Consumer Medicines information (CMI) was a huge advance on what had previously been there.
It was a neat idea: giving Australian consumers up-to-date information about their medicines as a highly usable printout at the point of sale, when they picked up their prescriptions. The decision to do so was the result of one of those rare historical moments when industry and consumers stood shoulder to shoulder in agreement on the best course of action. But it hasn’t worked. Despite much effort, pharmacists, according to the most recent research, still continue after 15 years to deny consumers their rights to information about the medicines they are taking.
In a recent review and case history we at CRI went over this sad record (see Better CMI: The sad failure of a design project. At a recent conference, where I presented the results of this review and case history, I suggested that pack inserts were the best alternative practical option for both industry and consumers. Some delegates were alarmed; so let me elaborate.
In 1994 we wrote the first edition of Writing about Medicines for People. It is now in its third edition and remains a useful guide to anyone concerned with writing and testing CMI. The layout and typography in the design was predicated on the assumption that CMI would be printed at pharmacies using the then crude pharmacy software, and delivered by pharmacists at the point of dispensing. This meant that, while the CMI were usable, they failed to meet any of the other criteria for good document design. As a consequence, many CMI, even if available to consumers, were unlikely to be read. Nonetheless, we believed that the software for producing CMI would quickly improve and make them more acceptable to consumers. In anticipation of this, we built the design in such a way as to make the transition to more flexible technologies, such as pdf and xml, straightforward. But it was not to be, and the same crude printing used in 1994 is still being used on the few occasions when pharmacists deign to grant consumers their rights to the information.
At every step, pharmacists—through the Pharmacy Guild—have blocked attempts to improve the quality of CMI for consumers. Despite the fact that pharmacists are actually paid out of taxpayer funds for delivering CMI as part of their counselling, have been given taxpayer funds to buy duplex laser printers for printing CMI because they complained about the number of pages in a CMI, and have been repeatedly exhorted to give consumers CMI by their professional bodies, CMI are not available to consumers as a matter of routine. Moreover, I have yet to see evidence that the money was actually used to buy the dedicated duplex CMI printers pharmacists asked for, rather than double hopper laser printers—a cheaper alternative that can be used for multiple purposes, not just printing CMI. There are, in my view, sufficient grounds for an investigation into the potential misuse of taxpayer funds.
Meanwhile the road to quality information for consumers at the point of dispensing remains blocked. And recent research commissioned by the Pharmacy Guild to develop ‘effective CMI’ does not inspire confidence, though it would be nice to be wrong about this.
As a consequence of all these events, I have come to the view that there is little point in pursuing the goal of providing CMI at the point of dispensing. The pharmacists have had their chance to be relevant in consumer counselling, and blown it. Government should seriously consider withdrawing its funding for counselling and CMI delivery, and industry should consider going back to pack inserts as the preferred way of delivering CMI. Our private research and design for a number of pharmaceutical companies strongly suggests that pack insert CMI can be delivered to a much higher standard than the pharmacy-produced CMI, and much more specifically suited to consumer needs for information about specific medicines and to the branding opportunities for industry (as long as they avoid the EU template). The only drawback, apart from the cost to industry of new designs, would be the lack of timeliness in updates. But there is not much point in having timely information that is unavailable, and the branding opportunities should easily offset the additional costs to industry.
I know that I have till now been a champion of pharmacy-delivered CMI. But after 15 years of disappointing progress, and nothing better in sight, I have changed my mind. I still think it’s the best option in the long term, but in the short term the joint goals of industry and consumers can be best met by well designed pack inserts.