsteede and Heringa (2019) showed a substantial proportion of Dutch prescription label instructions was too complex, and could be optimized by rephrasing them. In this study, we collected data about the comprehensibility of dosage instructions, auxiliary label warnings or advices, and how they are interpreted by patients with limited and adequate health literacy using a mixed methods approach.…”

“…Moreover, research of Borgsteede and Heringa (2019) showed a substantial proportion of Dutch prescription label instructions was too complex, and could be optimized by rephrasing them. For example, of the 100 most frequently used dosage instructions, 23.8% were instructions for multiple times a day use without specifying the time of day (e.g., “1 tablet 2 times a day”), and 13% contained general instructions or instructions to “take as needed.” Arguably, as the instructions were about one-third of the total, the potential improvement on a population level is significant.…”

Investigating the impact of patient-centred labels on comprehension of medication dosing: a randomised controlled trial

“…The content and format of dispensing labels provided by pharmacies varies between and within jurisdictions. [11][12][13] To standardise the content and format of dispensing labels and to improve the comprehension of dosage instructions by patients, the concept of patient-centred labels (PCL) has been introduced. 14 15 PCL are designed to provide information in a more reliable way than standard labels.…”

Comprehensibility of a personalized medication overview compared to usual-care prescription drug labels

“…As such, numerous studies related to this topic have been published ( Maghroudi et al, 2021 ). Studies have focused on factors such as, complexity of dosing instructions particularly in relation to patient health literacy ( Beckman et al, 2005 ; Shrank et al, 2007 ; European Commission, 2009 ; Bailey et al, 2012 ; Emmerton et al, 2012 ; Koster et al, 2014 ; Patel et al, 2018 ), requirements concerning content an comprehensibility of the text ( Raynor and Bryant, 2013 ; Pires et al, 2016 ; Yuan et al, 2019 ), precision of writing dosing instructions ( Borgsteede and Heringa, 2019 ), and the use of icons, graphics and pictograms ( Kheir et al, 2014 ; van Beusekom et al, 2017 ). As a result, guidelines have been drawn up with standards on how information should be presented on the PDL (i.e.…”