OBJECTIVES: Pharmaceutical pictograms have been designed to help communicate medication instructions to patients. The study was conducted to evaluate the effectiveness of pictogram intervention in comparison to standard pharmacy practice in community pharmacies in Poland.

METHODS: Three pictograms informing about the proper way of using the drug were designed to be used on the packages of metoprolol prolonged release (PR) in community pharmacies. Pharmacies belonging to Farenta Research pharmacy practice-based research network were randomly assigned to a group using pictograms when dispensing metoprolol PR or one following their normal practice. Patients who had used metoprolol PR ≥3 months and visited the pharmacy to fill prescription were eligible to participate in the study. All patients giving consent to participate in the study answered structured questionnaire about their medication behaviour in the 7 days preceding the visit at the pharmacy. All questions focused on medication use aspects aligned with information on pictograms. Same questions were asked four weeks later to follow-up treatment adherence change and compare it in studied groups.

RESULTS: From the total of 253 patients screened 117 and 104 patients completed the study in the standard practice and pictogram intervention groups, respectively. Percentage of patients with adherence improvement was higher in pictogram group compared with standard pharmacy practice group. The most significant improvement in pictogram vs standard practice group concerned not crushing tablets (OR = 27.8, 95% CI: 1.4 – 537.3, p=0.02), not omitting daily doses (OR = 3.9, 95%CI: 1.1 - 14.8, p=0.4) and taking tablets with water (OR = 3.2, 95%CI: 1.3 – 7.5, p = 0.007).

CONCLUSIONS: To our knowledge, this is the first control-arm study assessing effectiveness of pictogram intervention. The real-world data suggests that pictograms are effective in conveying messages about the proper way of using medications and increase treatment adherence in comparison to standard dispensing practice.