Rx Labeling Project


Confusing Patients Less: Promoting Health Literacy through Simplified Prescription Drug Labels

NOVA ScriptsCentral (NSC) is a three-year old community-based nonprofit mail-order pharmacy providing medications and pharmaceutical services to uninsured, low income, children and adults in Northern Virginia. To date, NSC has dispensed over $2.1 million of generic and brand-name medications to patients through 8 clinic partners in the region. But medication access is only one piece of the puzzle. Patients need the right medication at the right time for the right disease, and need to know how to safely use their therapies.

From the beginning, NOVA ScriptsCentral was committed to producing low-literacy medication labels from the first dispensed prescription. For instance, NOVA Scripts places an indication line on the vial, telling the patient what the medication is for—something most pharmacies do not add. And as an extension of its medication literacy initiatives, NSC is a co-investigator on a study of a new prescription drug label to help patients take the guess work out of taking their medications.

The new labels use a graphic (called the Universal Medicine Schedule) to make it easier for patients and their care givers to understand how and when to take the medication by placing this information prominently on one section of the label. The UMS takes the guesswork out of pill taking by placing the number of pills for morning, noon, evening or bedtime in a graphic representation. This is a change from the standard prescription label that gives that information using scientific nomenclature and without the indication of the time period for medication usage.

Study Details

This three year IRB approved study is being funded by the federal Agency for Healthcare Research and Quality (AHRQ) in partnership with researchers at Northwestern University, Harvard, LSU and Emory and in collaboration with NSC’s seven community health centers and free clinic partners. The researchers have been working on the idea of increasing health literacy by developing and using simpler drug labels as a way of reducing the 1.4 million preventable adverse drug events that the Institute of Medicine estimates occur in the US each year.

To participate in this pilot study, patients must be between 18 and 64, enrolled in a NOVA Scripts partner clinic, be comfortable answering interview questions posed in English, have a confirmed diagnosis of type II diabetes, hypertension, or both, and be prescribed two or more medications for these conditions. NOVA Scripts expects to recruit 960 patients for the study—half receiving the new simplified prescription drug label with the new Universal Medical Schedule and the other half receiving NSC’s standard label. The study will assess the efficacy of the new drug labels from brief face-to-face interviews with patients and medical record reviews. The interviews will probe patients’ understanding of their medication labels, their diseases, and their health status. Project staff will perform medical record extractions to track HbA1c and blood pressure levels during each phase and will count patient’s pills to see if they coincide with properly dosed pill counts. NOVA Scripts and partner researchers plan to document and release the study results so that others can learn from this effort.

Northwestern University is spearheading the effort to secure funding to replicate the UMS study for a Spanish speaking clinic population.

In an August 2009 interview, JoAnn Knox, Executive Director of NOVA ScriptsCentral, talked about the progress and challenges in implementing the study. She explained the limitations of the existing pharmacy software program used by NSC and by large pharmacies means modifying labeling to better serve patients is very difficult and expensive. For instance, specific text placement, icons, and warning labels cannot be modified on medication bottles. She noted that one of the major challenges was the complexity and costs of reprogramming software to simply move the name of the pharmacy from the top of the bottle (where it just adds to the large amount of text already there) to the bottom so, that the most important features of the label—patient name, what the medication is for, and how and when to take it—are not lost amongst a cloud of scientific nomenclature and provider-centered notations. The label designed by the research team with the UMS aims to highlight these four label essentials by placing them altogether on one section of the label.

About NOVA ScriptsCentral

NOVA ScriptsCentral was created out of a realization that a shared, centralized non-profit pharmacy is the most cost effective solution for serving multiple safety-net clinics. NSC reduces the cost of purchasing and filling prescriptions by sharing one pharmacist, buying medications in bulk, participating in pharmaceutical manufacturer medication donation programs and working in donated space. NOVA Scripts has 8 clinic partners across the Northern Virginia region and is continuing to expand the clinics it serves.

NSC’s mission is more than just dispensing medications, however, as evidenced by its participation in innovative and ground breaking initiatives such as the drug labeling pilot. NSC is very proud to have launched Pharmacist InSite, a volunteer pharmacist program that trains and places professional pharmacists in clinics to counsel patients about their medications and help them better manage their illnesses. It was this commitment to patient-centered care and safety that began the relationship between NSC and its partner researchers as they joined to find creative ways to “confuse patients less” and improve their health outcomes.

For more information, please contact JoAnn Knox at jpknox@novascripts.org or go to www.novascriptscentral.org.

Written by Brittany Stanley, Princeton Project 55 Fellow 2009-2010

Additional Resources

The following links will take you to other websites with more information on health literacy and medication safety :

American College of Physicians Foundation Medication Labeling Initiative

Improving Prescription Drug Container Labeling in the US: A Health Literacy and Medication Safety Initiative White Paper


Confusing Patients Less: Promoting Health Literacy and Rx Drug Use was the title used in a January 2009 presentation by the researchers responsible for the drug label initiative.