Written information about individual medicines for consumers.

BACKGROUND: Medicines are the most common intervention in most health services. As with all treatments, those taking medicines need sufficient information: to enable them to take and use the medicines effectively, to understand the potential harms and benefits, and to allow them to make an informed decision about taking them. Written medicines information, such as a leaflet or provided via the Internet, is an intervention that may meet these purposes. OBJECTIVES: To assess the effects of providing written information about individual medicines on relevant patient outcomes (knowledge, attitudes, behaviours and health outcomes) in relation to prescribed and over-the-counter medicines. SEARCH STRATEGY: We searched MEDLINE, EMBASE, CINAHL, The Cochrane Library, PsycINFO and other databases to March 2007. We handsearched five journals' tables of contents, and the reference lists of included studies, and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) of medicine users, comparing written medicines information with no written medicines information; or trials that compared two or more styles of written medicines information. We only included trials that measured a knowledge, attitudinal or behavioural outcome. There were no language restrictions. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data relating to the interventions, methods of the trials, and outcome measures; and reconciled differences by discussion. Heterogeneity of interventions and outcomes measured meant that data synthesis was not possible. The results are presented in narrative and tabular format. MAIN RESULTS: We included 25 RCTs involving 4788 participants. Six of twelve trials showed that written information significantly improved knowledge about a medicine, compared with no written information. The inability to combine results means we cannot conclude whether written information was effective for increasing knowledge. The results for attitudinal and behavioural outcomes were mixed. No studies showed an adverse effect of medicines information. AUTHORS' CONCLUSIONS: The combined evidence was not strong enough to say whether written medicines information is effective in changing knowledge, attitudes and behaviours related to medicine taking. There is some evidence that written information can improve knowledge. The trials were generally of poor quality, which reduces confidence in the results. Trials examining the effects of written information need to be better designed and use consistent and validated outcome measures. Trials should evaluate internet-based medicines information. It is imperative that written medicines information be based on best practice for its information design and content, which could improve its effectiveness in helping people to use medicines appropriately.

Consumer medication information in the United States, Europe, and Australia: a comparative evaluation.

OBJECTIVE: To evaluate the quality of patient information leaflets provided with dispensed medications in the United States, United Kingdom, and Australia. DESIGN: Quantitative survey by an expert panel. SETTING: United States, United Kingdom, and Australia. PARTICIPANTS: Not applicable. INTERVENTION: Patient information leaflets for atenolol, glyburide (glibenclamide), atorvastatin, and nitroglycerin (glyceryl trinitrate) from the United States, United Kingdom, and Australia. MAIN OUTCOME MEASURES: Leaflets were evaluated against U.S. consensus criteria for both clinical information and general criteria, including the design of the leaflets. RESULTS: Leaflets from Australia received a mean overall score of 90% (range 83%-94%) adherence with criteria, those from the United Kingdom a score of 81% (range 73%-84%), and those from the United States a score of 68% (range 65%-77%). The U.S. leaflets achieved 50% or less adherence for contraindication and precaution information. Omissions included warnings about preexisting allergy and illness and information about drug interactions. The U.S. leaflets also scored poorly (60%) for legibility and comprehensibility. The lower U.K. score reflected shortcomings in information about how to use and monitor the medications (46% adherence) and on adverse drug reactions (64%), largely due to the lack of clear advice about urgency of action in relation to adverse drug reactions. CONCLUSION: Leaflet quality varied more among the three countries than within each country, reflecting the regulatory context. The Australian leaflets performed well across all criteria, whereas the U.S. leaflets had significant shortcomings with the omission of vital information for the safe and effective use of the medications. A repeat survey is needed to assess whether new legislation and guidance in all three countries successfully addresses the shortcomings identified.

The organisation and development of primary care pharmacy in the United Kingdom.

Primary care pharmacists carry out clinical and administrative work directly for family doctors and primary care organisations. They are a relatively recent innovation and their role in the United Kingdom (UK)'s National Health Service (NHS) is still developing. The economic liberalization of the NHS in the 1990s seems to have provided a major stimulus for the growth of primary care pharmacy. The establishment of the new professional group was not linked to a deliberate plan or change in health policy with respect to pharmacist development. Primary care pharmacy practice is much more varied and flexible than traditional pharmacy practice in the community and hospitals. Standards and professional organisation for primary care pharmacy are slowly emerging. Modernization of the NHS is providing many new opportunities, which primary care pharmacists are well placed to take advantage of. Traditional community pharmacy faces many problems unless it can learn to develop alongside primacy care pharmacy. Pharmaceutical care is set to improve in the United Kingdom, but the precise nature of future services and providers remains uncertain.