Using pictures and symbols, rather than handwritten words, on prescriptions may help illiterate patients take their medicines correctly when they leave hospital, a study in Pakistan found.
The idea was first tested in a hospital in where researchers working in outpatient clinics at Services Hospital in Lahore noticed very poor levels of adherence to patients’ take home discharge medication.
In the study, 100 medical inpatients were asked to read a simple sentence written in Urdu (their first language) to establish whether or not they were literate (52%).Each patients was shown a standard, text-based discharge prescription instruction and then randomized to receive counseling or no counseling about how to follow their prescriptions. 93% of literate patients understood the discharge prescription instructions without counselling and 100% did with counselling. Only 5% of illiterate patients understood the discharge instructions without any counselling, and even with counselling, only 12% of illiterate patients understood it correctly.
The team designed a new discharge prescription form, using pictures and symbols rather than words to convey the necessary information. For example, instructions like ‘bd’ and ‘tds’ were replaced by pictures of a sun rising over the mountains to represent morning, and a moon and stars to represent night time. Hospital pharmacists were then asked to number each medication on the form onto the box or strip of tablets; the illiterate patients could read the number even if they couldn’t read the name.
Results appeared in BMJ Quality Improvement Report.
The new discharge instructions were shown to the same 100 medical inpatients. Literate patients who received counselling with the new discharge instructions understood it 100% of the time (compared to 100% of the time with the handwritten instructions); literate patients who did not receive counselling understood it 100% of the time (vs. 93% with the handwritten instructions); illiterate patients who received counselling with the new form understood it 35% of the time (vs. 12% with the handwritten instructions); illiterate patients who did not receive counselling with the new form understood it 23% of the time (vs. 5% with the handwritten instructions.)
The authors wrote that the initiative “is likely to be of benefit to large numbers of patients” and feel that the project “is applicable to other patient populations with low literacy rates.”