how to augment information on instructions for use of medications, and communication training is enhanced during the introductory pharmacy practice experience as well as in other courses. One of the most popular courses is Spanish for health care providers. The demand for this elective has been so high that professors are brought from the academic campus to the medical campus to teach the courses on-site.

A popular course on the psychosocial aspects of disease includes a description of the effect of health literacy on services received. During service learning experiences students learn about overcoming barriers to access. Internships expose on-the-job students to the unique needs of their patients. There are also national competitions, such as the one on patient counseling sponsored by the American Pharmacists Association, that expose students to these issues.

With all the emphasis on communication and serving the underserved, why do problems with labeling and instructions still exist? What are the barriers to change? State boards of pharmacy regulate the information that must appear on the medication label and, as described earlier, this results in variation in labels. Some state boards of pharmacy do not require the capability of producing labels written in Spanish. Furthermore, how can one determine if the patient needs a label in another language? Does a pharmacist just look at the name and make an assumption? Does he or she wait until the patient comes in to discover if another language is needed? Another barrier relates to the small number of pharmacists who are bilingual or multilingual. Furthermore, there is reluctance to make major label changes.

However, changes are under way. Target, for example, is trying to address some of the problems with its prescription label. The name of the medication is in a large font. Directions are in a large font at the top of the label where they can be seen.

There are also increased dispensing software options. One software company provided a list of 524 different fields for which the pharmacist could suggest medication label changes. Font size on all of those fields can be adjusted for specific patients and also for routine labels. This particular software can print labels in English, Spanish, or French. However, as mentioned previously, the entire label is in one language, and pharmacists who do not speak the language printed on the label are concerned about its accuracy. Auxiliary labels can be printed with or without the icons.

The AACP and other pharmacy organizations are developing data that will help address the problems we have been discussing today. These data will also help in the proper training of students. In responding to a question from the floor, Kirkpatrick stated that pharmacy students are taught how to interpret the physicians’ dosage instructions or “sig.” However, what is printed on the label is what the pharmacy’s software



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