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Instrument to Evaluate the Level of Knowledge About Prescription In Rev Saúde Pública 2010;44(6) Samanta Etges FröhlichI Instrument to evaluate the Tatiane da Silva Dal PizzolII Sotero Serrate MengueII level of knowledge about prescription in primary care ABSTRACT OBJECTIVE: To develop and test an instrument to evaluate patients’ level of knowledge about drug prescription. METHODS: This study was conducted with users registered with the Family Health Strategy clinics of the city of Santa Cruz do Sul, Southern Brazil, selected by consecutive sampling. Name of the medication, therapeutic indication, drug dosage, times of administration, forms of use, duration of treatment, attitude when doses are missed, possible adverse effects and interactions were included in this study. Each item of the scale was weighted, according to the importance for safe prescribed drug use. The questionnaire was tested by applying an interview to users in 2006 and by analyzing 320 prescriptions. Descriptive statistics, prevalence ratios and chi-square test were calculated for categorical variables and the Tukey test was calculated to compare means. RESULTS: The level of knowledge about drug therapy was considered good in 11.3% of participants, fair in 42.5%, and insuffi cient in 46.3%. The highest levels of knowledge were observed in times of administration, therapeutic indication and duration of treatment. The lowest levels occurred in drug dosage, adverse effects and attitude when one or more drug doses are missed. CONCLUSIONS: The proposed instrument enabled the analysis of the magnitude of the gap existing between what the patients must know and what they actually know about their medications. Thus, key aspects of prevention, education and follow-up can be detected to avoid problems associated with unsafe drug use. DESCRIPTORS: Patients. Health Knowledge, Attitudes, Practice. Drug Prescriptions. Primary Health Care. Questionnaires. I Programa de Pós-Graduação em Epidemiologia. Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre, RS, INTRODUCTION Brasil In Brazil, it is diffi cult to obtain drugs, specifi c therapeutic drug classes are II Departamento de Medicina Social. UFRGS. 14 Porto Alegre, RS, Brasil under-used and new pharmaceutical products are misused. In addition, there are distortions of aspects comprising all drug manufacturing and supply Correspondence: processes and inadequate drug use.13 Fulfi llment of drug prescriptions is an Samanta Etges Fröhlich integral part of high-quality clinical care and an object of improvement and R. Visconde do Herval, 556 Apt. 304 4 Menino Deus evaluation. This fulfi llment is related with the patient’s level of information 90130-150 Porto Alegre, RS, Brasil about their therapy.5,15 Their knowledge about the prescription can refl ect the E-mail: [email protected] communication between doctor and patient and the cultural and language Received: 5/29/2009 differences existing between them. Approved: 8/19/2010 The information provided to patients must be written preferably, because they Article available from: www.scielo.br/rsp can forget it or not understand it correctly, which would hinder the fulfi llment 2 Evaluation of knowledge about prescription Fröhlich SE et al of the therapy.16 Studies show that this information This study included individuals with the following includes: generic or trade name of the medication, characteristics: to be aged more than 18 years, to therapeutic indication, drug dosage, times of admin- accept participating in the research, to be able to istration, forms of use, duration of treatment, attitude communicate adequately, to have used one of the ESF when dosages are missed, possible interactions with medical services during the data collection period, and foods or other drugs, relevant adverse effects, risks of to have received a medical prescription that needs to dependence and adequate storage.1,7,20,21,a be fulfi lled. Users who met the inclusion criteria and were available after consultation were interviewed, Misunderstanding the prescription may be the result using consecutive sampling. of lack of information,17 failure to interpret and read it, or previous experiences the patient had with the Responses to questions were transcribed and compared drug.11 Questions about the prescription may cause an to the medical prescription. Items not expressed individual to feel unmotivated, change it according in the prescription (therapeutic indication, attitude to their criteria or stop following it. In addition to the when dosages are missed, adverse effects and inter- correct diagnosis and adequate prescription, the patient actions) were based on a publication of the United must have the necessary information to use the drugs, States Pharmacopeia Drug Information (USP DI).19 according to the professional’s intention, that is opera- Participants’ responses were classified into the 6 tionalized by medical prescription. following categories, according to the level of agree- 19 It is recommended that the patient should receive ment with the prescription and in this publication: information about drug identifi cation (generic or brand 1) does not know, 2) thinks he/she knows (wrong name), therapeutic indication, drug administration response), and 3) knows. (dosage, times, forms of use), duration of treatment, The name of the medication was considered correct relevant adverse effects and precautions, among other when pronounced correctly or similarly to the generic things.1,21,a or brand name of any product commercialized in Brazil Aiming to identify the gap that may refl ect the differ- with the active substance in question. The therapeutic ence between safe drug use and non-adherence to treat- indication was regarded as adequate when there was ment, the objective of the present study was to develop agreement with the therapeutic drug class (differences and test an instrument to evaluate patients’ level of between technical and popular terminology were not knowledge about prescription in primary care. considered). The dosage was considered correct when there was agreement between the patient response and the amount to be administered at each time. In addi- METHODS tion to the International System Units, responses given A literature review was conducted to develop the instru- in dosage units, such as “one pill”, were classifi ed as ment used to evaluate patients’ level of knowledge correct. Times, forms of use and duration of treatment about drug prescription. (agreement between patient response and the acute or chronic nature of the prescribed treatment) were A questionnaire was designed, aiming at an empirical analyzed in the prescription and, when there was no model founded on a theoretical model, as proposed by information in such sources, in the pharmacological Presser et al12 (2004) (Attachment). This instrument literature.17 For the items not described in the prescrip- was applied by previously qualifi ed Pharmacy students tion, responses were considered correct when there using face-to-face interviews. was at least one adverse drug effect and any proper attitude that was reported when dosages were missed Participants in this study were users registered with or with regard to the interaction between food and/or Family Health Strategy (ESF) clinics of the city of medications. Santa Cruz do Sul, Southern Brazil. In September 2006, the city was served by eight ESF clinics, in different The interpretation of the existence of an agreement districts, which cared for 8,149 families and 28,863 between patient responses and the information present users (24.1% of the total population).b Health educa- in the prescription and pharmaceutical literature was tion was provided in group services, which included conducted independently by two reviewers. In cases of hypertensive patients, diabetics, pregnant women, and disagreement, a third reviewer was consulted. mothers with low-weight children, in addition to health programs for women, children, adolescents, alcoholics, The scale was constructed so that each item was elderly individuals and family planning.b weighted, according to the importance for safe drug a German Foundation for International Development. Report of the 1o International Seminar on Improving Acess to Drug Information in Developing Countries; Berlin, Germany; 1995. b Prefeitura Municipal de Santa Cruz do Sul. Secretaria Municipal da Saúde. Plano Municipal de Saúde de 2006. Santa Cruz do Sul; 2006[cited 2006 Sep 15]. Available from: http://www.pmscs.rs.gov.br/index.php?acao=areas&areas_id=17 Rev Saúde Pública 2010;44(6) 3 use. Indispensable items for the patient to identify and knowledge” and “level of education” variables were administrate the medication received higher scores. dichotomized into: low (less than eight points) and high A total of two points were attributed if the user really (from eight to 13 points) and low (incomplete primary knew the name of the medication, the dosage, the form education) and high (complete primary education or of administration and its frequency. Information not higher), respectively. directly related to drug administration, which could, however, be important for adherence to treatment, Tukey test was used to compare the mean levels of received lower scores. If the user knew the therapeutic knowledge for the main prescribed drug classes. indication, the duration of treatment, any adverse effect, Descriptive and explanatory statistical analyses were any interaction with foods or other medications, and performed in the SPSS 13.0. Frequencies, means, what to do if one or more dosages were missed, one standard-deviations, prevalences, prevalence ratios and point was attributed. The level of knowledge about chi-square were estimated for categorical variables and drug prescription was obtained by adding up correct the Tukey test was used to compare different means. responses and considering the weights {mathematical formula: score = (q1 + q3 + q4 + q6 (x2)) + (q2 + q5 The present study was approved by the Santa Cruz + q7 + q8 + q9)}. do Sul Department of Health (official letter 530/ SMS/2005/PF) and the Research Ethics Committee of Cut-off points were attributed based on similar the Universidade Federal do Rio Grande do Sul (process studies,7,16,20 and patients were classifi ed into one of 2005450).
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