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Risk Management
Segmentation Analysis of Prescription Drug Information-Seeking Motives Among the Elderly
  by Louis A. Morris, Pharmaceutical Executive, May 2004

 
hough people over the age of 65 constitute only 12% of the national population, they consume approximately 30% of the medications prescribed by physicians [Solan et al. 1987]. This disproportionality is likely to grow in the coming decade. It is estimated
that by the year 2000 the elderly will constitute 19% of the population but consume 50% of the medications prescribed [Rogers, Nesbitt, and Bachman 1987]. Prescription medications have enormous capacity to ameliorate, control, or prevent serious disease. However, these products also have the capability to produce morbidity, hospitalization, and mortality. In a review of the literature, Nolan and O'Malley [1988] found several studies indicating that more than 30% of hospital outpatients experience adverse drag reactions and that 3 to 8% of hospital admissions are a consequence of an adverse drug reaction.

Some adverse drug effects are due to idiosyncratic reactions to the medication, but many others are preventable. Approximately 30 to 50% of patients taking medication fail to adhere sufficiently to the prescribed regimen, risking therapeutic failure due to inadequate dosage or toxicity from overdosing [Burrell and Levy 1985; Sackett and Snow 1979]. Elderly patients are especially susceptible to problems from taking insufficient amounts of medication and to adverse drug reactions because of the large number of therapeutic agents they take, the duration of their illness, social isolation and lack of social support, poor health status, and lack of knowledge about the medications they take [Fincham 1988].

As studies indicate that improved communications can help prevent drug misuse [Kusserow 1990], improving the communication of prescription drug information has been identified as a national priority. Recently, the Commissioner of Food and Drugs urged health professionals to re-intensify their efforts to educate patients about prescription medication [Kessler 1991]. Further, educating elderly patients about the uses, benefits, and risks of medications prescribed has been identified as an essential national health objective in the report entitled Healthy People 2000 [U.S. Department of Health and Human Services 1990].

Numerous programs have been developed to encourage greater information sharing with elderly patients about their medicines [Bullman and Rowland 1985]. These programs include a wide variety of protocols for health professionals to use in their counseling activities as well as printed information to augment and reinforce verbally supplied directions. The information supplied to patients varies widely in form and content, from brief notes encouraging patients to follow verbally supplied directions to lengthy brochures that detail the uses, risks, and benefits of prescribed medications. Though some research has been conducted to investigate the extent to which the elderly understand and follow the directions provided in these materials [Morris and Olins 1984; Vander Stichele et al. 1991], no consumer research has examined the extent to which elderly patients desire or accept different health messages.

Morris et al. [1987] investigated overall information search activities among prescription drug users and found that elderly consumers were twice as likely to obtain prescription drag information at the doctor's office as at the pharmacy. However, a sizable proportion (39%) stated that they had received no information from either source when they obtained their most recent prescription. In a separate analysis, Morris et al. [1987] also found four distinct patterns of drug information-seeking behavior based on the source of the information (i.e., physician-reliant, pharmacist-reliant, self-reliant, and non-information-seeking groups). Though motivations were not specifically examined, several attitudinal and situational factors were found to moderate search activities among elderly consumers. Elderly patients were more likely than others to obtain warning information about drugs prescribed for chronic conditions and were less likely to view the pharmacy counter as a barrier to speaking with the pharmacist. However, the elderly were more likely to state that it was unnecessary to ask the doctor questions about their medication if they trusted the doctor.

Hence, the risk-benefit nature of the information provided and relationships with health professionals appear to be important factors underlying information search. However, the heterogeneity of the elderly population suggests that a unitary characterization of the motivations for seeking prescription drug information is likely to be misleading [Moschis 1989]. We therefore provide a segmentation analysis of elderly prescription drug users for the purpose of investigating different information-seeking motivations about these products.

Theoretical Foundation
There are many possible reasons why patients may or may not be interested in drug information. Some patients may want to know about their medication because they want to be better able to take care of themselves, others may want to know more about their medication so they can communicate more clearly with their physician, and others may want to avoid drug information because they are fearful about drug side effects. To provide a basis for developing questions that would discriminate reasons for seeking or avoiding prescription drag information, we used several theoretical models that have been postulated to guide general health information-seeking or consumer information search activities.

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