Implementation of patient-centered prescription labeling in a safety-net ambulatory care network.

Khoong EC1, Cherian R2, Smith DE3, Schillinger D2, Wolf MS4, Sarkar U2.

Author information

1: UCSF Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA. elaine.khoong@ucsf.edu.
2: UCSF Center for Vulnerable Populations and UCSF Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA.
3: San Francisco Department of Public Health, San Francisco, CA, and UCSF Department of Pharmacy, San Francisco, CA.
4: Department of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Abstract

PURPOSE:

An initiative to implement patient-centered medication labeling at 4 pharmacies within a publicly funded safety-net healthcare system is described.

SUMMARY:

Medication nonadherence negatively affects patient outcomes and safety. Nonadherence has been attributed to poor understanding of instructions on medication labels. Research has demonstrated that patient-centered labeling (PCL) can improve adherence and produce safer medication-taking practices. As part of a mixed-methods study by a safety-net health system, audits of nearly 9,000 prescription labels generated at 4 pharmacy sites, as well as interviews with 6 stakeholder informants, were conducted to determine PCL adoption rates and factors contributing to success. Descriptive statistics were used to analyze audit data; constructs of the Consolidated Framework for Implementation Research were used to analyze interview data. Among the 4 sites, 3 pharmacies successfully converted more than 85% of audited prescriptions to a PCL format; 1 pharmacy converted less than 25% of prescriptions. Barriers to implementation included pharmacists' reluctance to modify prescriber instructions and inadequate real-time data on conversion rates. Interviewees perceived that leadership and policy directives promoted PCL conversion efforts. Successful pharmacies used adaptable software, had closer communication networks with prescribers, and/or used automation to facilitate PCL conversion.

CONCLUSION:

Three pharmacies successfully converted more than 85% of labels for audited prescriptions to a PCL format; 1 pharmacy converted less than 25% of prescriptions. Barriers to implementation included pharmacists' reluctance to modify prescriber instructions, inadequate real-time data on conversation rates, and lack of customizable software to automate changes.