To indicate or not to indicate?

medicine label

Study reveals widespread support for including the indication on scripts and medication labels, but concerns have been raised over workload and privacy

Adding the indication or purpose of the medication to a prescription and then a medicine label could improve adherence and decrease errors, researchers believe.

A series of detailed interviews conducted with pharmacists, prescribers and patients revealed broad support for the concept, but concerns were raised over healthcare provider workload, and over patient privacy.

A team of Australian and Swedish pharmacy and public health academics interviewed seven Australian pharmacists, eight prescribers and 19 consumers.

“All interviewed stakeholders identified numerous benefits of documenting the indication on prescriptions and dispensed medicines labels,” they said.

“Whether these potential benefits can be realised remains unknown and addressing prescribers’ concern regarding the time involved in documenting the indication on prescriptions remains a challenge for vendors of electronic medication management systems”.

In Sweden, as with a number of other European countries, including an indication in lay language is already standard practice.

A retrospective study of prescription errors in Swedish community pharmacies “found that having the indication documented on the prescription helped pharmacists identify and rectify prescription errors”, the authors said.

Most of the Australian pharmacists interviewed said documenting the indication on the dispensed medicine label would be beneficial.

“It helps patients just taking control over their own medications, knowing what they’re taking and why, having that information is power to them,” one pharmacist commented.

Additionally, pharmacists reported it would be beneficial to document the indication on the prescription when the medication has multiple indications or when the medication is being used “off-label”.

Many interviewees felt the indication could act as a safety check for both healthcare professionals and consumers. Pharmacists, in particular, felt it could reduce prescribing and dispensing errors of ‘look-alike, sound-alike’ medications.

“One pharmacist gave the example of allopurinol sounding very similar to haloperidol, which are used for completely different conditions,” the authors said.

However, there were concerns raised, with prescribers expressing concern about the time take to document the indication, as well as concerns over privacy.

“Changing prescribing practices represents a fundamental change hence the potential workflow and practice barriers,” the authors said.

“Particularly, time to document and privacy concerns need to be addressed to fully realise the potential of incorporating indications into prescriptions and dispensed medication labels, although there are likely creative ways these barriers can be effectively overcome”.

The study was published in BMC Health Services Research.

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  1. Stephen Roberts

    Guild will be dead against it b’cos it potentially slows down dispensing especially if you need to chase Dr. for indication.

  2. Jarrod McMaugh

    I’m interested in the privacy concerns…..

    Are the respondents worried about situations that occured in Seinfeld where Jerry is turned off from dating a woman because he finds an antifungal in her medicine cabinet?

    Or are they trying to keep the indication “private” from the pharmacist?

    The first is a valid concern, but can be overcome. The second represents an attitude that needs to be challenged, since the pharmacist should have access to this information to ensure their clinic role is performed adequately.

  3. PeterC

    I’m with you Jarrod. I’ve been agitating for this on-and-off since about the time I graduated.

    It is simply not possible for pharmacists to fulfill our legal responsibility and professional function without this information being included BY THE PRESCRIBER ON THE PRESCRIPTION.

    By any measure, a prescription is a REFERRAL TO CARE. Who could imagine for example a referral of a patient to a physiotherapist for treatment that didn’t include the indication for treatment? It would be interpreted as both nonsensical and showing contempt towards the therapist.

    And so it is with prescriptions as well. We’re being asked to do our job with a blindfold on and one arm tied behind our backs, which is complete bullshit that no other group would tolerate.

    There should be no privacy concern from a prescriber to pharmacist perspective as pharmacists are part of the patient-care covenant. There should be no privacy concern from a pharmacist to patient perspective for the same reason. If the patient doesn’t feel they can trust a particular pharmacist, they should take it to one they can trust.

    The indication DOES NOT have to be included on the label – that should be up to the patient, so the Seinfeld dilemma doesn’t apply. Similarly the argument about pharmacists having to chase prescribers for indications is also irrelevant. This only makes sense as an obligation on prescribers. You could make it a compulsory field in the prescribing software and it would appear on the script like it does now with computer-generated Authorities.

    In summary, this is a no brainer. Should have happened 50 years ago. We will never get anywhere professionally until this happens.

    • Jarrod McMaugh

      It could be argued that Medicare would be interested in this from a PBS point of view.

      It could eliminate the need for authorities based on indication, since it would already be part of the prescription. Only quantity/repeat increases would be required to have an authority.

      It would also minimise the use of PBS funds for indications that aren’t covered

  4. Andrew

    I started doing this a few years ago and it seems to be a cheap and effective QuM measure for a certain type of patient. Usually restrict indication to “for blood pressure”, “for angina”, “for heart rate”, “for reflux” – and so on. I briefly tried “for sleep” and “for mood” but it didn’t stick and I now understand why.
    Easy to do with a few new sigs and I found it really useful for teasing out just how much the patient knows.
    Of course, patient consent is the most important part though.

  5. Debbie Rigby

    Pharmacies should register for My Health Record. This will provide access to the shared health summary which provides diagnoses and allergies / ADRs.

    • Glen Bayer

      Unless patients choose not to make that information visible, or don’t have My Health Records (unsure if retrospective data will be available after the automatic creation of records starts in mid-2018).
      Having seen the quality (?!) of some GP letters/medical summaries for patient medication histories, I’d be interested to know what QA (if any) goes into identifying the correct and current medication regimens of patients with this system.

      • Debbie Rigby

        Data cleansing will be a positive outcome from electronic health records. But there will always be an obligation for health providers to do medication reconciliation to determine the current actual use of medicines.

      • juliet richards

        I believe retrospect data can be pulled from dispense records but this may not be done automatically. So far, there have been very few people who have chosen to hide or block data on their MHRs (~1%). The small percentage of people who have chosen to block information are actually largely health professionals! As Debbie said, we can’t take the information in MHR at face value and you still need to speak to your patient to confirm.
        It would be fantastic if the indication was communicated to the pharmacist on the script as well and so it can be added to the label for the patients sake. It would also help facilitate effective and more efficient patient-pharmacist interaction at the dispensing end especially as nowadays medications can be used for a variety of different indications. I’m sure it would be a slow process with a lot of resistance getting GPs on board but it is possible! Persistence always pays off!!

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