The ideal nonsteroidal anti-inflammatory drug patient information leaflet

Autor: Joanna Mary Seager, Roger Jones
Rok vydání: 2001
Předmět:
Zdroj: The American journal of medicine. 110(1A)
ISSN: 0002-9343
Popis: The prescribing of medicines is often at the heart of the physician–patient consultation for medical problems, yet patient compliance is erratic and generally not in accordance with advice provided by physicians, pharmacists, or the drug packaging itself. Indeed, patient nonadherence to medicine taking is the rule, rather than the exception. There are some extraordinary examples of patients’ failure to adhere to prescribed regimens. One of the most common causes of renal transplant rejection in children is failure to take their immunosuppressant drugs, representing a parental failure of adherence as well as (or resulting in) patient noncompliance. For patients who have had a severe upper gastrointestinal hemorrhage requiring hospitalization and blood transfusion, adherence rates to subsequent acid suppression therapy are in the region of only 50% to 60%. In hypertension, the rule of halves applies: Only half of the cases are ascertained, only half of these are started on treatment, and only half of the treated patients stick to their medication. Finally, the treatment of depression, at least in primary care, is truly bedevilled by nonadherence to medication. Recent work from London has indicated that after 2 and 3 months, respectively, only some 40% and 25% of patients started on antidepressant medication by their physicians are still taking the drugs. These extraordinary figures apply not only to the anticholinergic group of drugs but also to the more modern selective serotonin reuptake inhibitors (SSRIs), which have a much more benign side-effect profile. Communication between physician and patient is clearly a central issue in encouraging compliance, but there is evidence to show that patients can recall only a small fraction of the information imparted in consultations in primary and secondary care. It is not surprising, therefore, that other methods of providing information to patients have been tried, and patient information leaflets (PILs) are among these. Indeed, since January 1, 1999, European law requires the inclusion of PILs in all packages of medicine. There is some research evidence that the form and content of these leaflets fail to meet the purposes for which they are designed. In this article, we present suggestions for an “ideal” PIL for an imaginary nonsteroidal anti-inflammatory drug (NSAID), seagerprofen (Analgen), manufactured by a fictitious company (Hawkpharm plc) (Table 1). It is important to realize that the provision of written information alone is no substitute for good communication between physicians and their patients. In recent years, such concepts as concordance (agreement after negotiation between physician and patient about the nature of the problem and the most likely beneficial courses of action) and enablement (giving patients information and responsibility for the management of their own problems) have emerged and are being incorporated into modern thinking about physician–patient encounters. There is some evidence that when concordance is achieved between physician and patient, adherence to medication is enhanced, and that patients who are provided with prescriptions they do not want or do not understand are extremely unlikely to even fill their prescription, much less take the medicine. The PIL, therefore, needs to be seen in the context of a patient-centered, negotiated consultation in which physician and patient strive for a concordant view of the problem and its solution.
Databáze: OpenAIRE
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