Consumers have different decision-making styles and interest in health information. However, virtually all want to be informed about and make decisions about their medicines, to some degree. Some take a passive approach and choose to ‘let the doctor decide’, while others wish to be much more active, to receive detailed information about their treatment options and to share in the decision-making.
Other factors may also influence how actively or passively involved consumers wish to be, for example, what stage they are at in the continuum of care. The amount of information consumers want at diagnosis may be quite different to what they want when coping with their condition over the long term.
The risks of not informing consumers about their medications are that they may not adhere to treatment - if, for example, they do not understand what the medicine is for, or do not know what effects to expect or the potential benefits and harms. Poorly informed consumers may also take the medicine incorrectly, they may fail to recognise problems that occur and will be ill-equipped to act appropriately if problems do arise.
Conversely, well informed consumers are more likely to adhere to treatments and have better health outcomes. Errors are more likely to be avoided if consumers are well informed. Informing consumers also encourages them to become more self-reliant and confident in the management of their medications.1
In 1993 the National Health and Medical Research Council (NHMRC) published guidelines2for health professionals on providing information to consumers. Since then a number of tools have become available to make providing information to consumers about their medication easier. Consumer Medicine Information (CMI) for prescription medicines is the most significant. The information helps the consumer to understand what the medication is for, its benefits, adverse effects and risks. CMI also contains practical information about dosage, administration and contraindications, which consumers can refer to if needed.
CMI also has the advantage of being standard for a particular medication, irrespective of whether the consumer receives it from their pharmacist, their doctor or as a package insert. Practitioners can therefore be sure about what information their patients will be receiving.
CMI has to remain consistent with the product information and so is updated when any changes occur to the product information. In practice, companies differ in how thoroughly they test CMI on consumers and as a result CMI does vary in quality.
CMI is now available for virtually all prescription medicines. However, its distribution to consumers is still far from widespread. Encouraging consumers to ask for the CMI when their medication is dispensed would help. This may be more practical than printing it out for consumers at the surgery, although it is certainly available through prescribing software.
Of course, CMI has its limitations and will never be the complete answer to people’s information needs. A significant proportion of the population has some or great difficulty with the written information encountered in everyday life.3People also vary in the extent to which they prefer receiving information verbally, in written form or a combination of the two. However, it is a mistake to assume that, for example, just because a person’s spoken English is not good, that they have no use for CMIs in English. Research suggests that many people would prefer receiving a CMI about their medication in English rather than not receiving one at all.4They may be able to read it at their own pace at home or they may have family members who can read it for them.
An often-voiced concern about CMI is that the information about the risk of harm does not indicate how frequently harm actually occurs and, as a result, consumers may be too scared to take their medication. The newer and better CMIs include such information. A good technique is to encourage consumers to come back with any queries they may have after reading the CMI. This then opens up opportunities to address any fears and correct any misunderstandings which may have prevented them taking the medicine.
CMI also does not contain information about how much a drug will cost. Failure to talk about costs may result in consumers not getting a prescription dispensed. If cost concerns are discussed there is then an opportunity to talk about cheaper options or the consequences of not going ahead with the treatment.
To make informed decisions about treatment consumers need comparative information about the pros and cons of the various options. CMI can help in this discussion to an extent, although an individual CMI only provides information about one particular medicine. It is also important that doctors explain when prescribing outside an approved indication, that the indication will not appear on the CMI, but information about adverse effects and interactions will still be relevant.
The internet is increasingly being used as a source of health information. In the USA up to 75% of internet users have used it to obtain health information and 41% of Americans say that material they found affected decisions about whether they should go to the doctor, how to treat an illness or how to question a doctor.5Australia may not be that different.
Doctors are right to be concerned about the quality of information available to consumers via the internet. Consumers may have difficulty distinguishing between good and poor quality information and independent versus promotional material. Doctors can play a key role in guiding consumers to good and reliable web sites relevant to Australian consumers. The Federal Government’s health web site HealthInsite (www.healthinsite.gov.au) is a good starting point for health information that conforms to standards of quality and independence and is written for a consumer audience. The Australian Prescriber web site (www.australianprescriber.com) also has brief information for consumers on the topics of the main articles.
A new telephone medicine information service for consumers has just been set up by the National Prescribing Service. Staffed by pharmacists, Medicines Line operates Monday to Friday 9 a.m. to 6 p.m. AEST and offers an avenue through which consumers can get free reliable accurate information about their medication if they are unable, or unwilling, to ask their doctor or pharmacist. The Medicines Line number is 1300 888 763.
- Coulter A. After Bristol: putting patients at the centre. Br Med J 2002;324:648-51.
- National Health and Medical Research Council. General guidelines for medical practitioners on providing information to patients. Canberra: Australian Government Publishing Service; 1993. Currently being revised by the NHMRC. http://www.health.gov.au/nhmrc/
- Australian Bureau of Statistics. Aspects of literacy: assessed skill levels, Australia, 1996. Catalogue No. 4228.0. Canberra: Australian Bureau of Statistics; 1996.
- Lawrence A, Fogg S. ‘In our country all medications had an instruction leaflet’. Older people from diverse linguistic and cultural backgrounds talk about Consumer Medicine Information and the quality use of medicines. Canberra: Australian Pensioners’ and Superannuants’ Federation; 1998.
- Fox S, Rainie L. The online health care revolution: how the Web helps Americans take better care of themselves. Washington DC: The Pew Internet and American Life Project; 2000. http://www.pewinternet.org/reports/toc.asp?Report=26