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Medicinal instructing: to read = to understand?



nikit of POLES, "Remedy allowance"

MEDICINAL INSTRUCTING: CHITAT =PONIMAT?

— And then look. Did you read it?

— Read.

— And this — small letters? Here it is clearly told that after washing by hot and cold water or soapsuds and kerosene hair should be not wiped at all, and to dry in the sun or at a kerosene stove. Why you did not dry? Where will you go with this green "linden" now?

Ippolit Matveevich was depressed.

(I. Ilf and E. Petrov "Twelve chairs")

However this dialogue between Bender and Vorobyanino-vy was not comic, it it is very realistic reflects those incidents and misunderstanding which can arise or by inaccurate drawing up the instruction on goods by the producer, or at its superficial reading by the consumer. Let's note that to the Pussycat, through an oversight painted a head of hear in green color, the carelessness managed rather cheap since it suffered from "parapharmacy". In a case with medicines of a mistake and omission — both from the developer of the instruction, and from her "reader" — can lead to consequences much more drama. The danger proceeding from irrationally made leaf insert is quite comparable to threat which is concealed in itself by low-quality medicine.

The article by Nikita POLYAKOV is devoted to the main problems Russian patients encounter when reading the leaflets which usually come with drug packs. The article covers the key omissions and mismatches in the Russian normative documents, which regulate this sort of absentee-distribution of information. The fundamental distinctions of Russian legislative standards in this field from those in European countries are also considered in the article. Furthermore, material contains the results of a number of studies and observations devoted to perception of such texts by end-users.

the place of instructions in the general information field and to mark out their key differences from other "informants" in the field of health protection for HP.

ZONE of DIFFICULT AVAILABILITY

It would seem, at such situation the development of instructions on HP in respect of contents and a form has to be an otreg-lamentirovana so strictly, accurately and in details as standardization of active agents and dosage forms of medicines. However, as the analysis of many corresponding regulations and real practice of "medicinal instructing" testifies, so important aspect of a health care system is debugged, to put it mildly, not ideally. If the maintenance of leaves inserts by means of various legislative instructions and restrictions is regulated rather strictly (though separate flaws meet and here), then with formal parameters of instructions the situation is is much more problematic. And at all priority of contents the form (in a broad sense) of instructions plays an enormous role in ensuring competent intake of medicines too — at least because of "kaverznost" of contents which inevitably abounds with special terminology and other

the moments complicating material judgment by the consumer owing to absence at it profound medical knowledge. The additional complexity in rationalization of this sphere is connected with subjectivity of refraction of information by the consumer. If at the level of physiology "perception" of concrete medicine (at all private exceptions and reservations) at different patients in general is same, then at the level of consciousness the perception by the same group of information users about this medicine can be followed by a wide range of discrepancies. Therefore within today's article we would like to focus first of all on a many-sided problem of availability (clearness) to the consumer of the data stated in instructions (further as the synonym will be used the concept "leaves inserts") on medicines.

| About the PLACE AND the ROLE of the INSTRUCTION

Before passing to more detailed analysis of the existing difficulties in this area, it is necessary to outline

♦ Unlike the expert prescribing medicine and defining the mode of its reception, the leaf insert is not only a source, but also the carrier of comprehensive information. As a rule, the doctor is limited only to a number of oral recommendations and partial fixing of the most important characteristics of HP on the material carrier (recipe, the sheet of paper, etc.). The instruction, thus, performs function of inanimate "assistant" to whom the expert "delegates" functions of fuller informing the patient on medicine.

At the same time, unlike the same expert (doctor/druggist), the instruction in the course of informing is not capable to consider specific features of perception of the specific patient as carries the correspondence and unified (depersonalized) character.

♦ Unlike scientific and practical information (scientific articles, monographs, etc.) the instruction fixes characteristics of HP in a form, more compressed, convenient for perception.

♦ Unlike information of marketing sense focused, as

the rule, on the expressed underlining of merits of a product, data of a leaf insert have character of impartial statement of HP properties without retouching of the "unattractive" moments (at least, the similar nature of the document is provided by a number of regulations).

♦ At last, in comparison with all other data carriers about HP properties the leaves inserts have the largest circulations. It provides not only the maximum coverage of target audience, but also high selectivity in distribution of information as the instruction accompanies each packing of medicine falling into hands of any given consumer / expert.

Thus, the leaf insert is the only "informant" combining at the same time completeness, capacity, the ordered objectivity of data on HP together with the highest mass character of distribution. All this, it seems, has to predetermine absolutely specific mode of dwelling of this documentary version in the information environment. How the situation in reality is?

SPECIAL ARTICLE No. 1

It is known that the right of the consumer for full and objective information about a product in the field of health protection — an integral part of its humanitarian and civil rights. The similar right is reflected in many legal documents, in particular in the Act of the Russian Federation "About Consumer Protection". Let's give several key excerpts from this document.

Article 10. Information on goods (works, services).

1. "Manufacturer... it is obliged to provide in due time to the consumer the necessary and reliable information about goods (works, services) providing a possibility of their right choice".
2. "Information on goods (works, services) without fail has to contain: a .svedeniye about the main on -

trebitelsky properties of goods.... The inventory (works, services), information on which has to contain contraindications for application at separate types of diseases, is approved by the Government of the Russian Federation".

3. "Information provided by Paragraph 2 of the present article is brought to the attention of consumers in the technical documentation attached to goods (works, services) on labels, marking or the different way accepted for separate types of goods (works, services)".

Attaching these general instructions to medicines, at once we will note couple of features distinguishing the considered type of products against the background of other commodity categories.

♦ The fragment of Paragraph 2 of Article 10 appealing to "the list of the goods approved by the Government of the Russian Federation" obviously means presence at this HP list. Thereby the Law initially defines oso-

system of private, specialized regulations.

♦ One of "different ways of bringing information on goods to consumers" about which tells Paragraph 3 of Article 10 in a case with HP is just the leaf insert supplementing "label and marking" information at turnover of drugs.

SPECIAL ARTICLE No. 2

Further in the context of our subject it is necessary to quote couple of Paragraphs (No. 4 and 5) of Article 12 of the same Law, rassmatriva-

yushchy legal consequences of violations in the sphere of informing consumers on properties of goods.

4. "At infliction of harm of life, to health and property of the consumer owing to failure to provide to it full and reliable information about goods (work, service) the consumer has the right to demand compensation of such harm in the order provided by Article 14 of the present Law".
5. "By consideration of the requirements of the consumer about indemnification caused by doubtful or insufficiently full information on goods (work, service) it is necessary to make an assumption of absence at the consumer of special knowledge about properties and characteristics of goods (works, services)".

Here, at all universality of the given provisions, it is necessary to notice that their practical application in a case with HP is accompanied by a number of specific difficulties. First, the level of risk connected with misuse of medicines, znachi-

telno exceeds potential danger at exploitation of other groups of consumer goods (absolutely we will not touch highly specialized goods now). Really, if we take as an evident illustration such goods as, for example, the TV, then at its "the wrong application" the worst outcome for the average consumer — "lack of the expected action" ("does not show" or "shows badly"). If to tell about drugs, then here mistakes in use, besides "single" effect,

by the status of information on HP which address, besides universal rules, has to be regulated

table 1 | Types of instructions on HP (on the subject of informing) in 50 accidentally chosen medicines,

registered in Russia

Instruction type in packing Number (piece) / share (%) The medicines containing this type of the instruction *

Only for the expert 40 (80%) Alka-Zelttser, Fenotropil, No-Spa forte, Remantadin (a tab. — Rozfarm), Nootropil, Klimaktoplan, Panthenol spray, Korinfar, Essentsiale, Linex, Valocordin, Viagra, Naftizin (Lekko), Ftalazol (Semashko), Tserebrolizin (amp.), Lazolvan, Klenbuterol (Sofarm), Kavinton, Anti-angin formula, Aktovegin (amp.), BioMAX, Stoptussin (Galen), Arbidol, Enap (amp.), Burdens sconces (amp.), Glycine (Semashko), Solkoseril (gel and ointment), Furagin (Olaynfarm), Pentalgin-N, Parodontotsid, Fervex, Acyclovir (cream — Akrikhin), Allokhol (Dalkhimfarm), Poliminerol, Trikhopol (a tab.), Atsilakt (St. — Vitafarm), Atsipol (Lekko), Linkomitsina / x (amp. — Veropharm), Bifidumbakterin dry (time. — "Ecopolice"), Dimedrol (amp. — Dalkhimfarm), Calcium gluconate (amp. — Novosibkhimfarm)

Only for the consumer 9 (18%) The coal activated (К^, Tincture of a valerian (TFF), the Rhodiola extract liquid (Kameliya NPP), Grammidin, Coldrex (powder), Lopedium (capsules), Corvalol (MFF), Bromhexine Berlin-Hemi (a tab.), Nikoflex

For the expert & #43; for the consumer 1 (2%) Orungal (capsules)

* Note: the dosage form is specified for the medicines produced also in other LF; the name of the producer is provided for medicines with unlicensed trade names.

are fraught also with direct threat for health of the consumer.

Proceeding from it, it is possible to make one more conclusion: concerning most of commodity groups stipulated in the law "the assumption of absence at the consumer of special knowledge about properties and characteristics of goods" carries more likely "reinsurance" character and is guided by extraordinary cases. In a case with same "TV" the number of the consumers who do not have basic ideas of its safe operation (at the level "do not put fingers in the socket"), is insignificant. And here in relation to drugs the similar assumption acquires already the status not of an exception, and the rule, a high-probable situation. The difference in degree of awareness on properties of medical products at experts and consumers considerably surpasses a similar difference in a case with the majority of other types of goods.

From here the second feature of "instructor" information on HP properties — its not one-linearity, opo-follows

sredovannost, aiming at different target audience. In a case with medicines the movement of this information not in a straight line "from the producer — to the consumer", and in a triangle "the producer — the expert — the patient (consumer)", with assignment of an essential role to the "mediating" link is meant.

"ATTRACTS INTEREST | the PARAGRAPH of the LAW "O LS"...

We not accidentally wrote that the similar movement "is not offered" and does not "exist", and it "is meant". Starting consideration of trajectories of the set information rotation, we at once face a number of contradictions and discrepancies both in the legal framework, and in a dichotomy "the theory — practice".

The law "About Medicines" (document of directive character) extremely muffledly differentiates target audience of instructions on HP. In Article 16, stipulating an official and binding character of this information

the carrier, he at the same time in any way does not mention division of instructions into "special" (for doctors and pharmaceutical workers) and "consumer". In other "thematic" article — behind number 43 — similar differentiation, it seems, is present (at very indistinct look), but at the same time it contains couple of amusing tricks aggravating confusion. Let's quote 2 key paragraphs of this article. ". Information on the HP released without prescription of the doctor can contain in publications and announcements of mass media, specialized and general printing editions, instructions for application of HP, other editions of subjects of the address of HP".

As we see, having told "And" (about instructions on HP), legislators in this point do not speak to "B" (do not specify type of the instruction on the subject of informing). ". Information on the HP released on the prescription of the doctor is allowed only in the specialized printing editions calculated on health and pharmaceutical workers. Information on HP for experts sfe-

ry addresses of HP it can be presented in the form of monographs, reference books, scientific articles, reports on the congresses, conferences, symposiums, scientific councils and also instructions for application of the HP intended for doctors".

Here the type of the instruction is seemingly called, however, interpreting this point literally, come to a conclusion that drawing up instructions by the producer on Rx-medicines for the consumer is not provided by the law.

Partly similar gaps smooth out provisions from the State information standard on HP (GISLS) to which the Law "About Medicines" in the 1st Subparagraph of the same Article 43 refers. In paragraph 04.02. of this document the accurate gradation of instructions on the subject of informing is made (for experts and for the consumer), their official and obligatory status is emphasized. However it is worth remembering that this industry standard which at the time is hastily "adjusted" to the Law "About Medicines" for giving of logical symmetry to that carries not directive, and only uslovnoobyazatelny character. It is easy to understand that it does not promote formal toughening of the considered aspect of informing.

AT THE WRONG DOOR

Actually, "live life" visually illustrates the specified standard omissions. In practice the address of the majority of medicines in the domestic pharmaceutical market accompanies only one type of the instruction — for experts. Not to be unfounded, we will provide data of the mini-experiment conducted by us. During it in the "subjects of informing" parameter leaves inserts to 50 accidentally chosen medicines were subjected to the analysis. In the field of experience, instructions to drugs which are produced in different countries and the different companies got, have different conditions of a holiday (OTS and IH) and are issued in different dosage forms. Results of a research are reflected in table 1.

As we see, among a set of the leaves inserts to medicines which are accidentally chosen by us for consideration, only once (2% of cases) the 2-sided instruction which was at the same time containing information both for experts, and for consumers (Orungal, capsules No. 14) got to us. 9 more instructions (18%) contained only data for consumers without information for experts. Other 40 leaves inserts (80%) chosen for consideration it is formal adreso-

bathtubs only to doctors and pharmacists/pharmacists. Thus, the contradictory situation in most cases takes place: being de jure the instruction for experts, de facto the leaf insert also acts as the consumer's "informant". Hardly such "dissonance" facilitates assimilation by the patient of data on HP. And, whatever one may do, bad assimilation of information inevitably increases risk of the wrong intake of medicine "with all that it implies".

"It is good" — WELL, BUT it "is NECESSARY" — BETTER ■

The attempt of elimination of this misunderstanding is partly put in the project

Technical regulations which, we will remind, it is planned as replacement to the "obsolete" Law "O LS". In general, in the analysis of the new document its "homology" to Directive 2001/83/EU of the European Parliament and EU Council of November 6, 2001 attracts attention. "About the code of laws of Community concerning medicines for the person" (further — the EU directive). In the Old World the subject of availability of texts of instructions to consumers is in a zone of close attention of experts of health care long ago, inducing them to various researches and adoption of the regulations guaranteeing increase in this availability. And so, in Section V ("Marking and the summary insert in packing") of the EU directive the obligation if it is so possible to be expressed, "a cognitive universalization" of data from the instruction is recorded: "The text of the summary insert HAS TO be (our allocation — R.) is made with use of terms, accurate and clear for the patient, in a state language / languages of that member state in which medicine is sold" (Article 63, item 2).

Similar situation is found also in the Technical regulations containing, however, one essential "but". In Article 39 devoted to the maintenance of a leaf insert it is written: "In a leaf insert the following information has to be specified:

>. pharmacotherapeutic group or type of action, it is PREFERABLE in the terms clear to the consumer (our allocation — P)".

As we see, the fundamental difference in the given provisions is in what in the EU directive "clearness of information for the patient" has a binding character ("HAS TO be"), and in Technical regulations — only desirable ("PREFERABLY"). In other words, if in the market of EU countries the producer does not adapt the text of a leaf insert for "mere mortal", it is expected by legal sanctions, at us such sanctions are not provided yet.

FIGURE 1

| Logical structure of poll

RSHSHCHTSTSM 2007 January

[law! hope! nosamneplshay

Certainly, it is possible to count upon "an invisible hand of the market", that in fight for competitive advantages the domestic manufacturers of HP and representative office of the foreign companies by drawing up instructions will it is universal to seek for "promoting" of data on the goods (for example, by means of introduction of the corresponding internal rules). However, besides, you should not forget about high specificity of the market of drugs, its social importance which dictates need of much more strict regulation of its various parties, first of all at the state, "obligatory" level. And as is well-known from "the alphabet of law", the relevant regulatory standards are effective only when their developers initially are guided by "the worst of possible options". In a case with such parameter of the instruction as "clearness of information for the consumer", to legislators for providing high degree of this clearness, probably, it is worth making by analogy with the paragraph of the Consumer Protection Law given above "an assumption of absence at the producer of desire to make the text of a leaf insert available to the incompetent consumer in medicine".

ONE SMALL RESEARCH

Of course, clearness, availability to the consumer of the instruction — only one of indicators of its quality. If information in a leaf insert does not maintain criticism on such characteristics as reliability (contents parameter) and detail of the description of HP properties (bilateral, substantial and formal aspect), any "popularity" of statement of these flaws does not compensate. However only experts, "competent persons" can estimate reliability and detail, we within this article are interested, first of all, the consumer -

sky perception at the level of "it is clear — it is not clear".

Following this task, we tried to look at texts of medicinal instructions from positions of the most "ordinary consumer" and carried out small questioning. To consumers the number of questions, the concerning different aspects of leaves inserts was set. Total number of respondents was 50 people, gender — 27 women / 23 men (54/46%). The age dispersion of respondents captured an interval from 18 to 71 years; at the same time the greatest share of respondents (30 people — 60%) fell on persons 50 years are more senior (owing to obvious reasons, the most "problem" group of users of instructions). Survey was conducted in

a half-closed form (the choice of answers from in advance offered options at a simultaneous opportunity to use "the" answer in point "another"). Answering the specific question interviewed could choose one or several possible answers (in case different possible answers did not contradict each other). The logical structure of poll is given in fig. 1.

1. What for you most often is the main source to information on use of medicine?

The question assumed a possibility of the choice of both one, and several answers.

FIGURE 2

| Results of one of polls which is carried out on the basis of Roszdravnadzor Federal State Institution in 2006

WHETHER YOU READ the INSTRUCTION FOR MEDICAL APPLICATION ON MEDICINE WHICH you ACCEPT? (PATIENTS)

40
20
100
84 1 — yes
" 2 — do not have
80 3 — not completely
60 4 — it depends

_і_і_і_і_і_і_і_

12 3 4

E.A. Ovchinnikova, 2006. Survey was conducted in 68 cities of the Russian Federation; 318 patients, 116 doctors, 231 pharmaceutical workers participated in poll.

stvennost" document, which not

8

Results. 30 people (70%) specified as the answer "information of the expert" (option A), 28 (56%) chose "the instruction on HP" (B). The version of "the recommendation of acquaintances" (C), in 3 (6%) — "advertizing" (D) occurred in 19 questionnaires (38%).

26 respondents (52%) used several answers, 24 (48%) — only one. Among questionnaires with multiple answers — the most popular options of combinations "A+ B" (8 respondents — 16%) and "A & #43; With" (too 8 people — 16%). In questionnaires with the "single" answer option A dominated (12 people — 24%); at the same time ONLY "leaf insert" (B) as the main source of data on HP was called by 7 people (14%). The only respondent (2%) who chose other possible answer specified that he generally scoops information on drugs from "scientific and practical reference books "VIDAL" and "RLS". As we see, the percent of the consumers seeing in instructions not only the carrier, but also source of data on medicine is very great (28 people — 56% of respondents). The similar situation, undoubtedly, demonstrates once again the importance of the instruction in the general process of drug treatment and need of its strict regulation. Level "information the answer -

only "reminds" the consumer of data known to him, but also "educates", has to be higher, than in a case with simple "instruction".

2. How often at medicine acquisition you read the instruction attached to it?

The question meant only one answer.

Results: investigating the frequency of reading instructions by the consumer, we only indirectly raised the question of whether he reads them in general. It was connected with the fact that the specified question already was studied at the time on the basis of NC ESMP Federal State Institution of Roszdravnadzor (fig. 2). From this research it is visible that at drug intake in Russia the leaf insert attached to it is read by over 90% of consumers, i.e. the vast majority (in brackets we will notice that this figure considerably exceeds a similar indicator in the western countries).

As for the data on "regularity of reading" obtained by us, they in general will be agreed with results of the mentioned research: 25 respondents (50%) answered that they read the text of a leaf insert "always" (L), 34% — "in most cases" (C). "Seldom" (C) znako-

to be rumpled with information of the instruction of 5 people (10%). Only 3 of 50 respondents (6%) "never" ignore data of leaves inserts (the answer — — D).

2 (B-C-1). In what cases do you surely read the instruction?

The results received at the answer to the 2nd question became a point of intermediate bifurcation during our poll. The consumers reading a leaf insert "always" (50%) or "never" getting acquainted with its contents (6%), owing to clear logic were exempted from the answer to this question. Only 44% of respondents — those which read the instruction "in most cases" (34%) answered it or is "rare" (10%). The question meant one or several answers. The following possible answers were offered: Results. 16 people (72.7% of the "branched-off" sample and 32% of the total number of respondents) never chose the possible answer "earlier took the acquired medicine" (L).

The answer "appeared in 12 questionnaires (54.5% and 24%) medicine is acquired without doctor's advice" (C).

5 respondents (22.7% — 10%) specified a situation when "the expert who appointed/recommended medicine emphasizes need of attentive reading of the instruction" (C) as "a factor of obligatory reading". Only 1 respondent (4.5% — 2%) specified other reason of obligatory acquaintance with the instruction — "medicine from so-called "Third World country".

We will note that a combination of answers "L & #43; With" met 10 times (45.4% — 20%), "triplet" "L & #43; In & #43; With" — 4 times (18.1% — 8%). The provided figures allow to assume that the leaf insert for our many respondents serves as an important information component both self-treatment, and treatment "from giving" the expert.

2 (B-C-2). In what cases do not you read the instruction?

The circle of respondents was limited the same 44% of the total number of respondents, as in a case with the previous question. The question allowed one or several answers.

12 main subject: hp: instruction for application

REMEOShM 2007 January

Results. 19 people (86.4% of the "branched-off" sample and 38% of the total number of respondents) specified the possible answer "well I know medicine" (L).

9 respondents (40.9% — 18%) do not read a leaf insert in case "have accurate instructions and the recommendations of the expert" (C).

In 8 questionnaires (36.4% — 16%) the impossibility to understand an essence of the sections interesting me" (C) was called the reason of "rejection" of instructions ".

And 4 respondents (18.2% — 8%) avoid reading leaves inserts when them "too big array of information frightens" (B).

At last, 2 respondents (9.1% — 4%) do not read the instruction in those cases, "if they are inconvenient in terms of registration" (once was called such technical defect "an unsatisfactory font", in another — "an indistinct rubrication").

We will note that honor multiple answers on 2/3 moved "single" (14: 8 — 63.7%: 36.3%). Option L appeared in 7 of 8 questionnaires (31.8% — 14%) with one answer. Among multiple answers "doublet" of L & #43 was the most widespread combination; In — 5 cases (22.7% — 10%).

3. Do you, as a rule, entirely read the instruction?

The question was addressed to 94% of respondents; those 6% which never read leaves inserts (see above) were excluded from poll. The question assumed one answer.

Results. The answer "yes" (L) on this question was given by 18 people, i.e. 38.3% of "a polling branch" and 36% of the total number of respondents. 29 people (61.7% — 58%) usually "get acquainted only with separate headings of a leaf insert" (C).

4. What section of the instruction you, as a rule, read first of all?

The question was addressed to 94% of respondents; those 6% which never read leaves inserts were excluded from poll. The question assumed one answer. Results. 16 people, i.e. 34% of the "branched-off" sample and 32% of the total number of respondents, called at -

In neighboring countries (CIS and the Baltics) the assimilation by the consumer of data from instructions on HP often is complicated also by the fact that texts are stated in national language in the absence of "a Russian-speaking equivalent".

So, the resolution of the Ukrainian government on total transfer of leaves inserts adopted at the beginning of the century into Ukrainian became a serious problem for the huge part of the population which grew in Russian, universal for the USSR, and using it in everyday life. It is indicative that both in Ukraine, and in the states of the former Soviet Union which passed at the time in the sphere of medical informing to national language attempts are made recently "to win back back". At the Pharmsodruzhestvo — 2006 conference the Ukrainian pharmacologists for "simplifications of life to consumers" urged to apply in medicinal "instructing" Russian as the most extended to territories of the former Union. The similar initiative announced by one of parties seriously was discussed this year and in Latvia.

section of "indication to application", oritetny for.

And 12 respondents (25.5% — 24%) first of all read "a way of an application/dose", 6 respondents (12.8% — 12%) — "contraindications".

On 3 times (6.4% — 6%) answers "side effects" and "application at elderly/pregnant / children" occurred in questionnaires.

On 2 respondents (4.3% — 4%) first of all "precautionary measures at reception of HP" and "interaction with other HP" get acquainted with the maintenance of headings. At last, on 1 respondent (2.1% — 2%) gave a palm to the sections "date of statement/approval", "MNN/Structure" and "storage conditions/expiration date".

4 (3V-1). What sections of the instruction do you read most often?

After answers to question 3 in structure of poll one more logical fork appeared: question 4 (3V-1) designed to establish degree of "readability" of separate sections of the instruction (unlike question 4 which investigated priority of sections), was addressed those 58% of respondents who "read only separate headings of a leaf insert". And 36% of the respondents reading instructions entirely and 6% never of the reading leaves inserts, for obvious reasons, did not answer the given question. In each questionnaire it was allowed one or several possible answers. Results. On popularity degree the first four places with an essential separation from "persecutors" occupied the following headings our respondents:

♦ "indications to application" — 28 answers, i.e. 96.5% of "branch" and 56% of the total number of respondents; ♦ "contraindications" — 26 (89.7% — 52%); ♦ "a way of an application/dose" — 25 (86.2% — 50%);

♦ "side effects" — 23 (79.3% — 46%). The sections "Precautionary Measures at Application of HP" and "interaction with other HP" came across in questionnaires on 14 times (48.3% — 28%). Not much more the heading "Holiday/storage Conditions" which was found among answers of 13 times lagged behind (44.8% — 26%).

7 the person (24.1% — 14%) specified MNN/structure option, 6 (20.7% — 12%) — "overdose".

The heading "description of LF" 5 respondents (17.2% — 10%) systematically read, the section "pharmakodinamik" — 4 (13.8% — 8%).

"Pharmacokinetics" and "claimed/is approved" options were specified on

3 time (10.3% — 6%), "dosage forms" "pharmacotherapeutic group" and "information on the producer" — on 2 (6.9% — 4%).

In questionnaires multiple possible answers — 28 cases (96.6%) against the 1st "single" unconditionally dominated (3.4%). To speak about any one most popular combination of answers not absolutely correctly (the dispersion of options was enormous), however it is possible to note that a triplet "indications & #43; protivopo-

kazaniye & #43; the method of application" (in most cases in combination with other answers) came across 23 times (79.3% — 46%).

4 (3V-2). Why you read not all information provided in the instruction?

The question was addressed to the same 58% of respondents who gave the answer In on question 3 (see above). It was allowed one or several answers.

Rezuttata. 16 respondents (55.2% — 32%) chose the answer "extremely heavy (or it is actually impossible) to acquire all data from the instruction" (A).

12 more respondents (41.4% — 24%) read texts of instructions not completely because "consider a part of data useless for themselves" (C).

The other option occurred among answers 3 times (10.3% — 6%): "lack of time" and once a formulation "instructions to all goods was twice specified I read "on diagonal".

In questionnaires "single" answers — 27 times (93.1%) dominated. The pair combination of answers occurred only in 2 questionnaires (6.9%) (in both cases — And & #43; В).

5. Do you, as a rule, understand all information in those sections of the instruction which you read?

The question was answered by 94% of respondents; those who "never read the instruction" (6%), besides, dropped out of this point. Results. The vast majority of respondents — 42 persons (89.3% — 84%) — gave the answer "no" (C). In the affirmative ("yes" — A) only 5 respondents answered (10.6% — 10%).

5 (C). What most often causes in you misunderstanding of information from those sections of the instruction which you read?
with

the question was answered by 84% of respondents; those who "never read the instruction" (6%) and also those who, as a rule, "understand all information in a leaf insert" (10%) were logically eliminated answering. The question assumed one or several answers.

Results. 26 respondents (61.9% — 52%) specified the answer "the general style of statement (ponderousness, lack of public formulations)" (A). 24 times (57.1% — 48%) the "congestion of the text special scientific terminology" option appeared as the reason of "misunderstanding of information" (C).

The combined answers appeared at 8 respondents (19% — 16%).

6. How long you keep the instruction after medicine acquisition?

The question meant one answer. Results. 28 people (56%) said that "throw out a leaf insert after completion of packing of medicine" (A). 16 respondents (32%) "store the instruction even after completion of packing of medicine" (C).

4 respondents (8%) admitted that "throw out a leaf insert after single reading" (C).

At last, the possible answer "appeared in point "another" (B) 2 times (4%) did not pay to it attention", belonging to respondents who never read the instruction.

6 (And — C). If you read the instruction to the acquired medicine, then, as a rule, how many times it you do?

The matter was answered by 86% of respondents. Those who never read the instruction (6%) or throw out it after single reading (8%) for logical reasons were exempted from the answer. In each questionnaire one possible answer was allowed. Results. 21 respondents (48.8% of "branch" and 42% of the total number of respondents) said that he, as a rule, reads the instruction "once" (A).

20 people (46.5% — 40%) specified the answer "several times" (C).
2 respondents (4.7 — 4%) which chose other option (C), noticed that in their case "it is difficult to speak about distinct prevalence of single or repeated reading".
6 (And — C) / In — With/. What sections of the instruction do you usually re-read several times?

The question was addressed to 22 respondents (44%) — to those which, as a rule, read instructions "several times" (20 people) and also that who reads a leaf insert in the frequency mode "it depends" (2 persons).

Results. More often than others respondents re-read sections of "contraindication" and "method of application" — these options occurred in questionnaires on 15 times (68.1% — 30%).

Answers of "the indication to application" and "side effects" were mentioned in this section of the questionnaire on 13 times (59.1% — 26%).

9 respondents (40.9% — 18%) specified the section "interaction with other HP",
7 (31.8% — 14%) — "a storage condition/order".

The option of "a precautionary measure at application of HP" appeared in 6 questionnaires (27.3% — 12%).

On 3 participants of poll (13.6% — 6%) the headings "MNN/structure", "application at elderly/pregnant / children", "overdose", "pharmakodinamika" and "pharmacokinetics" mentioned. "Description of LF" and "dosage forms" options occurred among answers on 2 times (9.1% — 4%), "pharmacotherapeutic group" and "information on the producer" — on one (4.5%

Elwin Lawrence Elijah
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