Two senior pharmacy students from Ohio Northern University Raabe College of Pharmacy recently completed an unusual clerkship on drug information and patient education. The students, Sara Jutte and Wendy Gesaman, say they have come away from this six-week rotation convinced of the need to present health information to consumers in easy-to-understand language. What's more, they have learned the skills to accomplish this.

The Pharm.D. clerkship is offered by Consumer Health Information Corp., in McLean, Virginia, a company that specializes in the development of a variety of patient education materials including pamphlets and videos for consumers, health care professionals and the pharmaceutical industry. Dorothy Smith, Pharm.D., is the president and founder of the 18-year-old company. Smith is also the author of 23 books on patient education and medication use.

All patient education information must be clinically accurate but for these programs to be effective, the information must be written using terms and language that patients will readily understand, Smith explains. "Everything we write for patients is written at the 6th or 8th grade level. That's the reading level of the average consumer." Patient information typically incorporates "motivational instructions" to help convince patients to take their medication correctly. After all, as Smith points out, the medication won't work if the patient doesn't take it.

"What we will take with us for the rest of our careers is the importance of translating medical information to the 6th to 8th grade level so patients can understand it," says Jutte. "We translate hypertension as high blood pressure. Rather than compliance, it's managing your medication or not even medication, medicine." She adds, "The more patients understand about how the medications work and why they need to take them, the more likely they will take them and take them correctly."

Fully 50% of patients for whom antihypertensives are prescribed stop taking them within the year. "This can be because of side effects. Or it can be that they don't experience any symptoms of their disease and aren't convinced of the need to take the drug and spend money on it," Smith explains. Accordingly, the company develops patient education materials to try to convince people diagnosed with hypertension of the importance of taking their medication regularly. "We also teach them how they can manage any side effects they may be experiencing," says Smith.

An approach of a different sort was needed to make sure that children with ear infections complete the full course of medication. Smith notes that studies show that parents often stop giving the medication once the child feels better. The theme of the program developed by Consumer Health Information was: "Your child is counting on you."

"We really put the onus on the parent to give the medication for the full amount of time," says Smith. "It actually took us a long time to come up with this theme. Everything in the end has to sound simple but just because these materials look and sound simple, that doesn't make them easy to write."

The patient-centered approach of Consumer Health Information is summed up in a statement on its Web site (www.consumer-health.com): "The patient may be the most important member of the health team. The patient decides if, how and when to take medication. Without enough information, consumers will continue to make serious home medication errors. With high quality information, consumers will be able to manage their medications safely."

Consumer Health has offered its Pharm.D. clerkship program for 10 years. Two years ago, Smith added a paid summer internship program for undergraduate students. Top pharmacy students come to McLean, Va., from all over the country. Smith says the GPA for the five students who completed the internships last summer averaged 3.75. Smith looks for students "who are already showing leadership. I want to invest in people who will make a difference in their profession."

Gesaman and Jutte have been involved in a number of projects during their rotation including: evaluating of the quality of health information content on drugs on Web sites, found to be "mixed"; and developing a patient package insert that will later be submitted to FDA for approval as patient labeling. The students also learn how to work with graphic designers and see how layout and design of patient brochures can help in getting the message across. Smith brought Gesaman and Jutte with her to attend board of directors meeting of the National Council on Patient Information and Education (NCPIE) "so they can see how national health associations are working together in patient education. I just throw them in whatever we are doing," she explains.

One of the students' last assignments was to write a newspaper article (Click here to read more about the students and their articles.). Jutte wrote her article on the importance of patient compliance with a medication regimen for her hometown newspaper in Coldwater, Ohio. "I focused on how to get patients to take their medicine correctly. I included some tips and questions to ask their doctor and pharmacist to get them to understand the disease and their medicines better and hopefully to encourage them to take their medicine."

Gesaman wrote about diet aids, including the recent removal from the market of phenylpropanolamine for her hometown paper in Massillon, Ohio. Both students said it took about a dozen or so drafts to write their articles to a sufficiently consumer-friendly level. "It's the most drafts I've ever written for anything," says Gesaman.

"I want the students to see they can write articles for consumers and that they don't need a journalism degree to do this," says Smith. "My hope is that once they are in practice, if there's an opportunity for them to write a newspaper column and to be visible and more involved with the public, they will pursue it."

The Ohio Northern University students say this rotation was quite different from the others they've done in hospitals. They both agreed it was a lot of fun and would recommend it to their friends.

One of the areas Jutte says she found of particular interest was direct-to-consumer advertising of prescription drugs. "There are so many issues to consider, FDA regulations, fair balance, legal issues." As a result, says Jutte, she now looks at television ads for prescription medications different than she did before. "I especially look at the language they use to convey the information," she adds.

"I never realized that there were so many steps that patients go through in deciding whether or not to fill a prescription," says Gesaman. "Patients look at drug costs a lot. It also influences their decision whether they really understand why they are supposed to take the drug." As a result of completing this rotation, "I feel like I'm more qualified to make interventions that will enhance patient compliance," she says. "The first step is to see where patients are in their decision making process. Then I can tailor my counseling techniques to where they are in that process."