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Confusion Over Drug Dosing Common for Seniors

By Steven Reinberg
HealthDay Reporter

MONDAY, Feb. 28 (HealthDay News) -- Instructions for taking medications are often so vague that older patients, sometimes taking an average of seven pills a day, may take their drugs incorrectly, a new study finds.

Moreover, many patients don't realize that they can take several medications at once. Standardized, simple instructions that will make dosing times easy to grasp are sorely needed, the researchers added.

"When given the task of taking multiple medications, people unnecessarily complicated the regimen," said lead researcher Michael Wolf, an associate professor of medicine and learning sciences at Northwestern University's Feinberg School of Medicine in Chicago.

Wolf noted that many older people are taking as many as seven different drugs a day. "People took medicine more times a day than they needed to," he said.

The report is published in the Feb. 28 issue of the Archives of Internal Medicine.

For the study, Wolf's team talked to 464 patients aged 55 to 74. Although most of the patients were well-educated, roughly half didn't have strong "health literacy skills," the researchers noted.

Health literacy is the ability to understand the information that patients are given about their health, the drugs they are supposed to take and their ability to perform skills related to their health, Wolf said.

"There have been studies over the past two decades that linked poor health literacy to poorer outcomes and worse mortality rates," he said.

After giving patients a seven-drug regimen, they found that people were often taking drugs up to 14 times a day, Wolf said. "We are arguing they shouldn't have taken them more than four times a day," he noted.

Patients need to find the most efficient way of taking their drugs by consolidating their regimen, Wolf explained.

"We found that when people were given two medicines with the exact same instructions, a third of patients wouldn't combine those medicines," he said. "When one said take with food or water, half the patients wouldn't combine those medicines."

Moreover, when two medicines were to be taken every 12 hours, two out of three people wouldn't combine them, Wolf said. "It may be that a lot of people have concerns that they can't take these medicines together, that there may be a harmful interaction," he said.

"We are not talking to patients about this," Wolf said. "This is the number one cause of non-adherence in the United States, beyond cost."

To solve this problem, Wolf suggests that instead of saying take this drug twice a day or every 12 hours, prescriptions should say to take the drug morning, noon, evening or bedtime -- a so-called "universal medication schedule."

In addition, doctors need to better inform their patients about the medications they are taking, when and how to take them and which medicines can be combined, Wolf said.

Dr. Laurence Gardner, executive dean for education and policy at the University of Miami Miller School of Medicine, agreed that "it's not easy for older patients to simplify the medication program down to four times a day at most."

However, Gardner said the study did not show that patients were harmed by not simplifying their medication regimen. But, mistakes can happen more often in these settings, he added.

One of the things that could simplify medication prescribing is electronic medical records, Gardner said.

"While it may not save money, it's safer for patients," he said. "It would not be hard to build common language about frequency of medication."

Another expert, Terri Ann Parnell, corporate director of Health Literacy at North Shore-Long Island Jewish Health System in Lake Success, N.Y., was surprised at how many educated patients were health-illiterate.

"The study highlighted in a compelling way that most of the people in the study were highly educated, and still many had marginal health literacy skills," she said. "The assumption is that poor health literacy is only among the less educated and low socioeconomic groups. This study shows this is not the case."

Parnell thinks that doctors need to explain things to patients in plain language.

In addition, in a process called "teach-back," doctors can have their patient repeat what they were told.

"It's not testing the patient, but asking them to repeat in their own words what had just been gone over," Parnell said. "You'll know in seconds if what was just said was understood."

More information

For more information on health literacy, visit the U.S. National Network of Libraries of Medicine.

SOURCES: Michael Wolf, Ph.D., M.P.H., associate professor of medicine and learning sciences, Northwestern University Feinberg School of Medicine, Chicago; Laurence Gardner, M.D., executive dean for education and policy, University of Miami Miller School of Medicine; Terri Ann Parnell D.N.P., R.N., corporate director, Health Literacy, North Shore-Long Island Jewish Health System, Lake Success, N.Y.; Feb. 28, 2011, Archives of Internal Medicine

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