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Expanding the Universal Medication Schedule: a patient-centred approach
  1. Stacy Cooper Bailey1,
  2. Michael S Wolf2,
  3. Andrea Lopez3,
  4. Allison Russell2,
  5. Alice Hm Chen3,
  6. Dean Schillinger3,
  7. Glen Moy4,
  8. Urmimala Sarkar3
  1. 1Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
  2. 2Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
  3. 3Center for Vulnerable Population at San Francisco General Hospital and Trauma Center and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, USA
  4. 4California HealthCare Foundation, Oakland, California, USA
  1. Correspondence to Dr Stacy Cooper Bailey; scbailey{at}


Objective Improved drug labelling for chronic pill-form medications has been shown to promote patient comprehension, adherence and safety. We extended health literacy principles and included patients' perspectives to improve instructions for: (1) non-pill form, (2) short term, (3) ‘as needed,’ (4) tapered and (5) escalating dose medications.

Setting Participants were recruited via convenience sampling from primary care clinics in Chicago, Illinois and San Francisco, California, USA.

Participants 40 adult, English-speaking participants who reported taking at least one prescription drug in the past 12 months were enrolled in the study.

Primary and secondary outcomes Participant opinions, preferences and comprehension of standard and improved medication instructions were assessed during four iterative waves of discussion groups. Brief interviews preceding the discussion groups measured individuals’ literacy skills, sociodemographic and health characteristics.

Results On average, participants were 46 years old, took four medications and reported two chronic health conditions. Patients varied sociodemographically; 40% were men and 33% had limited literacy skills. Patients agreed on the need for simpler terminology and specificity in instructions. Discussions addressed optimal ways of presenting numeric information, indication and duration of use information to promote comprehension and safe medication use. Consensus was reached on how to improve most of the instructions.

Conclusions Through this patient-centred approach, we developed a set of health literacy-informed instructions for more challenging medications. Findings can inform current drug labelling initiatives and promote safe and appropriate medication use.

  • GENERAL MEDICINE (see Internal Medicine)

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