Handwritten Prescriptions Pose Barrier to Patient Understanding, Indian Study Finds

A recent study from eastern India reveals that over 36% of patients have poor understanding of prescription medication instructions, risking adherence and safety.

The study, published in the Indian Journal of Pharmacology (March–April 2025), which is published by Wolters Kluwer – Medknow for the Indian Pharmacological Society, was conducted at a tertiary care public hospital in Kolkata over a three-month period (February–April 2023). Researchers assessed 380 patients or caregivers attending outpatient departments (cardiology, medicine, pediatrics, and ENT), aiming to evaluate how well they comprehended handwritten prescription details. 

Key Findings:

• Dosage Understanding: 59.2% of respondents had good or excellent understanding of the dosage prescribed (95% CI: 54.2–64.04).
• Drug Frequency: Only 40% demonstrated a good grasp of frequency instructions (95% CI: 35.2–45), a concerning gap given the risks of under- or overdosing.
• Drug Duration: 59.8% understood the duration of therapy well (95% CI: 54.66–64.7).
• Overall Comprehension: 36.8% of patients had poor composite understanding of their prescriptions (95% CI: 32.14–41.8), while only 20% achieved “excellent” comprehension scores.

Understanding was significantly correlated with several sociodemographic variables:

• Patients with more than secondary-level education were over 2.4 times more likely to have excellent understanding (44%) than those with lower education (18.7%) (P < 0.001).
• Age mattered—patients ≤50 years had better scores than those over 50 (P = 0.03).
• Socioeconomic status also played a crucial role: 57% of upper SE strata had excellent understanding vs. 20% of lower SE strata patients (P < 0.001).
• Gender differences were noted, with female respondents nearly twice as likely to have poor understanding compared to males (39.8% vs. 20.1%, P < 0.001).

Despite 96% of prescriptions being legible and 86% complete per NHM guidelines, comprehension remained suboptimal—particularly for frequency-related terms like BD, TDS, or HS, which were often left unexplained and misunderstood.

Patients proposed solutions including the use of vernacular language prescriptions and pictorial aids. The authors echoed these recommendations, emphasizing the need for patient-tailored strategies, especially in public hospitals serving predominantly low-literacy, rural populations.

This landmark study highlights the pressing need for improved prescription communication in India’s public healthcare system. Institutional reforms—such as vernacular printouts, visual aids, and expanded counselor roles—are already underway at the study site. Follow-up evaluations are planned to assess the impact of these interventions.

Reference: Das D, Kotal S, Chatterjee S. How well do patients understand medication information written in prescriptions? A study from Eastern India. Indian J Pharmacol 2025;57:83-9. DOI: 10.4103/ijp.ijp_359_24.