like? What are the costs of standardizing? What level of evidence is needed to introduce a best practice? One may be willing to adopt what looks to be an improvement, even without the highest bar of evidence, if the cost is low. However, if there is a high cost, then more evidence is required.

The benefits of standardization have been well presented. The main risk may relate to the energy required to implement a standardized drug label. That is, those efforts might detract from other efforts that are needed to address the problems of low adherence and medication errors.

The Agency for Healthcare Research and Quality (AHRQ) is engaged in a number of activities related to drug labeling and patient understanding. For example, AHRQ has been working with the National Council for Prescription Drug Programs on a program related to standardization in ePrescribing.1 It is important to examine whether the standardized message the pharmacist receives from the physician is actually a good message to put on the pill label.

AHRQ has also been working on the opportunities for counseling about medications. There are opportunities in inpatient care for discharge education and counseling. A number of projects have been funded in this area, and some of them have developed pictorial graphic pill calendars for patients that display the schedule for their medications. Another project has developed a pill card that is currently being tested. When a patient fills a new prescription at the pharmacy, he or she will receive a pill card with a list of all the medications that have been filled at that pharmacy and instructions for how to take them. The pill card uses various icons such as the sun to indicate morning and the moon to indicate night. The project has also developed a health literacy assessment guide. The guide is used by pharmacies to determine how well they are doing in communicating with their patients and addressing variable health literacy.

AHRQ is also involved in a project called “Questions Are the Answer.” Research has shown that patients who leave a provider’s office with questions are more likely to have a patient safety event. Thus, a website that aids patients in constructing a list of pertinent questions to ask their doctors has been developed for patients to use before their appointments. The project has also developed a musical public service announcement. And AHRQ is developing a health literacy assessment of patients’ experiences, including a question about how easy it was to understand the medication instructions given by the physician.

1

ePrescribing is defined as “the transmission, using electronic media, of prescription or prescription-related information, between a prescriber, dispenser, PBM, or health plan, either directly or through an intermediary, including an ePrescribing network. E-prescribing includes, but is not limited to, two-way transmissions between the point of care and the dispenser” (Federal Register, 2005).



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