Review: providing patients with written information about medicines does not guarantee increased knowledge
Q Does written information about individual medicines improve patients’ knowledge, attitudes, and behaviour?
Medline, CINAHL, EMBASE/Excerpta Medica, Cochrane Library, Digital Dissertations, Health Management Information Consortium, Index to Theses, ISI Proceedings, Pharmline, PsycINFO, Sociological Abstracts, and Web of Science (1970–2004); and reference lists.
Study selection and assessment:
English-language, randomised controlled trials (RCTs) that evaluated the effectiveness of printed (eg, leaflets) or electronic (eg, internet) written information about individual medicines (prescription or over-the-counter) provided to patients at any time after the decision to prescribe or purchase the medicine. 36 articles reporting 43 RCTs (n = 9222) met the selection criteria. Quality assessment of individual trials was based on randomisation method, allocation concealment, blinding, and follow-up.
patient knowledge (about the drug, how to take it, or side effects), attitudes (patient satisfaction or perception of risks), and behaviours (adherence, reporting of side effects, worry, or reading the leaflet).
Because of the wide variety of outcomes, meta-analysis was not done. Results from individual trials are summarised in the table.
Providing patients with written information about medicines does not guarantee increased knowledge about those medicines. Presentation of risks of medicines in a numerical, rather than verbal, format increases patients’ knowledge about side effects and satisfaction with the information. Little evidence exists that written information improves adherence to medication or reporting of side effects.
- Paula Eyles, RN, MHSc, CNS
- St Joseph’s Healthcare Hamilton and McMaster University School of Nursing, Hamilton, Ontario, Canada
The comprehensive review by Raynor et al was initiated after the recent movement in many countries for legislation or guidelines requiring additional written patient information to be given with pharmaceuticals. Inferences on the effectiveness of this written information were made using systematic analysis, expert advisors, and stakeholder workshops. No evidence was found that printed medication information in isolation is effective in increasing patients’ knowledge. The authors’ conclusions included the recommendation that verbal professional communication should always accompany written material. The review showed that much of the research in this field is methodologically poor and that “no strong claims can be made about their findings.”
However, this summary of evidence (and lack thereof) contributes to current knowledge by highlighting similar ideas reflected in the health literacy literature. Pharmaceutical companies and healthcare providers responsible for writing handouts about medications can glean several essential points to consider. The evidence suggests that clear, non-technical language is important, but oversimplification may not be helpful. Attention should be given to formatting and presentation. Information on risks, benefits, and adverse effects should be given, and numerical estimates of risk may be preferable. Patients should be involved in development and field testing of individual handouts, which should be tested using adequate sample sizes.
The qualitative evidence in the review also highlighted patients’ preference for information tailored to their individual conditions. The feasibility of providing medication information for each medical indication presents a challenge to healthcare providers and pharmaceutical representatives. The internet can offer consumers a choice of formats; however, not everyone has access to computers or the literacy skills to search and understand this information.
For correspondence: Dr D K Raynor, University of Leeds, Leeds, UK,
Source of funding: National Institute for Health Research Health Technology Assessment Programme.