The PicturRx Prescription Picture Cards
Improving Patient Comprehension Of Medication Instructions
PictureRx1 has a simple solution to one possible cause of medication noncompliance: the inability of some patients to understand instructions about taking their prescribed drugs.
PictureRx produces graphical cards, such as the one pictured above, for each patient with a photo of each medication taken by that patient, instructions on the medication schedule and dosage, and an explanation of the purpose of that medication. While prose is included, the emphasis appears to be on conveying as much information as possible by the use of graphical elements.
This excerpt from the PictureRx web site identifies the rationale for this methodology.
• Nearly half (47%) of adult Americans lack adequate literacy skills.
• Low literacy increases annual health care costs by over $1500 per person.
• Limited literacy skills lead to incorrect medication usage. 42% of patients in two public hospitals could not understand instructions to take medication on an empty stomach; the American Medical Association estimates that only 50% of patients take medication as directed.
This abstract elaborates the same concept:
Katz, Marra G.; Kripalani, Sunil; Weiss, Barry D. Use of pictorial aids in medication instructions: A review of the literature. American Journal of Health-System Pharmacy. 63(23):2391-2397, December 1, 2006.
[Note: At least one of the authors "serves as a consultant to and holds equity in PictureRx, LLC"]
Purpose: The effects of pictorial aids in medication instructions on medication recall, comprehension, and adherence are reviewed.
Summary: Many patients depend on medication labels and patient information leaflets for pertinent drug information, but these materials are often difficult for patients to understand. Research in psychology and marketing indicates that humans have a cognitive preference for picture-based, rather than text-based, information. Studies have shown that pictorial aids improve recall, comprehension, and adherence and are particularly useful for conveying timing of doses, instructions on when to take medicine, and the importance of completing a course of therapy. Other research has compared various techniques for using picture-based information and supports the use of integrative instructions, a combination of textual, oral, and pictorial communication, to promote comprehension and adherence. While pictures have generally proven useful for improving patient comprehension and adherence, not all picture-based interventions have produced successful results. Some icons, particularly clock icons, have been found to be too complex to enhance understanding and could not overcome the advantage provided by the familiarity of the textbased format, suggesting that patients be trained to use pictorial medication information before they are expected to use icons as an aid for medication administration. In addition to enhancing understanding, pictorial aids have been found to improve patients’ satisfaction with medication instructions.
Conclusion: The use of pictorial aids enhances patients’ understanding of how they should take their medications, particularly when pictures are used in combination with written or oral instructions.
Commentary
As previously noted in this blog (see Health Literacy: A Clear Problem Without A Clear Solution), health illiteracy is widespread and a significant contributor to noncompliance. The use of graphically enhanced instructions is an appealing response to the problem.
Questions do, however, arise. It is unclear, for example, who will be responsible for the additional cost of the picture card (e.g., the patient, the third party payer, the pharmaceutical industry). How will the logistics be managed (e.g., Will new cards be issued with every medication change? What if the patient becomes confused about which picture card is the currently valid one?) If, as the abstract states, there is research “suggesting that patients be trained to use pictorial medication information before they are expected to use icons as an aid for medication administration,” who will provide and pay for that training? And the notion that individuals must be trained to use a simpler protocol is itself somewhat disconcerting. None of these potential problems appear irresolvable, but the solutions implemented could be key to this product’s clinical usefulness and commercial success.
At the risk of nitpicking, I also suggest the company’s promotion should clearly point out that health literacy deficits may be a significant cause of noncompliance but is hardly the only cause. Consider these two sentences placed adjacent to each other on the web site, implying a cause-effect relationship:
If this were a test asking how these two statements are related, the correct answer would be “True, True, and Unrelated.” I.e., both statements are accurate but “limited literacy skills” are not the sole cause of “only 50% of patients tak(ing) medication as directed.”
Nonetheless, if a system for efficient management of the economics and logistics of the picture cards have been or can be developed, they could well prove one step toward improved adherence to medication regimens.
Footnotes
- According to the LinkIn Profile of Arun Moran, the company’s Director, PictureRx is a privately held startup company “focused on improving medication compliance by simplifying prescription information.”↩
