Standardized Dosing Could Help Patients Organize Medication Regimens

In the United States, physician prescriptions and labels on medications dispensed by pharmacies often include vague information outlining recommended medication schedules. The schedules are identified either in hourly intervals (every 4-6 hours) or times per day (twice daily). Previous studies have found that nearly 50% of patients misinterpreted common instructions when attempting to dose a single prescription medication. For patients who need to manage multiple prescriptions and over-the-counter medications, the problems are more serious. According to the Medical Expenditure Panel Survey, the average adult in the United States fills 9 prescriptions per year; adults >65 years of age fill, on average, 20 prescriptions per year. Complexity in medication regimens can lead to poor adherence and worse health outcomes, and the known variability and poor quality in which instructions are written by physicians and interpreted by pharmacists can impede a patient’s ability to organize and properly dose multiple medications. In 2008, the Institute of Medicine issued a report titled Standardizing Medication Labels that called for setting standards within prescribing and dispensing practices to promote safe and accurate medication use. The report proposed a universal medication schedule (UMS) that specified 4 standard times (morning, noon, evening, and bedtime); all prescriptions would instruct patients to take their medications using these times, and label instructions would subsequently be described in a single standardized fashion. Reaction to the report in the medical and pharmaceutical communities was mixed: while acknowledging that a UMS would help patients organize and group complex medication regimens for daily use, both groups concluded that further evidence was needed to support the need for the UMS. Researchers recently conducted a study to “fill the gap of existing literature” and to determine whether multiple prescription regimens are complicated when patients take their medications >4 times a day. The study specifically assessed the accuracy and variability in the way patients implemented a 7-drug regimen. Study results were reported in Archives of Internal Medicine [2011;171(4):300-305]. The primary outcome was the number of times per day that participants would take medicine. The study also examined the root causes for patients complicating the regimen (taking medications ≥4 times a day). Mean age of the participants was 63.3 years, 71.1% were female, 60.8% were white, 61.4% were college graduates, and 61.9% had an annual household income >$50,000. One fifth of the participants were identified as having low health literacy skills (20.7%); another 22.8% had marginal health literacy skills. More than three quarters of the participants reported having 1 or more chronic health conditions (83.8%). On average, the participants identified 6 times in 24 hours to take medicine (when dosing the 7-drug regimen). Regimen dosing ranged from 3 times a day to 14 times a day. Nearly one third of participants (29.3%) dosed their medications 7 times a day; 14.9% dosed their medications ≤4 times a day. Multivariate analysis found that low health literacy was an independent predictor of more times per day for dosing regimen (Beta=0.67; 95% confidence interval, 0.12-1.22; P=.02). Two of the drugs had identical instructions, but 31% of the participants took the drug at different times. Another set of drugs had similar instructions, with the primary exception of the instruction to take the drug with food and water; 49.5% of the participants took these medications at different times. When the medications had variable wordings for the same dose frequency (every 12 hours or twice a day), 79.0% of the participants did not consolidate their medications. In conclusion, the researchers noted that “many patients, especially those with limited literacy, do not consolidate prescription regimens in the most efficient manner, which could impede adherence. Standardized instructions proposed with the universal medication schedule and other task-centered strategies could potentially help patients routinely organize and take medication regimens.”