Table 1.

Targeted patient behaviors in medication safety used in the survey.

Medication safety behaviors			Examples provided to participants		Justifications and references
Bring medications
	Patients are expected to bring all medications and all relevant health-related documents to their health care provider office visits.	Collect all medicine bottles, including those over the counter such as Tylenol and vitamins, and bring them with you to the health care provider’s office. Make sure to also bring documents such as medication lists and blood sugar and blood pressure logs (if asked to keep one).		The FDAa recommends keeping a list of all medications (prescribed and over the counter) and bringing it to all doctors’ appointments [17]. Although often encouraged by primary care providers [18,19]. Only about 20%-40% of the patients bring in their medications or medication list. Medication reviews lack standardization which can result in increased mortality, morbidity, and poor patient outcomes [20,21].
Confirm medications
	Patients will verify any changes in their medications after each provider’s visit.	You have been taking 20 mg of Simvastatin every day for cholesterol for a long time. In the last visit, your cholesterol level has decreased. Your provider reduced the medication dose to 10 mg. You make this change on your personal medication list.		FDA recommends to verify the medication list at least once a year or any time there is a change [17]. Medication discrepancies are very common among patients with chronic conditions, especially those who require frequent hospitalizations or see numerous providers [22,23].
Refill system
	Patients will establish a refill system.	Your provider advised you to call the pharmacy when you are about to run out of refills, and not their office. The pharmacy will contact the provider’s office for refill prescriptions. Using two 7-day pill boxes allows you to know 2 weeks in advance when a medicine will run out.		Current recommendations are to address all refill needs during the provider’s visit and send all prescriptions ideally to one pharmacy only in order to prevent gaps in medication therapies in chronic care due to disruptions and lapses in obtaining refills timely. Innovative systems use technological advances; however, older patients and individuals who speak English as a second language are less likely to use technology to refill medications [24-28].
Use portals
	Using patient health care portals.	Your provider’s office sent you a link for creating an account to access the patient portal website. After you sign up, you can use the portal to communicate with your provider and access your health information.		Patient portals were intended to improve the communication between the health care team and patients. They allow patients to be actively involved in their care, access their medical records, verify for accuracy, report concerns, and seek medical advice or medication refill [6,8,29-31].
Organize medications
	Using pill dispensers and other organizer tools.	Pill boxes are effective tools to remind you when and what medicines to take. You may also set reminders on your phone. To-go boxes are convenient to carry in your bag or purse when you are out, running errands. Charts, calendars, and electronic pill boxes are other ways of organizing medications.		The importance of having a system to organize medications was extensively studied. A list of memory tips and reminder systems (such as daily pillbox, calendar, or chart) to help organize scheduled prescriptions are available on various online resources [32-35].
Check medications
	Verifying medications for duplicates and expired medications.	The mail-order pharmacy sends you your refills automatically, so they always arrive before you run out of it. You know how to check the medicines against your list, as the color of the pills and names of medications (eg, generic vs brand name) may change from time to time, and you do not want to take duplicate medicines. You also dispose of expired medicines, so you do not accidentally take them.		The FDA and NIHb recommend that patients check all medications for expiration dates. Ingesting expired medications may pose significant health hazards [17,36].
Medication awareness
	Accessing resources pertaining to medication-related issues.	You went to the pharmacy to pick up a prescription, but they did not have it. To clarify the situation, you call your provider’s office to inquire if you are still supposed to take the medication and verify the correct pharmacy on file. In another situation, you may need to call the pharmacist or the provider to find out what you need to do if you accidentally doubled your heart medicine.		The World Health Organization recommends that patients learn to identify and report any issues or side effects pertaining to taking medication [17,36].
Know medications
	Have basic knowledge about medications.	When you look at your medicine bottle, you are able to locate the medicine name, dose, when and how to take this medicine, how many refills are left, expiration date, and telephone number to call if you have questions about this medicine. For instance, you are prescribed to take a round white pill twice a day for high blood pressure. You wrote the name (“metoprolol”) on the medication list. You know to take 1 pill in the morning and 1 pill in the evening. You also know that you should take the pill with food. Symptoms to watch for are lightheadedness or very slow heartbeats.		Patients are advised to read carefully all information provided with the medications such as package inserts and pharmacy instructions. As many as an estimated 87% of patients do not read these instructions. Health illiteracy continues to be a challenge. Patients who are younger and have a higher formal education are more likely to have an adequate knowledge of medications [35,37-39].

^aFDA: US Food and Drug Administration.

^bNIH: National Institutes of Health.