Supplying Sincere and Direct Consumer Medication Information

APRIL 11, 2016
In the early 1980s, I did some pharmacist intern work at a very large outpatient pharmacy for a military hospital. At any given time, there were 10 or more pharmacists and twice as many technicians working behind the scenes.
 
There was a wall of big computers where technicians typed orders. A conveyer belt circled around a tremendous island of pharmacists pulling orders, filling them, and placing them back on the belt. Telephones at every turn were constantly ringing, and the unbelievably large waiting room looked like a bus terminal. There must have been more than 100 seats with 1 drop-off window, 1 pick-up window, and a large electric sign in the middle that lit up with a number when a prescription was ready to be picked up.
 
Even in the early ‘80s, privacy was an issue. They wouldn't call out the patent’s name when the prescription was ready. Instead, when patients dropped off prescriptions, they were given a number, and when their number was on the overhead sign, their prescription was ready for pickup.
 
When patients saw their number on the sign, they would come up to the window. The technician at the window would verify their identification against the prescription label and then hand over the medication. Then, the technician would move to the next prescription and the next patient. 
 
The pharmacy was on the front end of practice for its time. Automation was just coming online, technicians were doing work that pharmacists were verifying, and pharmacists were constantly on the phone discussing clinical and therapy issues with the medical staff. 
 
The issue was that sincere and direct patient medication information hadn’t come to the forefront of pharmacy practice yet. How to take a medication, what reactions to look for, how a medication may interact with any other medications, and a host of other issues weren’t regularly discussed with the patient at the pharmacy counter.
 
In the next decade, the federal government passed the Omnibus Budget Reconciliation Act of 1990 due at least in part to growing concerns about improper medication use. The law mandates that all Medicaid patients with any new prescription receive counseling from a pharmacist.
 
It didn’t take long for state pharmacy boards to make this a standard of practice for all patients, instead of just Medicaid enrollees. For nearly a quarter of a century, the law has mandated that every time a patient receives a new prescription at the pharmacy, he or she must be offered a counseling session with the pharmacist.
 
These counseling sessions need to include specific information in order to be complete. The American Society of Health-System Pharmacists developed a set of guidelines that includes all information necessary for a complete pharmacist-based patient education session.1 Each state pharmacy board’s legal department has also developed specific guidelines on what information needs to be discussed during a patient counseling session about a new prescription.
 
Fast forward from the early 1980s to 2016, and it’s my impression as a practicing community pharmacist that this level of counseling doesn’t always take place. 
 
Pharmacists are under tremendous pressure to meet performance metrics and will regularly cover the counseling points of 3 or 4 medications with a patient in less than 2 minutes. Patients are frequently sent home with stacks of medication information that’s cumbersome to read and regularly ends up in a waste basket.
 
Although no specific regulatory agency approves the development of consumer medication information handouts, the FDA developed a guideline document that specifies the following 6 criteria2:
  1. Scientifically accurate
  2. Unbiased in content and tone
  3. Sufficiently specific and comprehensive
  4. Presented in an understandable and legible format that’s readily comprehensible to consumers
  5. Timely and up-to-date
  6. Useful
AudibleRx is a consumer education tool developed to bridge the medication education gap between the patient and his or her pharmacist and prescriber.
 
Consumers visit the AudibleRx website on their computer or smartphone, easily navigate to the medication they would like to learn about, and then click and listen. After listening to a consumer medication information session about a specific medication, patients will have a better idea of what they do and don’t know about their medication and will be prepared to take educated questions back to their health care provider.
 
In addition to highlighting all of the required counseling information, each session also discusses any important black box warnings associated with a specific medication. The session will also explain how the medication works so that patients will have a better understanding of why they’re taking the medication and the consequences of not following their medication regimen. 
 
AudibleRx isn’t a replacement for the important face-to-face counseling sessions that a patient will have with a community pharmacist. Rather, it’s an alternative to paper consumer medication information handouts and designed specifically for individuals challenged with literacy, patients with visual impairment, or those who just learn better by listening.
 
References
1. American Society of Health-System Pharmacists. ASHP guidelines on pharmacist-conducted patient education and counseling. Am J Health-Syst Pharm. 1997;54: 431-434.
2. FDA. Guidance: useful written consumer medication information (CMI).
http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm080602.pdf. Published July 2006. Accessed April 10, 2016.

Steve Leuck, PharmD
Steve Leuck, PharmD
Steve Leuck, PharmD, has been practicing both hospital and community pharmacy for over 30 years. He founded AudibleRx, in 2011, which provides Consumer Medication Information which is both Useful and Accessible. Content designed to meet health literacy guidelines. Format designed to "read along" with the audio presentation in a simple to use web application. More information at AudibleRx.org.
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