Health professionals, including a pharmacist, at Brigham and Women’s Health (BWH) call for including the purpose of medications on prescription labels to inform patients and enhance safety, calling it the “sixth” patient right (N Engl J Med 2016 July 28. [Epub ahead of print]).
“Currently, even though there is a widespread commitment to sharing drug information with patients, the reason for a medication prescription is generally not recorded or shared when it is being written and is therefore missing a key piece of information,” said Gordon D. Schiff, MD, the lead author and a general internist at BWH, in Boston.
Providing this information helps create patient engagement in their care, according to John Fanikos, RPh, MBA, the executive director of pharmacy at WBH. “It’s critical for patients to understand why they have been prescribed a medication and the condition being treated. This engages patients as active participants in their treatment. It provides both the patient and clinician the opportunity to assess therapy over time and determine if the medication is providing the intended benefit,” he said.
The authors describe it as the sixth patient right. “Beyond the ‘five rights’ for safe medication ordering and use—the right patient, right drug, right dose, right time and right route—a sixth element must be correct: the indication. Indications-based prescribing can improve medication use in multiple ways,” they wrote.
They outlined how incorporating indication into the prescription can make prescribing better and safer, stating the following reasons:
- Reduce errors including mismatches, prescribing or dispensing errors, and errors related to drugs with similar names.
- Enable patients to better understand and adhere to their medication regimens and question the necessity for a medication.
- Provides clinicians with a system to identify therapeutic alternatives to choose the best drugs for their patients’ problems.
- Informs prescribers, pharmacists, patients and caregivers about what is being treated and what outcomes are desired.
- Reconciles the list of medications by indication instead of randomly, alphabetically or chronologically, and makes duplication and discontinued medications much easier to spot.
- Permits clearer assessments and comparisons to track and evaluate prescriptions and measure a drug’s long-term effectiveness.
Patients have been intentionally kept in the dark about the ingredients and indications for their drugs, which dates back to an 1833 article in the Boston Medical and Surgical Journal, which explained why prescriptions should be written in Latin to protect patients from the knowledge of the names of, and indications for, the prescribed drugs and allow the patient to rely on the skill of the physician, the authors noted.
Today, that paradigm is certainly different. There are many health care providers involved in patient care, and they realize that having patients as active participants helps improve their care. Mr. Fanikos reiterated that pharmacists are important health care providers, especially when it comes to helping patients understand their medication needs.
“Hospital and clinic encounters are brief. Information provided can be overwhelming or in a format that the patients don’t understand,” Mr. Fanikos said. “Pharmacists are uniquely poised to explain or reinforce the reasons for the medication and the possible risks and benefits. Providers and patients become synchronized, with the same intent and goals of medication use.”
With funding from the Agency for Healthcare Research and Quality, BWH researchers are bringing together information technology design specialists and policy leaders for a three-year project to build a prototype that will enable prescribers to start from the patient’s problem and guide users toward best choices. The researchers said they will test whether this deficit can be fixed with electronic prescribing and whether that will result in a safer, more efficient way of ordering medications.