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Building a Better System For All: Reducing Medication Misunderstandings Statewide

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July 30, 2021, Posted by AHW Endowment
 

Photo of Prescription Medication Bottle

Nearly half of adults in the United States have taken a medication incorrectly. It’s a costly – and deadly – problem. The impact of incorrect medication use is estimated to cost the U.S. health care system as much as $289 billion a year and result in as many as 125,000 deaths annually.

Advocates across health care and public health have identified a combination of factors as causes: Low health literacy nationwide, poorly designed labels for prescription medications, costs, side effects, patient beliefs, and a complex set of systems between prescribers and pharmacies that have made creating any changes to the prescription process a daunting task.

For the past seven years, a coalition of prescription label champions led by the nonprofit Wisconsin Literacy, Inc., has steadily taken on this challenge. Their aim: Create simple, understandable labels for prescription medications, and then equip pharmacies and health systems across the state with the tools to put them into use.

Today, the coalition is delivering on their goals. And with the support of a new $468,413 AHW grant – part of nearly $1.2 million AHW has invested into separate phases of the project since 2016 – they are poised to take a big step forward, working with Wisconsin’s health systems to make the use of clear medication instructions on prescription labels the standard.

“It’s all about improving care,” says Michele Erikson, executive director of Wisconsin Literacy. “If people take their medication appropriately, they are more likely to be managing their conditions, and they are less likely to be hospitalized for taking their medications wrong or making their condition worse.”

This latest phase builds on years of development, testing, and change driven by patients, pharmacists, technicians, and health care practitioners working together. 

“Getting all the right partners at the table and engaged in honest conversation has been critical,” said Stan Hudson, health literacy director at Wisconsin Literacy.

The collaborative process allowed the coalition to overcome challenges that have come along the way. For instance, when some pharmacy software systems wouldn’t allow for new label designs, the coalition was able to identify vendors that could, while helping those pharmacies who couldn’t change vendors navigate the ways they could change their labels.

The coalition’s Patient Advisory Group and statewide surveys also provided answers, helping to re-organize the content on standard labels to place the most important information more prominently.


“It’s all about improving care,” says Michele Erikson, executive director of Wisconsin Literacy. “If people take their medication appropriately, they are more likely to be managing their conditions, and they are less likely to be hospitalized for taking their medications wrong or making their condition worse.”


The result has been steady progress and a growing impact. Not only have patients reported satisfaction with the new label design, but pharmacies are seeing positive outcomes in their patient’s health. In the label testing phase, one pharmacy partner found that medication adherence increased for their patients taking asthma, antihypertensive, and oral contraceptive medications.

Now, as Wisconsin’s pharmacies continue to drive change within their organizations – today more than 20% of Wisconsin’s pharmacies have joined the project – the coalition is looking upstream to focus on a critical piece of information on the label itself: the directions for use.

While the project’s previous work resulted in a more patient-friendly organization of the label’s content, changing the written information printed on the label is another step in the process.

These medication instructions – referred to as the SIG in medical jargon – explain how, when, and the dose of a medication a patient should take.

The instructions are most often transmitted from the prescriber electronically to a pharmacy.  But these instructions aren’t always written in clear language. Take, for example, the seemingly simple statement “take two pills twice daily.” This basic instruction has been found written across prescription labels in multiple ways. The result is not only inconsistent instructions, but misunderstandings that can be dangerous.

“These misinterpretations can have very serious consequences for people,” said Bhumi Khambholja, project manager with Wisconsin Literacy, and a pharmacist by training.

In surveys of Wisconsin residents, Wisconsin Literacy has documented real-world examples of these consequences, with respondents sharing their own or loved ones’ experiences in accidentally over- or under-medicating as a result of complicated or unclear instructions.

The coalition has a solution.

As a result of its work with the coalition, long-time project partner Epic, the international electronic health record corporation, is taking the step to embed a set of plain language options with morning, noon, evening, and bedtime timings (referred to as the UMS, or Universal Medication Schedule) into its prescribing software. The feature will enable prescribers to automatically use the simplified instructions. The next step for Wisconsin Literacy will be to help health systems statewide embrace the change as part of their standard operations.

This phase will bring the project full circle – making the seemingly simple re-design of a prescription label possible for the prescriber and pharmacist who input the information, and for the patient who has to interpret that information.

“Really, it’s about making the system work better for all,” said Erikson.

Find more information on this and other AHW-funded projects in the AHW Funded Project Listing.

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