# Presentation: 716907

## Evaluation of Written Prescription Information Provided in Community Pharmacies: A National Study 

- Bonnie L. Svarstad, Ph.D.
- University of Wisconsin - Madison

- July 31, 2003

## Objectives   

- Briefly review criteria, scoring methods
- Summarize major deficiencies
- Examine ratings by leaflet type, vendor
- Illustrate problems using sample leaflets

## Study Differs From Past Work  

- Shoppers presented 4 prescriptions at 384 randomly selected pharmacies in 44 states
- Expert raters nominated by 7 organizations
- Experts used 8 criteria from Action Plan
- Consumers also rated leaflets

## Eight Criteria from 1996 Action Plan for Useful Information  

- 1.  Drug names and indications
- 2.  Contraindications and what to do before using
- 3. Specific directions about how to use, monitor, and get most benefit
- 4.  Specific precautions and how to avoid harm

## Eight Criteria from 1996 Action Plan for Useful Information

- 5. Serious and frequent adverse reactions, what to do
- 6. General information, encouraged to ask questions
- 7. Scientifically accurate, unbiased, up-to-date
- 8. Readily comprehensible and legible

## Expert Rating Forms 

- Each form had 8 criteria, 62-63 sub-criteria
- Sub-criterion worth 0-2 points (2=full adherence)
- Computer calculated % of points obtained
- Adherence to criteria ranged from 0-100%
- Five levels of adherence were defined

## Five Levels of Adherence to Criteria  

- _Adherence Level __	__	__	__Point Range %_
- Level 5..................................	80-100
- Level 4..................................	60-79
- Level 3..................................	40-59
- Level 2..................................	20-39
- Level 1..................................	0-19

## Consumer Rating Process  

- Recruited 154 consumer raters in 11 states
- Facilitator met with 8-15 raters per session
- Each rater independently rated ~ 10 leaflets
- Leaflet rated on 12 items (1-5 points each)

## Comprehensibility Items

- Poorly-well organized
- Poor-good length
- Unclear-clear
- Unhelpful-helpful
- Incomplete-complete
- Hard-easy to find important information

## Legibility and Summary Items

- Legibility: Poor-good print size, poor-good print quality, poor-good spacing between lines
- Summary Items: overall ease of reading, overall ease of understanding, overall usefulness

## % Shoppers Given Leaflet and Mean Expert Rating of Leaflet  

- atenolol		90 %		51 %
- glyburide		89 %		51 %
- atorvastatin	89 %		52 %
- nitroglycerin	88 %		55 %

-  **Given leaflet    Mean expert rating**

##  Expert Ratings, All Criteria (n=1,367 leaflets)

## Expert Ratings by Criterion

- Highest Ratings: 	#7: accuracy, unbiased
- Moderate Ratings:  	#1: names, uses		#3: directions

- Low Ratings:		#5: ADRs, what to do	#6: general information
- Lowest Ratings:		#2: contraindications	#4: precautions		#8: legibility/comprehens.

## % Leaflets Rated Level 4-5

## Lowest Expert Ratings - Criteria 2 & 4

## Lowest Expert Ratings - Criterion 8

##  Consumer Ratings, All Items (%)  

## Consumer Ratings by Item 

- Lowest ratings: print size, print quality, spacing,  overall readability
- 36% of leaflets given low ratings on readability

## Consumer Summary Rating: Readability and Understandability  

## Consumer Summary Rating:  Usefulness   

## Factors Linked to Ratings (atenolol) 

- Leaflet type: 	- abbreviated (n=48 sites or 13.7%)				- standard (n=302 sites or 86.3%)
- Leaflet vendor	 and version				- Vendor 1, Versions 1-3 (304 sites, 86.9%)		- Vendor NA, Version 1-2 (46 sites, 13.1%)		- Vendor 2 (comparison, hospital leaflet)
- Leaflet format and pharmacy type

## Expert Ratings by Leaflet Type, Vendor, and Version 

- St= standard leaflet  Ab= abbreviated leaflet

## Expert Ratings of Standard Leaflets:  Vendor 1 Vs. Vendor 2 (atenolol)  

- .

## Expert Ratings of Standard Leaflets: Vendor 1 Vs. Vendor 2 (atenolol)  

## Consumer Ratings by Leaflet Type, Vendor, Version (atenolol)

- St= standard leaflet         Ab= abbreviated leaflet

## Consumer Ratings of Standard Leaflets: Vendor 1 Vs Vendor 2 (atenolol)

- 1=poor, 5=good

## Consumer Overall Ratings by Leaflet Format 

- p <.001 all tests; n=1,417 leaflets, including Vendor 2

## Leaflet Distribution and Ratings by Pharmacy Type

- P<.001 all tests

## Leaflet Type by Pharmacy Type

- P<.001

## Conclusions: Four Main Problems Identified 

-  11% of pharmacies gave no leaflet
-  13% of pharmacies gave abbreviated leaflet
-  36% of leaflets hard to read (font, spacing)
-  leaflets failed 6 of 7 content criteria; >90%  failed on contraindications and precautions