Target’s Canadian withdrawal is also a loss for patients

January 20, 2015
Target_ClearRx

Target’s departure from the Canadian market has an important impact on Canadian healthcare. The chain was committed to opening a pharmacy in each of its locations. Along with the loss of jobs and the reduced options for patients, Target Pharmacy in the US provides a unique patient care offering which, had Target remained in Canada, might have seen its way north of the border.

Deborah Adler's ClearRx prescription vial system.

Deborah Adler’s ClearRx prescription vial system. Image courtesy of Adler Design.

ClearRx is Target’s innovative prescription vial and label. It was designed by Deborah Adler as part of a thesis project after her grandmother mistakenly took her husband’s medication. The vial and label are designed to be easier to read, putting the most important information in clear large type at the top of the label. The vial itself is flat, not round, making it immediately easier to read a label. Colour-coded rings will distinguish medications for persons in the same household — which can be much easier than having to read every label every time. A pocket on the back of the vial allows for an individualized patient card to provide additional instructions about the medication beyond the instructions printed on the label and a magnifier to ensure immediate access to the aid when required. Adler also designed new warning icons, to ensure auxiliary instructions could also be communicated through clear symbolism. These auxiliary labels are included on every label. In Canadian pharmacies, these warning labels are often printed in 4pt font in low resolution and must be affixed separately from the main label, meaning they often get missed or applied inconsistently.

I’ve written and demonstrated the case for better OTC label design in Canada before, and a recent study demonstrated the inadequacy of prescription label legibility for seniors and visually-impaired persons across all pharmacy chains. Innovation in this area is desperately needed, and the introduction of ClearRx in Canada would have been a welcome step in the right direction. One study shows that patients indeed prefer the ClearRx label design. The Institute for Safe Medicine Practices lauded the design as patient-centred and one that improves the safe and proper use of medications. When NY Magazine profiled ClearRx in 2005, it lamented many of the problems of traditional prescription labels — many of which continue to persist in Canada — including:

Inconsistent labeling.

Every pharmacy’s bottle has a different style and placement of information. […]

Branding trumps all.

The first and largest piece of type on a label is often the drugstore’s logo and address—not the name of the drug and instructions on how to take it, which should be given priority.

Confusing numbers.

Numerals are often printed without explanation. The number 10 floating in empty space, for example, could be read as ten pills or “take ten times a day.”

Poor color combinations.

Color-coded warning stickers—like those that say take with food, for example—don’t contrast strongly enough with either bottles or text. Black type set against a navy background is hard to decipher. An orange sticker can hardly be read against an orange bottle.

Curved shape is hard to read.

Existing pill bottles have no flat surfaces and are too narrow for an entire label to be visible at once. In order for all pertinent information to be observed, the bottle must be rotated.

Tiny type.

[…]

Designing prescription vials and labeling may seem a mundane endeavour, but the lack of change is surprising given the clear improvements presented by ClearRx. There have been innovations in the prescription vial industry, but most are not driven by patient concerns. For example, Ecolo Vial‘s worthy goal of creating an environmentally-friendly vial uses a mechanism that’s very difficult to manipulate, even for persons without disabilities. (Notably, though, it does have the advantage of being one piece, making it difficult to lose the cap from the container.) PillPack seems focused on becoming the Amazon of pharmacies, rather than improving patient medication utilization. Even the current push-and-turn mechanism that is used make a vial child resistant, but which can be difficult for patients with dexterity issues, has not changed much since it was introduced in 1967.

If Target had imported their prescription vial to their Canadian pharmacy operations, it would have represented one of the first truly patient-centred innovations to be introduced to prescription vial labeling in Canada. With increasing literature showing that medications are being improperly used and leading to emergency department use, prescription labeling as an element of a patient’s overall health literacy is one area which is under-explored.