Patient education about safe medicine purchasing and the risks of substandard and falsified medicines should occur throughout all points of contact within the health system. Education should be ongoing and integrated into routine care, at points such as:
When prescribing, discussing diagnosis or reviewing symptoms, nurses, pharmacists and general practitioners can explain safe purchasing, expected therapeutic effects and normal side effects, signs of SF medicines. Patients should be encouraged to report any lack of effect or unexpected reaction.
Pharmacists can explain risks of unauthorized sources, encourage vigilance regarding packaging and appearance, answer questions about expected effects, and link patients to reporting systems if concerns arise.
In waiting rooms, clinics and hospitals, staff can display accessible materials such as posters and leaflets to raise awareness passively and prompt patients to ask questions.
In routine discussions during care or consultations, health professionals can discuss the following topics to raise awareness about substandard and falsified medicines and discern any risk factors that may predispose the patient towards encountering these medicines:
- Where will the patient purchase their medicines? If the patient is considering an online pharmacy, the risks should be thoroughly explained along with steps patients can take to purchase safely (as described here). Patients can also be directed to educational resources like the FDA’s BeSafeRx Campaign.
- Will the patient face financial barriers in purchasing their medicines? If the patient has inadequate prescription coverage, is low-income, or is prescribed an expensive or long-term use medicine, the patient will struggle to afford their prescribed medicine and look to riskier avenues to obtain these medicines at a discount (ie online pharmacies). It is important health professionals probe for these barriers and connect patients to the appropriate financial support programs, resources or savings strategies. In the U.S., these include: Needy Meds, Medicine Assistant Tool, and Rx Outreach.
- What are the expected side effects and therapeutic effects of the medicine, and what is the expected timeline of these events? Health professionals should explain the normal side effects and expected time to feel better after medicine consumption. Patients should be encouraged to report if their side effects or time to treatment differ from the expected.
- How can patients identify warning signs and report potentially unsafe medicines? Patients should be encouraged to do a visual inspection of their medicines, as described here. Health professionals can provide examples of what substandard and falsified medicines look like, and they can provide a sample of the real medicine if possible to further support their visual inspection.
Cancer makes patients vulnerable in many ways, not just physically but mentally as well, resulting in feelings of hopelessness, uncertainty and anxiety. The potential of encountering substandard and falsified medicines is another factor that may add on to the fear cancer patients already face. To avoid further exacerbating mental turmoil, health professionals should frame their conversations carefully so patients feel empowered and supported by the entire medical system.
The Health Belief Model is a helpful framework to help health professionals structure conversations with patients about SF medicines in an empowering way:
- When discussing the risks of substandard and falsified medicines, equally emphasize protective behaviors and knowledge to increase patients’ self-efficacy, or their confidence in the ability to protect themselves. Demonstrate to patients how they can practice these behaviors in a simple way.
- Acknowledge the barriers patients may have in practicing these behaviors (cost, access, health literacy, etc) and address them appropriately.
- Provide resources or cues to action that help patients remember these protective behaviors (cue cards, posters, etc).
Other tips for patient communication:
- Avoid causing panic, worry, or undermining trust in medicines or the health system. Especially in the U.S. where the supply chain is very regulated, patients should feel confident in their medicines when they use legitimate sources.
- Avoid blaming, stigmatizing or judging patients who struggle to identify legitimate medicines, who have engaged in risky medicine purchasing behaviors, or who have exposed themself to substandard and falsified medicines.
- Encourage questions and open communication about the topic.