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| FOR SELECT GROUPS |
It has often been said that when communicating about medicines, "one size
does not fit all." Elsewhere on this website, we provide basic
questions to ask whenever a new medicine is prescribed or received, and
ways to keep track of all medicines taken. This section examines medicine
communication needs of select population groups.
The following background papers, published by NCPIE, may include recommendations
for health care professionals. References and website links are included
wherever possible. These papers will be updated periodically, and new
"select groups" will be added. |
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| OLDER ADULTS |
As a group, persons aged 65 years and older account for less than 15% of the U.S.
population, but they consume about one-third of all retail prescriptions.
They also purchase at least 40% of all non-prescription medicines.
Why would older adults benefit most from talking about prescriptions?
Older people are more likely to suffer from multiple chronic
diseases, requiring multiple medicines. The average number of concurrent
medicines is 4.5 prescription medicines and two non-prescription medicines
(General Accounting Office, 1996). Thus, they may routinely visit more
than one physician, each of whom may be unaware what other medicines have
been prescribed.
Because of physiological changes associated with the aging process, older
persons are more sensitive to effects of medications and may not be able
to tolerate adult dosages ("When Medicine Hurts Instead of Helps," pps.
5-6). Clinical trials of prescription medicines are routinely conducted
on people under age 65; few involve persons aged 65-74 or older, even
if the drugs are developed to treat conditions primarily afflicting the
elderly.
About 17% of elderly hospitalizations were due to adverse medicine reactions,
almost six times that of the non-elderly population (Nanada, C; Fanale,
J; Kronholm, P, "The Role of Medication Noncompliance and Adverse Drug
Reactions in Hospitalizations of the Elderly," Archives of Internal Medicine,
1990, 150 (4), pps. 841-46). |
How can one effectively talk about prescriptions with an older patient?
- Involve them in the selection of and adherence to their medication
regimen. If accompanied by a caregiver, review the proper dosing schedule,
precautions, and use of a medicine.
- If a device is involved, ask the patient or his caregiver
to demonstrate using it.
- Ask about experiences with new or continuing medicines, about
medicines prescribed by other physicians, about non-prescription medicines
purchased by the patient, his caregiver, a family member or friend.
- Make a point to mention common side effects.
- Provide a medicine record form
like that in NCPIE's Prescription Medicines and You: A Consumer Guide
(a large-print brochure in English, Spanish
and Asian languages). At each visit, ask your patient to show it to
you.
- At least annually, or twice a year for older adults on three
or more concurrent medicines, conduct a medication check-up that includes
a review of prescription and non-prescription medicines. NCPIE offers
the National Medication Check-Up Kit
to simplify conducting such reviews for seniors.
- Ask if they have any questions or concerns about their medicines;
about lifestyle, diet, and family support systems.
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| Resources: |
| "When Medicine Hurts Instead of Helps: Preventing Medication Problems in Older
Persons," June 1998: Alliance for Aging Research, Washington, DC, - (202)
293-2856, http://www.agingresearch.org/
"Identification of Elderly Nursing Facility Residents at High Risk
for Drug-Related Problems," Oct. 1997: American Society of Consultant
Pharmacists, Alexandria, VA, - (703) 739-1300, - http://www.ascp.com/
SMART
Coalition: An educational effort to increase appropriate use of medications
and decrease associated health care costs. (Sacramento, CA) - (916) 658-0144
"Take
Time to Talk With Your Health Care Providers," developed by theTake
Time to Talk Advisory Council. 1-800-931-3321
"Talking
with Your Doctor: A Guide for Older People," from the National Institute
on Aging - 1-800-222-2225 - http://www.nih.gov/nia/health/general/general.htm
"Multiple Medication," Jay Siwek, M.D., The Washington Post (Health Section),
July 14, 1998, p. 31.
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| WOMEN |
NCPIE is pleased to be a collaborator and sponsoring organization for
The FDA Menopause and Hormones Information Campaign.
The Society for Women’s
Health Research, a NCPIE member, developed in 2002
articles on herbal supplements,
on mixing medications,
and on how drug reactions might cause different effects
in women vs. men. Please click on the phrase(s) above to view these articles.
Women
often serve as their family's caregiver: they may care for children, grandchildren,
and/or elderly parents. As such, a woman may be charged with making health
care decisions for more people than just herself. Traditionally, women
have more physician visits per year than do men. This stems from reproductive
needs, their tendency to seek help for problems, and to suffer disproportionately
from depression. Consequently, women are prescribed more medicines per year than men. They
also purchase more non-prescription medicines, including dietary and nutritional
supplements.
Women
may seek more information about their own and their family's medicines.
They may want to ask more questions, but given women's competing priorities
on their time, they may be reluctant to get the answers they need if they
cannot be obtained quickly.
Getting
women to talk about prescriptions is vital because:
- Women account for 59% of physician office visits, and average 3.2 visits per
year vs. 2.3 visits for men (National Ambulatory Medical Care Survey,
1996 Summary).
- Women
aged 50 and older were more likely than men (49% vs. 35%) to fail to comply
fully with their doctor's prescription orders (AARP's Survey on Prescription
Drug Issues, May 1996). This gender dichotomy is increasing: in 1991,
women's rates of self-reported non-compliance were 42% vs. 35% for men
(AARP).
-
Prescriptions
for estrogen/progestin products were one of the fastest growing therapeutic
categories in 1997, up 85% from 1996 (Scott-Levin's Source Prescription
Audit, reported in Drug Topics, March 16, 1998). The number-one selling
retail drug in 1997 was Premarin Tabs® (Wyeth-Ayerst), with over 40 million
prescriptions sold.
-
On
average, nearly four women in 10 (37%) are trying to lose weight. One-third
of women who are normal weight, and 58% of women classified as being overweight,
are trying to reduce their weight ("Women's Health-Related Behaviors and
Use of Clinical Preventive Services, The Commonwealth Fund", 1995, pps.
51-56). Women are twice as likely to have a major weight gain during ages
25-34, compared to men (Williamson, DF; Kahn, HS, et. al., "The 10-Year
Incidence of Overweight and Major Weight Gain in U.S. Adults, Archives
of Internal Medicine," 1990; 150: 665-672). However, only about half of
over-weight women were asked about diet and eating habits at a checkup
during the past year. Further, only about a third of normal-weight and
underweight women were asked (Commonwealth Fund, 1995, pps. 76-78).
This may indicate missed opportunities
to talk about a female patient's possible use of dietary supplements,
non-prescription weight-loss remedies, and similar medicines. Such "teachable
moments" should be routine in women's annual checkups.
-
Among the elderly with hypertension who receive prescription medicines,
over 66% of the women (vs. 55% of the men) do not have their condition
controlled (Burt, V. et al., "Prevalence of Hypertension in the U.S. Adult
Population," Hypertension, 1995; Vol. 25, pps. 305-313).
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Women
may experience adverse drug effects but attribute the symptoms to aging;
thus, they are likely to go unreported to a health care professional.
Female patients should be told about the potential side effects of their
drug regimen; at follow-up visits, they should be asked directly if they
are experiencing such symptoms ("Controlling High Blood Pressure in Older
Women," p. 11).
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| Resources: |
| National
Women's Health Information Center - 1-800-994-WOMAN - http://www.4woman.org/
"Get Real:
Straight Talk About Women's Health," video for teens and women in their
early 20s. Society for the Advancement of Women's Health Research (Washington,
DC) - (202) 223-8224 - http://www.womens-health.org
"Take
Time to Care, Use Medicines Wisely," U.S. Food and Drug Administration,
Office of Women's Health: a national public awareness campaign launched
in 1999 to help women, particularly those who are underserved. Materials
are available in English and other languages. 1-877-RX WOMEN- http://www.fda.gov/womens/tttc.html
National
Heart, Lung and Blood Institute "Controlling High Blood Pressure in Older
Women: A Clinical Guide" - (301) 496-4236 - http://www.nhlbi.nih.gov/health/public/heart/hbp/hbpow.htm
National
Women's Health Resource Center, "The Women's Guide to Nonprescription
Medicines" (1998) - (202) 537-4015 http://www.healthywomen.org/
|
| CHILDREN |
Children may represent an overlooked target for "Talk About Prescriptions" campaigns.
Indeed, a decade ago, a NCPIE-issued research report was entitled, "Children
and America's Other Drug Problem: Guidelines for Improving Prescription
Medicine Use Among Children and Teenagers."At that time, less
than 10% of pharmaceutical expenditures were for children younger than
18 years old (1987 data, reported in American Journal of Public Health,
Vol. 87, No. 10, Oct. 1997). However, about one-third of children take
medicines prescribed or recommended by physicians.
According
to the FDA, the top 10 prescription medicines used for pediatric patients
are: Albuterol® (asthma), Phenergan® (allergic reactions), ampicillin
(infections), Auralgan® (ear pain), Lotrisone cream® (topical infections),
Prozac® (depression, obsessive-compulsive disorder), Intal® (asthma),
Zoloft® (depression), Ritalin® (attention deficit disorders), and Alupent
(asthma). (Federal Register, Vol. 62, No. 158, Aug. 15, 1997, p. 43900.)
Asthma
affects five million children, and is the most common chronic condition
among American youngsters. Today, there are over 200 medicines
for children in development or awaiting FDA approval: 44 target cancer,
14 target cystic fibrosis, 13 are for asthma, 12 for AIDS and nine for
epilepsy. Many of these pharmaceutical manufacturers are involving children
in clinical trials for the first time.
Many medicines
prescribed for children involve antimicrobial agents. Unfortunately, appropriate
use of those medicines may be more the exception than the rule. Among
a national Gallup survey of adults, 60% agreed (incorrectly) with the
statement, "Antibiotics are effective against cold and flu" (American
Lung Association, 1995).
Parents may expect their child's physician to prescribe an
antibiotic before the presence of a bacterial infection is confirmed.
Further, the Gallup survey found that 54% of adults who admitted
not finishing their last antibiotic prescription taken for a respiratory
infection stopped taking it because "they felt better." In children as
well as in adults, stopping an antibiotic before the prescribed course
of therapy can cause the illness to linger and/or return. (ALA news release,
Oct. 12, 1995.)
Children
may be especially vulnerable - and thus prime candidates for "Talk About Prescriptions" - for several reasons:
- In a study of 100 caregivers who came to emergency rooms with children, only
30% were able to state an appropriate dose of acetaminophen and to accurately
measure the correct amount. Nearly half of families studied would have
under-dosed the medicine, and nearly 10% would have given too much (Simon,
H.K., Archives of Pediatrics & Adolescent Medicine, Vol. 151, July
1997, pps. 654-656).
- Accidental
poisonings can occur if adults leave their own medicines out when a child
is unsupervised. All medicines must be stored safely out of reach, with
child-proof caps locked on.
- Pediatric
dosing may be untested or unfamiliar to the prescribing health professional;
an adult dosing regimen could be very dangerous, and older medicines probably
were not tested for use in infants or children.
- Throughout
any day, several different caregivers may be responsible for ensuring
that a child uses her medicines properly: parents, day-care worker, school
nurse, sibling, babysitter, grandparent. Does each caregiver understand
the how to give the child his medicine safely?
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| Resources: |
| "The Pediatric
Medication Education Text," patient information for 200 commonly-prescribed
pediatric medicines. English, Spanish. AACP (Kansas City, Mo), 1997 -
(816) 531-2177, ext. 20 - http://www.accp.com/ped_medtxt.html
"Ten Guiding
Principles for Teaching Children and Adolescents About Medicines," and
"Guide to Developing and Evaluating Medicine Education Programs and Materials
for Children and Adolescents," USP, 1998 - (301) 816-8351 - http://www.usp.org/ (Click on "Drug
Infromation")
"Judicious Antibiotic Use," a list of free resources to help children
and their caregivers, from the Office of Health Communications, Centers
for Disease Control, Atlanta; FAX: (404) 639-0817 - http://www.cdc.gov/ncidod/dbmd/cause/spr99.pdf
"Katy's
Kids," Iowa Pharmacists Association - (515) 270-0713 - http://www.iarx.org
"Be SAFE,"
an initiative by the American Pharmaceutical Association and McNeil Consumer
Products to promote the safe use of non-prescription medicines by children
- 1-800-472-3923.
"New Medicines
in Development for Children," Pharmaceutical Research and Manufacturers
of America (PhRMA), 1998. (202) 835-3400 - http://www.phrma.org
Allergy
and Asthma Network / Mothers of Asthmatics, Inc.1-800-878-4403
Asthma
Awareness Day: A Planning Guide (1995). (301) 496- 5717 National Institute
of Allergy and Infectious Diseases, National Institutes of Health
"Overuse
of Antibiotics Supplement," Pediatrics (Jan. 1998), American Academy of
Pediatrics 1-800-433-9016, ext. 7903 - http://www.aap.org/pubserv
|
| THE LOW-LITERACY CHALLENGE |
"Talk About Prescriptions" takes on new meaning - and a
renewed urgency - for people who have difficulty reading at the most basic
levels. Over one-fifth of American adults read at the lowest literacy
levels, and over one-fourth read at the next-lowest level (1993, "Adult
Literacy in America," U.S. Dept. of Education). The average reading skills
of all U.S. adults is between the eighth and ninth grade level. Medicaid
recipients were found to have average reading skills at the fifth grade
level.
In the
landmark Department of Education study that surveyed over 26,000 adults,
researchers found that the least-literate group would probably not be
able to read and understand dosage instructions on medicine bottles; poison
warnings; a newspaper; or notes from their child's teacher. Because ensuring
appropriate use of medicines often assumes a patient's comprehension of
written instructions, there are many challenges to "talk about prescriptions"
with this special population.
Indeed,
low-literacy patients "may fail to understand written information they
receive from health care providers, thereby contributing to noncompliance,
errors in treatment, and poor outcomes" (Smith, TJ, "Johnny Can't Read
and Didn't Take His Leucovorin," cited in Weiss, B.D., "Communicating
With Patients Who Have Limited Literacy Skills," Report of the National
Work Group on Literacy and Health, The Journal of Family Practice, Vol.
46, No. 2, Feb. 1998, pps. 168-176).
In a study
of hospitalized patients with hypertension or diabetes, researchers found
that 49% of the patients with hypertension, and 44% of the patients with
diabetes, had inadequate health literacy ("Relationship of Functional
Health Literacy to Patients' Knowledge of Their Chronic Disease," Williams,
M., et. al., Archives of Internal Medicine, Vol 158, Jan. 26, 1998, pps.
166-172).
What steps
have been taken to develop medicine communications that are at appropriate
literacy levels?
The Action Plan for the Provision of Useful Prescription Medicine Information,
developed in 1996 by NCPIE and over 30 other key stakeholder organizations,
and approved by HHS Secretary Donna Shalala in 1997, addressed literacy
levels. The Plan recommends that information be written at the sixth-to-
eighth-grade levels, but should also be available at higher levels (p.
23). (Publication # 63 from The Keystone Center, 202/783-0248; http://www.keystone.org)
The National
Work Group on Literacy and Health recommends that materials should be
at the fifth grade level or lower. (Weiss, B.D., loc. cit.).
The use of pictograms is advocated by many literacy organizations. A detailed
list of pictograms, and a summary of research on their usefulness for
low-literacy populations, is available from the USP. Currently, they are
widely used on warning stickers affixed to prescription bottles, and on
non-prescription packages. There is an increasing use of multimedia computer-based
educational programs that permit patients to choose to see and hear information
about a particular disease or medical condition (Weiss, B.D., p. 172).
|
| Resources: |
| "MedCoach" patient information leaflets vary according to two reading
levels and may contain pictograms. Published by USP, Rockville, MD. (301)
816-8351
Health
Literacy Center, University of New England (207) 283-0170, ext. 2205
Health
Promotion Council of Southeastern Pennsylvania (215) 731-6155
National
Cancer Institute, Cancer Information Service (NIH Pub. No. 95-3594) 1-800-4-CANCER
"Counseling the Low-Literate Patient," produced by the North Carolina
Pharmaceutical Association (919) 967-2237
National
Work Group on Literacy and Health: Denver, CO (303) 239-3405 e-mail: schneider@amc.org
The Pfizer
Journal, "Responding to the Challenge of Health Literacy," Vol. 2, No.
1 (Spring 1998), 37 pps. Contact Impact Communications, Inc., New York.
(212) 490-2300
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Infórmate Antes de Medicarte
Conocimento es la Mejor Medicina |
The National Council on Patient Information and Education offers
several Spanish-language educational resources
for purchase. Our medication wallet card, translated in 2002, is featured below.
Medicamentos
sin receta (marque aquellos que utiliza de forma continuada):
|
Antiácidos
Aspirina/otros medicamentos para el dolor, dolor de cabeza o fiebre
Laxantes
Medicamentos para la alergia
Medicamentos para el catarro
Medicamentos para la tos
Pastillas para adelgazar
Pastillas para dormir
Plantas medicinales
Vitaminas
Otros (escribir debajo)
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Recuerde preguntar
a sus farmacéuticos, a sus médicos o a otros proveedores médicos:
- ¿Qué nombre tiene el medicamento y para qué sirve?
¿Es su nombre comercial o es su nombre genérico?
- ¿Cómo, cuándo y durante cuánto tiempo
he de tomarlo?
- ¿Es necesario realizar algún exámen de
seguimiento con este medicamento (por ejemplo, exámen de la función hepática
o renal)?
- ¿Qué alimentos, bebidas,
medicinas, y otras actividades deberé evitar mientras tome este
medicamento?
- ¿Cuáles son los efectos adversos
posibles?, y si se presentan, ¿qué debo hacer?
- ¿Esta nueva receta médica no dará
problemas mientras sigo tomando otros medicamentos de receta y otros sin receta?
- ¿Hay alguna información escrita
disponible sobre este medicamento? (¿La tiene en letra grande, o en otro idioma que no sea
inglés?)
National
Council on Patient
Information and Education
200-A Monroe Street, Suite 212
Rockville, MD 20850-4448
(301) 340-3940
(301) 340-3944 (fax)
e-mail:ncpie@ncpie.info
Datos Médicos Personales
Mi
nombre es ________________________________________________________
Teléfono privado (____)____________ Teléfono del trabajo (_____)_____________
Soy alérgico a (por favor marcar):
Aspirina
Alimentos
Antibióticos
Codeína
Penicilina
Picaduras de insectos
Otros medicamentos
Mi estado de salud incluye:
Alteración de la vista
Ataque cardíaco
Enfermedad cardíaco
Marcapasos
Alteraciones del ECG
Depresión
Epilepsia
Presión arterial alta
Artrosis/Artitris
Diabetes
Hemodiálisis
Sordera
Otros________________________________________________________________
Nombre del médico________________________ Teléfono (_______)__________
Nombre del farmacéutico______________________ Teléfono (_______)__________
En caso de emergencia llamar a:
Nombre:__________________________________ Teléfono (_______)__________
Medicamentos que estoy
tomando:
Por receta:_______________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Si Ud. tiene preguntas acerca de algún medicamento, visite www.medlineplus.gov
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