comparison of consumer-oriented books on medications

107

COMPARISON OF CONSUMER-ORIENTED BOOKS ON MEDICATIONS

TIMOTHY P. STRAITON, M.S., and ALAN BARREUTHER, Pham.D. College of Pharmacy, University of Arizona, Tucson, Arizona

STEPHEN W. SCHONDELMEYER, Pharm.D. School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Indiana

ABSTRACT

Consumers increasingly want to be informed about the processes involved in their own health care. Health professionals may be called upon to recommend appropriate consumer-oriented sources of information. To assist the health professional in making a rational recommendation, 15 currently available consumer-oriented books on prescription medications were compared with respect to readability, number of drugs covered, completeness of drug monograph information, price, and other factors. Mean readability scores, reported as a reading grade level, ranged from 9.2 to 14.3. ‘Ihe number of drugs covered by these books ranged from 135 to 1,200. Monograph completeness scores were assigned by determining the percentage of information from a standard reference’s drug monograph covered in each book. The lowest percentage completeness score was 21.48, while the highest was 76.7%. Prices for the books ranged from $2.50 to $19.95. Regardless of the relative priorities placed on these factors, a consumer or health professional may use the objective and descriptive assessments of this study to make an informed decision when choosing among consumer- oriented sources of medication information.

INTRODUCTION

Consumers of health-care services want to be more involved in making decisions about their treatment. At the same time, them is an increased demand for health-related information, particularly in the area of drug therapy. The Food and Drug Administration has suggested that “im- proving patient knowledge of prescription drugs in an ef- fort to reduce the level of misuse of prescription drugs. . . will significantly improve the quality of health ~are.“l-~

Physicians, pharmacists, nurses, health educators, and other health professionals will find themselves either actively or passively involved in providing information on medications to the public. Such health professionals must choose both the form and the source for such information.4 The form may include verbal, written, and audiovisual materials on a medication or group of medications. Sources of information suitable for consumers include locally developed materials, materials from pharmaceutical companies, commercially available information sheets, or commercially available books and compendia.

This study focuses on consumer-oriented medication information in books. Such books are widely available and seem to be increasing in popularity. As a source of consumer information on medications, they have both advantages and disadvantages. The advantages are: (1) Informa- tion on a large number of medications can be delivered to the consumer in a single source. (2) Through the price of such books, only those consumers who use the information would bear the costs of its assimilation, printing, and distribution. (3) A one-time investment in a book would provide the consumer with a continuing reference source. (4) A consumer can take this written information home, to consult as often as necessary. Disadvantages include: (1) The general information about a drug in a book cannot be tailored to the specific circumstances of the consumer’s use of the drug. (2) The consumer ordinarily does not have a health professional readily available to assist in the in- terpretation and application of the information. (3) Infor- mation on medications becomes outdated within a few years and so a book may not contain the most complete or accurate information available. (4) A certain amount of technical language must be used, and the consumer may not fully understand such technical terms or their implica- tions. (5) Commercially available books may not cover all drugs of interest to a consumer, such as new drugs or special dosage forms.

The ideal book on medications would meet all of the following “universal criteria”: (1) be readable by persons with an eighth grade reading comprehension level; (2) have an internal readability range of less than one grade level; (3) present information on all commercially available drug products and their respective dosage forms; (4) contain especially thorough coverage of the 200 most frequently prescribed brand and generic drug products; (5) present 100% of the information considered by the individual to be appropriate for a consumer; (6) have a rea-

VOLUME 5NJMBER 3

108

sonably low purchase price; (7) have been written or re- vised within the last year; (8) have been written and reviewed by expert panels of physicians, pharmacists, and researchers; and (9) have a table of contents, index, or other means for easily locating the information on a specific drug product.

Some health professionals may actively promote the use of a book on medications to increase their patients’ understanding and safe use of prescribed drug therapy. More passive health professionals may be asked to recommend a consumer-oriented book on medications. When a health professional is faced with recommending a book on medications to a consumer, the professional should have a rational basis for recommending a specific source.

PUBPOSE AND OBJECTIVES

The purpose of this study was to provide health professionals with both objective and descriptive criteria to help them evaluate consumer-oriented books on medications. Six specific objectives were identified and accomplished: (1) to measure the reading grade level of each book as an indicator of the readability of the information provided, (2) to determine how widely the readability levels vary within each book, (3) to determine the total number of drug entities covered in each book; (4) to determine the number of study drugs coveted in each book; (5) to measure the relative amount of information on the study drugs provided by each book, (6) to identify other descriptive elements that should be considered in choosing a consumer-oriented book on medications.

MATERIALS AND METHODS

More than 20 books providing consumer-oriented information on drugs were identified through Books in Print,= Paperback Books in Print,s and advertisements. During the fall of 1982,15 of these books were found to be still in print or, at least, currently available through bookstores or libraries in Tucson (Appendix). The Physician’s Desk Reference (PDR), while not a consumer-oriented book, is available to consumers through bookstores. Although authors of the books evaluated in this study may have intended other purposes for their books, our assessments were made only with respect to the book’s utility as a consumer-oriented source of information on medications.

Readability Readability of a passage of information has been described as a measure of the reader’s understanding of written information.’ Understanding is affected by such structural elements as vocabulary, sentence length, word length, and grammatical complexity. Because of the technical language found in medication information, the readability of such information is a primary concern in books or other

written sources of consumer-oriented medication information.8~g

The Fry Readability GraphlO and Gunning’s Fog Index11 are reliable measures of readability currently used for assessing the level at which health-related information can be understood. Both of these measures are based upon syllable counts and the average length or number of sen- tences. However, because a number of the consumer- oriented medication information books present significant portions of their information in an outline or phrase format, these two frequently used measures of readability were not practical for this evaluation.

The readability formula developed by Caylor and Sticht12 was chosen for use in this study because it may be used irrespective of the sentence or paragraph structure of the information being evaluated. This formula, when used to evaluate the same reading material, was found to have a 0.9 correlation with both the Dale-Chall formula and the Flesch formula. Klare” cites the Dale-Chall formula as the most accurate measure for assessing the readability of reading material and Flesch as the most widely used formula. Based on these comparisons, the Caylor-Sticht formula was considered valid and reliable for its intended use in this study.

The Caylor-Sticht formula relies upon the number of one syllable words (NOSW) per 150-word passage. The formula for calculating reading grade level (RGL) is:

RGL = 20.43 - 0.11 (NOSW)

To assure a representative determination of the reading grade level for the study books, eleven M-word passages were selected from each book. The first 150 words in each book’s introduction and in each section of the book de- scribing ten randomly selected drugs were scored for reading grade level. If a book’s section on a given drug began with a list of brand names for the drug, the 150-word passage evaluated did not include that list.

Reading material for the same ten study drugs was evaluated for each book. A random numbers table was used to select two drugs from each quadrant of Pharmacy Times’ “Top 200 Drugs” list and two from the “Top 25 Generic Drugs” list.13 The ten drugs selected for study were: HydroDiuril@ , Libriume , Timoptic@, Pavabido , potassium chloride, Septrao , Tussionexo , Tolectine , penicillin VK, and aminophylline.

Internal Readability Range The degree to which readability grade levels varied within study books was also assessed. For the 11 passages out of each book, the lowest grade level score was subtracted from the highest grade level score, resulting in a reading grade level range width for each book.

Number of Drugs Covered As one indicator of a book’s breadth of information, the number of different generic drug entities mentioned by

PATIENT EDUCATION AND COUNSELING

109

each book was tallied. In general, as a greater number of drugs ate covered in a book, the consumer eives more information. If, however, the book does not cover the spe.cifK drug a consumer is using, the amount of other information is somewhat i&event. The ten randomly selected drugs e representative of the most frequently used brand-name and generic prescription medications. l’he number of these study drugs found in a given book was considered a measure of the likelihood that a book would contain a specific drug of interest to the consumer.

coInpleteness

The amount of information presented on a specific medication may vary considerably. To assess this factor, an instrument with 39 items representing different types of information about a medication was devised. The instrument was structured around the 13 items listed by the American Society of Hospital PharmacistG4 in their “Statement on Pharmacist-Conducted Patient Counseling. ’ ’ Table I lists the 13 items and the weight, as a percent, for each category.

Assignment of weights to each category was based upon the relative importance of the categories to consumers ac-

Table I. Percent-of-completene score by item category for determining completeness of medication-information mOtlographS.

Percent-of- completeness

Item score

1.

2. 3.

4. 5. 6.

7.

8.

9. 10.

11. 12.

13.

Name: trademark, generic, common synonym or other descriptive name(s) Intended use and expected action Route, dosage form, dosage and administration schedule Special directions for preparation Special directions for administration Precautions to be observed during administration Common side effects that may be encountered, including their avoidance and action required if they occur Techniques for self-monitoring of drug therapy Proper storage

Potential drug-drug or drug-food interactions or other therapeutic contraindications Prescription refill information Action to be taken in the event of a missed dose Any other information peculiar to the specific patient or drug

8 12

20 4 2

10

12

4 6

14

2

6

-

Total 100

cording to several studies reported in the literature and a consumer panel conducted by one of the authors. Joubert and LasagnaI conducted a survey in which patients were asked to indicate specific facets of dmg information for which they wanted more information. More than 80% of the respondents indicated a desire for more information on: name of the drug, patient-specific indications, possible common side effects, risks associated with overdosage, and the risk from undermedication. White reported questions most frequently asked by consumers as including the following types of information: duration of therapy, addic- tion potential, patient-specific indications, drug-food and drug-alcohol interactions, and expected effects from the medication. I6 Schondelmeyer,17 using a Delphi-type tech- nique, found that a consumer panel rated the six most important ASHP categories in the following order: intended use and expected action; route, dosage form, and administration schedule; precautions; common side effects; trade and generic names; drugdrug and drug-food interactions.

The 1983 USP Dispensing Inform&on Drug Informa- tionfor the Health Cure Provider18 (USPDI) was used as a standard for comparing the relative amount of information contained in each of the 15 study books. This reference source was chosen because its drug monographs represent the most comprehensive source of medication information available. The USPDI has been developed and maintained through the combined professional expertise and judgment of physicians, pharmacists, other health professionals, and researchers using a panel review process. While it is intended for health professionals and not for consumers, its use as a reference standard is defended on the grounds that the completeness score measure is meant only to provide a relative scale for the amount of information in various consumer medication books. Value judgments regarding the types and amounts of information that a consumer “should” be given are left to the individual reader.

The ten selected drug monographs in each of the study books were compared with the drug monographs in USPDI. If, for example, the USPDI contained ten trade names for a specific drug while the study book contained only four trade names, that book would be given a score of 40% on that factor. The score for each of the 39 items was multiplied by its weighting factor, and the sum of these products represents a total completeness score for a given drug in a given book. The overall completeness score for a book was derived by averaging the completeness scores for each of the ten study drugs in that book.

Descriptive Factors

Descriptive factors regarding the price, authorship, organization, format, contents, and physical structure of each book were recorded. From the differences noted among sources, the most important descriptive factom to be considered in selecting a consumer-oriented medication book are identified and discussed.

VOLUME YNLJh4BER 3

110

RESULT!3

Objective measurement procedures were used for each of these five objective factors, and the resulting scores were classified according to a six-point rating scale. The rating scale labels ranged from a high of “excellent” to a low of “very poor.” The descriptive factors assessed for each book are descriptively reported.

telligence, and other factors. I9 Holcombzo has estimated that 80% to 85% of the population can comprehend material written at an eighth grade level. In recognition of this fact, the rating scale for readability was anchored with reading levels of material at or below the eighth grade designated as excellent. As the reading grade levels increase, the ratings become progressively lower (Table II). Material that requires reading comprehension at or beyond

Readability

Reading comprehension levels within the United States population vary according to educational background, in-

the level of a college freshman was rated very poor. These ratings are not meant to imply that information written at a higher level is less valuable than information written at a simpler level. The readability rating is intended to serve

Table II. Ratiugs and rankings of consumer drug-information books by readability as mean reading grade level (RGL).

Rating Rating criteria (RGL) Book* RGL Ranking

Excellent < 9.0 Very good 9.0-9.9

Good 10.0-10.9

Fair 11.0-11.9

Poor 12.0-12.9

Smith Evans USPC Graedon (1980) Gossel Long ASHP Graedon (1976) Silverman Jones Burack Stem Pawlina PDR

9.2 1 9.3 2 9.9 3

10.5 4 10.6 5 10.9 6 11.0 7-9 11.0 7-9 11.0 7-9 11.1 10 11.4 11 11.8 12 12.0 13 12.8 14

Very poor B 13.0 Geffner 14.3 15

*See Appendix for complete bibliographic information.

Table III. Rathgs and rankings of consumer drug-information books by width of readability range.

Reading grade level

Rating RGL* Rating criteria (RGL)* Book? Lowest Highest Range width

Excellent < 1.0 Very good 1.0-l .6 Graedon (1976) 10.2 11.5 1.3

Jones 10.3 11.6 1.3 Smith 7.9 9.2 1.3

Good 1.7-2.4 Gossel 9.5 11.5 2.0 Burack 10.6 12.7 2.1 Graedon (1980) 9.3 11.5 2.2 USPC 8.9 11.2 2.3 Pawlina 10.8 13.1 2.3 PDR 11.3 13.7 2.4 Long 8.8 11.5 2.7

Fair 2.5-3.2 ASHP 9.4 12.3 2.9 Stem 9.8 12.7 2.9 Evans 8.0 11.1 3.1

Poor 3.3-3.9 Very poor 2 4.0 Silverman 8.4 12.5 4.1

Geffner 11.6 16.0 4.4

*RGL = reading grade level. t&e Appendix for complete bibliographic information.

Ranking

l-3 l-3 l-3

4 5 6

7-8 7-8

9 10

11-12 11-12

13

14 15


111

only as a proxy measure for the relative proportion of the population capable of reading and comprehending a passage of material.

None of the 15 books evaluated was rated excellent. Three books were rated very good, and two books, rated as poor and very poor, respectively, would be comprehen- sible only to persons who read at the college level.

Intemal Readability Range

A range of less than one grade level within a book was considered excellent. Rating levels declined as the reading grade level range increased at increments of 0.6 and 0.7 grade levels (Table III). None of the 15 books was rated excellent on this factor. Only three books were rated very

good. A rating of very poor was awarded to two books that had range widths of greater than four grade levels.

Number of Drugs Covered

Two different measures of this factor were used. First the books were rated according to the total number of generic drug entities mentioned in the book. The excellent rating was reserved for books with more than 500 generic drug entities, and a book with fewer than 100 generic drug entities was rated poor or very poor (Table IV).

Not surprisingly, the PDR was the book that listed the greatest number of different generic drug entities. This book, with 1,200 entities, and a book with 700 entities were rated excellent. None of the study books was rated

Table IV. Ratings and rankings of consumer drug-information books by total number of generic drugs. Rating criteria No. of generic

Rating (no. of drugs) Book* drugs listed Ranking

Excellent 2 500 PDR 1,200 1 Geffner 700 2

Very good 300-499 USPC 400 3 Evans 300 4

Good 200-299 Pawlina 246 5 .ASHP 240 6 Stem 224 7 Long 210 8 Graedon ( 1976) 200 9-10 Graedon (1980) 200 9-10

Fair loo-199 GOSSd 195 11-12 Silverman 195 11-12 Jones 185 13 Burack 175 14 Smith 135 15

Poor SO-99 Very poor o-49


Table V. Ratings and rank&p of consumer drug-information books by number of study drugs covered. Rating criteria No. of

Rating (no. of drugs) Book* study drugs Ranking

Excellent 10 Geffner 10 l-5 Gossel 10 l-5 Long 10 l-5 PDR 10 l-5 USPC 10 l-5

Very good 9 ASHP 9 6 Good 8 Jones 8 7-8

Stem 8 7-8 Fair 7 Graedon (1980) 7 9-11

Pawlina 7 9-11 Silverman 7 9-11

Poor 6 Burack 6 12-14 Graedon (1976) 6 12-14 Smith 6 12-14

Very poor 5 Evans 5 15

*See Appendix for compkte bibl@raphic information.

VOLUME s/NUMBER 3

112

poor or very poor since all discussed more than 100 drug entities.

The second measure was a determination of the number of the randomly selected study drugs monographed within each book. An excellent rating was assigned to books that monographed all ten study drugs. Ratings decline by one category for each successive study drug not mentioned in a book, and the lowest rating was awarded to books that mentioned fewer than six of the study drugs (Table V). Five of the books reviewed contained all ten study drugs.

Completeness Ten drug monographs were evaluated from each book, and the mean completeness score for each book is presented in Table VI. The lowest completeness score among the 15 books was 21.4% while the highest was 76.7%. Only two books earned an excellent rating.

Descriptive Factors

Descriptive assessments were made for cost, date of publication, author qualifications, subjects indexed, print size, text organization, information format, and other general topics discussed. The prices of study books ranged from $2.50 to $19.95, and publication dates ranged from 1976 to 1982 (Table VII).

Consumer-oriented books on medications may be written by authors from many different backgrounds. A consumer should at least be aware of an author’s qualifications before purchasing a medication information book. Table VII designates the qualifications of the authors for each study book. Such books are usually written by a physician, a pharmacist, an academic researcher, or a professional review panel system, which may include all of the above types of personnel.

The contents of the study books could be indexed in six ways (Table VIII). One book did not have an index. All the remaining books included both generic and brand names of drugs in the index. Other material indexed con- cerned therapeutic categories, specific disease states, authors’ names, and general subjects.

Print size may subjectively affect a book’s readability. Type sizes in the study books ranged from 6-point to lo- point (Table IX). Several books mixed type sizes, using a smaller print for the index, the monograph, or both.

The text organization (order of presentation of material) also differed among the study books (Table IX). Four books were organized in alphabetic order by a drug’s generic name, three by a drug’s brand name, and three by a drug’s common name, that is, the name by which a drug is more frequently prescribed. The other five books were organized according to therapeutic categories of drugs.

Information format refers to the structure used to present medication information. Four books used an outline format and seven used a narrative format. The four remaining books combined both outline and narrative styles (Table IX).

Finally, a number of other drug-related topics were presented by one or more study books. Table X displays for each book the 22 other general topics presented. Eleven of the books discussed general information on medication use, and seven books commented on how to use the book most effectively. Twelve books addressed the subject of physician-patient relationships, and seven described appropriate pharmacist-patient relationships.

DISCUSSION

The importance of reading grade level as a consideration in recommending a medication information book varies in

Table VI. Ratings and rankings of consumer drug-information books by completeness of drug monographs.

Rating criteria Completeness Rating (a) Book* score Percent Ranking

Excellent 2 70 USPC 76.7 1 Long 75.4 2

Very good 60-69.9 ASHP 69.4 3 Geffner 69.1 4 PDR 68.8 5 Gossel 61.9 6 Silverman 61.3 7

Good 50-59.9 Jones 59.3 8 Smith 56.2 9

Fair 40-49.9 Stem 49.0 10 Pawlina 43.4 11

Poor 30-39.9 Graedon (1980) 39.3 12 Burack 34.7 13

Very Poor < 30 Evans 29.9 14 Graedon (1976) 21.4 15



113

inverse proportion to the level at which the target con- lower, however, have a smaller selection of appropriate or sumer reads. Any of the books evaluated would be accept- acceptable books from which to choose, so that, for them, able to the consumer with reading comprehension at the readability ratings would be particularly important. college level. Thus the readability score has little signifi- The practical significance of differences in reading level cance. Consumers who read at the tenth grade level, or is illustrated in the following passages discussing hypo-

Table VII. Summary of ratings across five factors for consumer drug-information books.

Book* Cost’r

6% Year of

publication

Author qualifications$

Readability RGLB

Readability RGL widths

Completeness Completeness Completeness total study drug

dmgs§ drug4 monographs9

USPC

J-o*g Gossel PDR ASHP Geffner Smith Jones Graedon

(1980) Stem Graedon

(1976) Pawlinall Evans Silverman Burack

5 1981 PP 10 1982 M 3 1981 R, G

15 1982 0 10 1982 PP 18 1981 M 3 1982 R

15 1980 M, G

VG G G P F

VP VG F

G G G G F

VP VG VG

VG G F E G E F F

E E E E

VG E P G

E E

VG VG VG VG G G

6 1980 R, G 6 1981 0

G F

G F

G G

F G

P F

1976 R, G 1979 R 1978 M, G, 0 1979 R 1976 M

F P

VG F F

VG G F

VP G

G

G VG F F

P F

VP F P

VP F

VP VG P

*See Appendix for complete bibliographic information. tCost is rounded to the nearest dollar for the least expensive version available. $E = excellent; VG = very good; G = good; F = fair; P = poor; VP = very poor. §M = physician; R = pharmacist; G = graduate degree in pharmacology; PP = professional panel; 0 = other; RGL = reading grade level. l/No longer in print.

Table VIII. Indexing of consumer drug-information books.

General Generic Brand Disease Therapeutic Book* Author subject name name state category

ASHP X X X Geffner X X X X Burack X X X X X Evans X X X X Gossel X X X Graedon ( 1976) X X X X X X Graedon (1980) X X X X X X Jones X X X X J-o*g X X Pawlinat PDR X X Silverman X X X Smith$ X X Stem X X X USPC

*See Appendix for complete bibliographic information. tNo index.

X X x SErroneous page number given in index for Pavabida.

VOLUME 5/NUMRER 3

114

kalemia associated with the use of HydroDiurP. The first passage, written at the eighth grade level, is from Evans and Cole?

Water will follow the sodium and chloride out of the blood to rebalance osmotic pressure. However, at the same time, they pump potassium out of the body. Sometimes, when they are given in too large amounts or too often, they pump out more potassium than is good for your body to lose. Under these circumstances, your heart action can be altered quite a bit and you can feel wrung out, weak, and a bit peculiar.

The second passage, written at the college level, is from Geffner: **

Hypokalemia may develop, especially with brisk diuresis, concomitant corticosteroid or ACTH therapy, interference with adequate oral intake of electro lytes, or in the presence of severe cirrhosis; may be minimized by including potassium-rich foods in the diet, or if necessary, with potassium supplements. Hypokalemia may result in digitalis toxicity.

Not only are these passages written at widely different reading grade levels, they also contain different amounts

of information. One should realize, however, that the complexity with which information is presented does not necessarily correspond to the amount of information presented. In this study, we used a separate measure to determine the relative amount of information presented. This factor, labeled “drug monograph completeness, ” is discussed later.

In addition to variation in readability among books, var- iations were also encountered within a given book. Con- sideration of the differences in internal readability range, such as the average readability score, also becomes less important as a consumer’s reading grade level is higher. Information that is presented at or below a person’s reading grade level will be understood regardless of the range width. Therefore, for the consumer with a high reading comprehension level, this factor is of little practical significance, but for consumers who read at less than the college level, the range width of reading levels in a book can be a prime consideration. The average readability score is one indication of the level at which a book can be understood, but it is possible that one half or more of a

Table IX. print size, text organization, and information format of consumer drug-information books.

Text organization

Book* Print size

(point) Common

namet Generic Brand Therapeutic Information format

name name category Outline Narrative Mixed

ASHP 10 X X Geffner 8$ X X

105 Burack 611 X

10 Evans 8 X X Gossel 6$ X X

88 Graedon (1976) 8 X X Graedon ( 1980) 10 X X Jones 811 X

10

Long 8 X X 1ofl

Pawlina 10 X PDR 6 X Silverman 611 X

8 smith 8$ X X

105 Stem 10 X X USPC 8 X X X

*See Appendix for complete bibliographic information. tThe name by which the drug is most frequently prescribed. $hlOllOgTf@S.

fl;flmoy chapters only.

,130thx&t km used throughout the book.

X X

X

X


115

given book could be written at a level above the mean score mported. Themfore, it seems wise for a health pm- fessional to consider the reading grade level range width of a book when the target consumer’s mading ability does not exceed the book’s average readability level by more than two grade levels.

When using a medication information book, a consumer is usually looking for information on a specific drug or set of drugs. The health professional or consumer should check a book’s in&x or table of contents to determine whether or not the particular drugs of interest have been included. When buying a book as a future reference source, however, the consumer may not know what specific drugs he or she may need to learn about. For this reason, two measures should be considered in choosing a medication information book. The more drugs coveted in a particular book, the more likely it is that the book will cover a specific drug for which a consumer may need information. The relevance of our assessing the proportion of the ten study drugs included in a given book lies in the fact that these products were randomly selected from the

200 most frequently prescribed dnrgs. Because the top 200 drugs are most likely to be prescribed, the proportion of the top 200 coveted by a book should be a sttnng indication of the chance that a consumer’s next prescription will be discussed in that book.

There were two primary reasons why several of the books did not include all ten study drugs. Some of the books were published before some of the drugs were released. Second, several books, by design, did not include information on ophthalmic, otic, topical, injectable, combination, and other special dosage forms of drugs. If a consumer wants information about a special dosage form or a combination drug product, the health professional should determine whether that type of product has been included in the book under consideration.

Consumers, by purchasing books on medications, are expressing a demand for information about their medicines. A health professional’s recommendation of a specific book should consider the relative amount of information provided by that book about any given drug. Value judgments regarding the appropriateness of preaent-

Table X. Other topics discussed in consumer drug-information books.

8 ‘S P

Book*

ASHP M,P Geffner M

Burack EhUlS W’

Gossel W’

Graedon (1976) M Graedon (1980) M

Jones

L-g M

Pawlina M,P

PDR

Silverman M,P

Smith Stem USPC

MJ M

M,P

X X

How to read a prescription. Ineffective drugs; color plates showing drug pmclucts; poisoning and overdose management information; tables of various drug information; information on nonprescription drugs. Tables of various dtug information. Drug kinetics. Pharmaceutical abbreviations. Ineffective drugs; tables of various drug information. Pharmaceutical abbreviations; tables of various drug information.

Drugs of choice; personal drug history; FDA pregnancy categories and warnings; tables of various drug information. Personal drug history; poisoning and overdose management information; immunization schedule. Color plates showing drug products; poisoning and overdose management information. Color plates showing drug products; tables of various drug information. Personal drug history; medication administration techniques.

*See Appendix for complete bibliographic information. tM = physiciaa-patient; P = pharmacist-patient.

VOLUME UNUMBER 3

116

ing various types of information are left to the individual selecting a book. This study demonstrates that, at maxi- mum, only 75% of the information contained in profes- sionally developed, standard reference monographs is presented in consumer-oriented books. Some books, however, offered as little as 21% of available information. Often the books with very low average monograph completeness scores systematically chose not to report certain types of information. Presumably, some authors felt that certain categories were not appropriate for a consumer publication. If a particular type of information about a medication is desired by the consumer, a book should be assessed specifically to determine whether or not that type of information is available in the book.

Completeness of the drug monographs should be an important consideration in recommending a book regardless of the consumer’s reading level. For those consumers with a lower reading grade level, however, completeness may have to be sacrificed to some extent in the interest of obtaining information in an understandable form.

A number of other descriptive factors may or may not be important to a particular consumer. One consideration may be the price of a book. Higher price did not necessarily correlate with the amount of information when measured either as number of drugs or as completeness of drug monographs.

Date of publication is another important consideration in purchasing a medication information book. New drugs are placed on the market each year, and more information about existing products is regularly released. The health professional would be wise to look for a work that has been recently published or recently updated.

Organization and format can be important features to consider in choosing any reference book. Is the information presented in a narrative style or an outline style? Are

REFERENCES

1. Federal Register, July 6, 1979; 44~40016. 2. Federal Register, September 12, 1980; 4560754. 3. Federal Register, February 17, 1982; 47:720@7202. 4. Moore SR. How to select patient publications that fit your practice.

Patient Cows Community Pharm 1982; 1:3-5. 5. Books in print, 1980-1981. New York: RR Bowker Co, 1980. 6. Paperback books in print, 1980-1981. New York: RR Bowker Co,

1980. 7. Liguori S. A quantitative assessment of the readability of PPI’s.

Drug Intel1 Clin Pharm 1978; 12:712-716. 8. Ley P, Jain VK, Skilbeck CR. A method for decreasing patients’

medication errors. Psycho1 Med 1976; 6:599-601. 9. Adams RC, Smith TP, Metts JK, Ross JW. Readability-Its appli-

cation to education of patients by pharmacy. Hosp Pharm 1979; 14:654-662.

10. Fry E. Fry’s Readability Graph: Clarification, validity, and exten- sion to level 17. J Reading 1977; 21242-252.

11. Klare GR. Assessing readability. Reading Res Q 1974-1975; 10:62-102.

the drugs arranged alphabetically or according to therapeutic function? Are generic drug names, brand drug names, or both used in the book? Is there an index to the book? How easily can the information on a specific drug be lo- cated using the index, the table of contents, or other means? Each of these features may or may not be of concern to a particular consumer, but these questions deserve some consideration before recommendation of a medication information source.

Finally, books on medications may discuss a variety of other topics. Subjects such as general use of medicines, brand-generic issues, prices of prescription medications, disease states and drugs of choice, medical terminology, how to use the book, how to read a prescription, how to maintain a personal medication history, and poisoning and overdose management were found in one or more of the 15 books reviewed in this study.

Health professionals must individually decide how to weigh each of the various considerations when recommending a book for a specific consumer. Unfortunately, none of the books reviewed achieved the optimum for all of the “universal criteria” listed above (Introduction). Performance of each book on these criteria has been sum- marized in Table VII. The books are listed in this table according to the degree to which they approximate the universal criteria. If a person chooses to weigh these criteria unequally, a different ordering may result. Regard- less of the preferences for the weights placed on each of these criteria, the information presented in this study may be used to compare currently available consumer-oriented books on medications. Such comparisons may assist the health professional or the consumer in making an informed decision about the appropriateness and usefulness of a book on prescription medications.

12. Caylor JS, Sticht TG. Development of a simple readability index for job reading material. Presented at the Annual Meeting of the Ameri- can Education Research Association, New Orleans, Louisiana, Feb- ruary 25, 1973.

13. 1980: Top 200 Drugs. Annual statistical report. Pharm Times, April 1981:17-25.

14. American Society of Hospital Pharmacists. Statement on pharmacist-conducted patient counseling. Am J Hosp Phurm 1976; 33:644-645.

15. Joubert P, Lasagna L. Patient package inserts. 1. Nature, notions and need. Clin Pharmacol Ther 1975; 18:507-513.

16. White SJ. Patient education. How practitioners see it. Editorial. Am Pharm 1981; NS21(7):394-407.

17. Schondelmeyer SW. Prescription counseling study, pharmacy issues consumer panel: Summary of proceedings. Unpublished manuscript. Tucson, Arizona: University of Arizona, May 20, 1983.

18. The 1983 USP dispensing information. Drug information for the health care provider. Rockville, Maryland: United States Phar- macopeial Convention, Inc, 1983.

19. Lanese RR, Thrush RS. Measuring readability of health education literature. J Am Diabetes Assoc 1%3; 47:214-217.

PATIENTEDUCATIONANDCOUNSELING

117

20. Holcomb CA. Reading difftcuhy of informational materials from a health maintenance organization. J Reading 1981; 25:130-132.

21. Evans WO, Cole JO. Your medicine chest. Boston: Little, Brown and Co, 1978.

22. Geffner ES, ed. The physician’s drug manual. New York: Doubleday and Co, 1981.

APPENDIX

Fifteen Currently Available Consumer-Oriented Books on Medications

American Society of Hospital Pharmacists (ASHP). Consumer drug di- gest. New York: Facts on File, 1982. 512 pages, $9.95.

Physicians’ desk reference (PDR). 36th edition. Gradell, New Jersey: Medical Economics Company, Inc, 1982. 3060 pages, $14.95.

Burack R, Fox F. The I976 handbook of prescription drugs. New York Pantheon Books, 1976. 451 pages, $3.95.

Evans WO, Cole JO. Your medicine chest: A consumer’s guide to the effects of prescription and nonprescription drugs. Boston: Little, Brown and Co, 1978. 339 pages, $5.95.

Geffner ES, ed. The physician’s drug manual: Prescription and nonprescription drugs. New York: Doubleday, 1981. 1213 pages, $19.95. (Out of print.)

Gossel TA, Stanasloski DW. Consumer guide: Prescription drugs. Skokie, Illinois: Publications International, Ltd, 1981. 255 pages, $2.50.

Graedon J. Thepeople’spharmacy. New York: St. Martin’s Press, 1976. 401 pages, $5.95.

Graedon J. The people’s pharmacy 2. New York: Avon Books, 1980. 468 pages, $5.95.

Jones JK. Family guide to medications and dictionary of prescription drugs. New York: Good Housekeeping Books, 1980. 349 pages, $14.95.

Long JW. The essential guide to prescription drugs. 3rd ed. New York: Harper and Row, 1982. 935 pages, $9.95.

Pawlina AM, Lesko LL. The family prescription and medication guide. Englewood Cliffs, New Jersey: Prentice-Hall, Inc, 1979. 367 pages, $13.95. (Gut of print.)

Silverman HM, Simon GI. The pill book. New York: Bantam Books, Inc, 1979. 417 pages, $3.95.

Smith DL. Family guide to prescription drugs. Willimantic, Connec- ticut: Pharmex, 1982. 208 pages, $3.29.

Stem EL. Prescription drugs and their side effects. New York Grosset and Dunlop, 1981. 160 pages, $5.95.

The United States Pharmacopeial Convention, Inc (USPC). About your medicines. Rockville, Maryland: USPC, 1981. 398 pages, $4.95.

VOLUME 5DJUMESER 3

comparison of consumer-oriented books on medications

Documents