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Jones PR, Santiago J, Pearsall BM, Chu DM, Wolff C, Kearsley A. A survey on perceived medication guide reading and comprehension ease among US adults. Health Promot Int 2024; 39:daad190. [PMID: 38386901 DOI: 10.1093/heapro/daad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Medication guides (MGs) provide patients with important information about certain prescription drugs to help them take these drugs safely. We surveyed US residents about their perceptions of MG readability and understandability. We randomly sampled 5204 US residents (age 18+) from Ipsos's KnowledgePanel to complete a two-part survey. Only respondents who reported receiving an MG with their prescription drugs (n = 3852) completed part 2, which included two key items: How easy to [(1)read/(2)understand] are the MGs that you have received from a pharmacy along with your prescription medicines? (1 = Very easy, 5 = Very difficult; reverse-coded). Health literacy (HL) and demographic data were also collected. After weighting our data, we found that 85% of respondents who reported receiving an MG perceived this information as 'very easy' (27.3%), 'somewhat easy' (28.3%) or 'about average' (29.3%) to read. Eighty-seven percent of respondents who reported receiving an MG perceived it as 'very easy' (27.6%), 'somewhat easy' (30.2%) or 'about average' (29.5%) to understand. ANOVAs revealed higher average perceived MG reading and comprehension ease scores among respondents presumed to have adequate versus inadequate HL (ps ≤ 0.0006). Younger or less-educated respondents and non-Hispanic Blacks perceived MGs as easier to read and understand, on average, than their counterparts (ps ≤ 0.0001). Many of these relationships remained intact in models predicting perceived MG reading and comprehension ease (ps ≤ 0.001). Adjusted R2 values across models were small, however (≤0.06). Our findings suggest most US residents (18+) who received MGs perceived them to be 'about average' to 'very easy' to read and understand.
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Affiliation(s)
- Paul R Jones
- Division of Medical Policy Programs, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, U.S. Food and Drug Administration (FDA), 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Jonas Santiago
- Division of Medical Policy Programs, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, U.S. Food and Drug Administration (FDA), 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Bryon M Pearsall
- Division of Medical Policy Programs, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, U.S. Food and Drug Administration (FDA), 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Dan-My Chu
- Division of Medical Policy Programs, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, U.S. Food and Drug Administration (FDA), 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Carolyn Wolff
- Office of Economics and Analysis, Office of Policy, Legislation, and International Affairs, Office of the Commissioner, FDA, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Aaron Kearsley
- Office of Economics and Analysis, Office of Policy, Legislation, and International Affairs, Office of the Commissioner, FDA, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
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Metkus T, Curran J, Lin S, Qato DM, Alexander GC. Assessment of the U.S. Food and Drug Administration's risk evaluation and mitigation strategy (REMS) for prasugrel (EFFIENT): A narrative review. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 38:100359. [PMID: 38371270 PMCID: PMC10871021 DOI: 10.1016/j.ahjo.2024.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Prasugrel, first approved in 2009, was subject to a US Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) to mitigate the risk of bleeding associated with its use. Methods We performed a narrative review of FDA documents obtained through a Freedom of Information Act request. Document classification and primary evidence extraction was performed by three authors (TM, JC, and SL). Results The prasugrel REMS consists of a medication guide and a communication plan. Assessment of the REMS was via patient and clinician surveys. 1560 patients were invited to participate and 212 individuals (13.6 %) completed the survey. Rates of awareness among respondents varied across key messages and were highest for those examining the risks of premature discontinuation (96 % and 88 % of respondents), while lower for those regarding the importance of perioperative discontinuation (66 %) and contraindications posed by a history of stroke (16 %) or transient ischemic attack (17 %). Of the 6000 clinicians invited to participate in the survey, 201 (3.4 %) agreed to take part. Four of 11 key risk messages did not meet prespecified acceptable levels of comprehension. No prespecified levels of patient or provider knowledge were required for the retirement of the REMS, which took place on March 23, 2012 based on the sponsor's request. Conclusions The prasugrel REMS consisted of passive educational materials whose adequacy was evaluated using highly limited, one-time, cross-sectional surveys. Our assessment adds to evidence suggesting the importance of improving the quality and impact of the FDA's post-approval activities to maximize drug safety.
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Affiliation(s)
- Thomas Metkus
- Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill Curran
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shanshan Lin
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dima M. Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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3
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Esposito DB, Desai VCA, Stephenson JJ, Cepeda MS, Lyons JG, Holick CN, Wedin GP, Lanes S. Patient Knowledge of Safe Use of ER/LA Opioid Analgesics Following Implementation of the Class-Wide REMS: A Survey Study. Patient Prefer Adherence 2021; 15:431-442. [PMID: 33658767 PMCID: PMC7917306 DOI: 10.2147/ppa.s286935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/RATIONALE The US Food and Drug Administration (FDA) approved a Risk Evaluation and Mitigation Strategy (REMS) for extended release/long-acting (ER/LA) opioids in 2012. The purpose of this study was to assess patient knowledge of the safe use of these products following implementation of the REMS and to determine possible effects of the REMS, including impact on medication access. OBJECTIVE To assess patient knowledge of safe use of ER/LA opioids and use of REMS patient education tools such as the Medication Guide (MG) and Patient Counseling Document (PCD). METHODS This was a cross-sectional survey of commercially insured (Commercial) and Medicare Advantage-insured (Medicare) adults with ≥1 pharmacy claim for an ER/LA opioid (10/01/2015 - 02/28/2017) in the HealthCore Integrated Research Database and Medicaid-insured (Medicaid) adult members of a research panel, about their knowledge of safe use of ER/LA opioids and receipt/comprehension of the MG and PCD. RESULTS Survey respondents consisted of 382 Commercial, 43 Medicare and 40 Medicaid adults. While ≥95% of respondents received and read the MG, fewer were aware of the PCD (Commercial: 47%, Medicare: 65%, Medicaid: 53%). Almost 75% of the knowledge questions were answered correctly by ≥80% of all respondents; fewer respondents recognized that use of opioids as directed can lead to death (Commercial: 73%, Medicare: 56%, Medicaid: 63%), the MG should be read at each dispensing (Commercial: 78%, Medicare: 53%, Medicaid: 75%), opioids should not be stored in the medicine cabinet (Commercial: 77%, Medicare: 79%, Medicaid: 58%), missed doses should not be taken as soon as possible (Commercial: 56%, Medicare: 51%, Medicaid: 50%), and pills should not be crushed (Commercial: 85%, Medicare: 67%, Medicaid: 52%). CONCLUSION Although most respondents reported reading and understanding the MG and exhibited knowledge of safe use of ER/LA opioids, providers' use of the PCD and increased understanding of safe use core messages need reinforcement.
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Affiliation(s)
| | | | - Judith J Stephenson
- HealthCore, Inc., Wilmington, DE, USA
- Correspondence: Judith J Stephenson HealthCore Inc, 123 Justison Street, Suite 200, Wilmington, DE, 19801, USATel +1 302-547-5770 Email
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See M, Butcher BE, Banh A. Patient literacy and awareness of medicine safety. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:552-560. [PMID: 32931060 PMCID: PMC7692901 DOI: 10.1111/ijpp.12671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 11/27/2022]
Abstract
Abstract
Objective
To assess public understanding of medicine safety, approach to risks and preferences in accessing safety information.
Methods
Qualitative data were obtained from an online survey (n = 1079) covering four major themes around side effects and risks of medicines: willingness to accept side effects of medications, information seeking, sufficiency of information and understanding pharmacovigilance process. Comparisons were made for age, gender and social/financial status.
Key findings
Most respondents acknowledged medications were associated with side effects. If side effects were experienced, most (73%) would seek advice from their doctor or pharmacist. Four in 10 respondents felt doctors and pharmacists do not provide sufficient information about medications, even though many (47%) relied on their doctor to provide this. Although 51% felt that pharmaceutical companies were already providing enough information to patients, 95% responded that extra effort could still be made. Two-thirds of the respondents felt it was the companies’ responsibility to educate doctors and pharmacists so they could pass the information on, even though younger respondents preferred direct communication to patients compared to older respondents (<24 years, 36% versus >65 years, 10%; P < 0.001). Men were more willing to accept risks, while women were more likely to seek information about their medicines. Understanding of the role of pharmaceutical companies and government in maintaining the safety of medicines was generally poor.
Conclusions
There is an ongoing need for consumer education regarding medicine safety. Doctors and pharmacists remain the more trusted source of information. Pharmaceutical companies play an important role in ensuring such information is both accessible and accurate.
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Affiliation(s)
- Marissa See
- Bayer (SouthEast Asia) Limited, Singapore City, Singapore
| | - Belinda E Butcher
- WriteSource Medical Pty Ltd, Lane Cove, NSW, Australia
- School of Medical Science, University of New South Wales, UNSW Sydney, NSW, Australia
| | - Alex Banh
- Bayer Australia Limited, Pymble, NSW, Australia
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Guadamuz JS, Qato DM, Alexander GC. Use of Risk Evaluation and Mitigation Strategies by the US Food and Drug Administration, 2008-2019. JAMA 2020; 324:299-301. [PMID: 32692379 DOI: 10.1001/jama.2020.6611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jenny S Guadamuz
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy
| | - Dima M Qato
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Zografos LJ, Andrews E, Wolin DL, Calingaert B, Davenport EK, Hollis KA, Schmidt-Ott UM, Petraro P, Vassilev ZP. Physician and Patient Knowledge of Safety and Safe Use Information for Aflibercept in Europe: Evaluation of Risk-Minimization Measures. Pharmaceut Med 2020; 33:219-233. [PMID: 31933286 DOI: 10.1007/s40290-019-00279-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND As part of the risk-management plan for aflibercept in the European Union, materials have been developed to educate physicians and patients in Europe on the safe use of aflibercept. OBJECTIVES The objectives of this study were to measure receipt of the educational materials and to evaluate understanding of key safety information for aflibercept. METHODS An observational cross-sectional study among physicians and patients with recent aflibercept experience in France, Germany, Italy, Spain, and the UK was conducted. Eligible physicians and patients completed a brief questionnaire regarding their knowledge of key safety information. RESULTS Among the 8424 physicians invited to participate in the survey, 428 physicians were eligible, completed the questionnaire, and were included in this analysis. Most physicians reported having received the aflibercept summary of product characteristics (87%) and prescriber guide (77%); approximately half reported receiving the injection procedure video (50%) and patient booklet (54%). Physician knowledge of the most important topics (i.e., side effects; preparing patients for aflibercept injection) was high. Physician knowledge of dosing was high for neovascular (wet) age-related macular degeneration and lower for less commonly prescribed indications. Most physicians knew the contraindications for aflibercept and recognized possible side effects. Among the 874 patients approached about participation in the study, 773 patients were eligible, completed the questionnaire, and were included in the analysis. Patients' reported receipt was relatively low for the aflibercept patient booklet (38%) and the audio CD (23%). Patient knowledge of the health conditions to discuss with a doctor prior to injection was generally high; knowledge about possible side effects varied. Most patients knew that they should speak to a physician immediately if they experienced a possible side effect of aflibercept. CONCLUSION Most physicians reported receiving the summary of product characteristics, prescriber guide, and patient booklet; half reported receiving the intravitreal injection procedure video. Patient receipt of the educational material was variable. Observed patterns of knowledge indicated the greatest knowledge of the most important risks emphasized in the educational material and lower knowledge of more complex or less salient aspects of safe use.
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Affiliation(s)
- Laurie J Zografos
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Elizabeth Andrews
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Daniel L Wolin
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Brian Calingaert
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Eric K Davenport
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Kelly A Hollis
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | | | - Paul Petraro
- Bayer US, Whippany, NJ, USA.,Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, NJ, 08536, USA
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Advancing regulatory science and assessment of FDA REMS programs: A mixed-methods evaluation examining physician survey response. J Clin Transl Sci 2019; 3:199-209. [PMID: 31660244 PMCID: PMC6799639 DOI: 10.1017/cts.2019.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/16/2019] [Accepted: 07/20/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose: Food and Drug Administration’s (FDA) Draft Guidance for Industry on pharmaceutical REMS (Risk Evaluation and Mitigation Strategies) assessment and survey methodology highlights physician knowledge–attitudes–behaviors (KAB) surveys as regulatory science tools. This mixed-methods evaluation advances regulatory science and the assessment of FDA REMS programs when using physician surveys. We: (1) reviewed published physician survey response rates; and (2) assessed response bias in a simulation study of secondary survey data using different accrual cut-off strategies. Methods: A systematic literature review was conducted of US physician surveys (2000–2014) on pharmaceutical use (n = 75). Kruskal–Wallis tests were used to examine the relationships between response rates and survey design characteristics. The simulation was conducted using secondary data from a population-based physician KAB survey on diabetes risk management with antipsychotic use in Missouri Medicaid (n = 973 accrued over 30 weeks). Survey item responses were compared using Pearson’s chi-square tests for two faster completion simulations: Fixed Sample (n = 300) and Fixed Time (8 weeks). Results: Survey response rates ranged from 7% to 100% (median = 48%, IQR = 34%–68%). Surveys of targeted populations and surveys using member lists were associated with higher response rates (p = 0.02). In the simulation, 9 of 20 (45%) KAB items, including diabetes screening advocacy, differed significantly using the smaller Fixed Sample strategy (achieved in 12 days) versus full accrual. Fewer response differences were found using the Fixed Time strategy (2 of 20 [10%] items). Conclusions: Published data on physician surveys report low response rates with most associated with the sample source selected. FDA REMS assessments should include formal evaluation of survey accrual and response bias.
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8
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Dorji T, Gyeltshen K, Pongpirul K. Rational use of paracetamol among out-patients in a Bhutanese district hospital bordering India: a cross-sectional study. BMC Res Notes 2018; 11:660. [PMID: 30201047 PMCID: PMC6131944 DOI: 10.1186/s13104-018-3764-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/05/2018] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Paracetamol or acetaminophen is a weak analgesic commonly used worldwide and in Bhutan. It is available across all levels of Bhutan's health care system and for purchase without prescription. Little is known, however, about patterns of paracetamol use in Bhutan. This study aimed to assess what the Bhutanese population knows about the indications for use of paracetamol, safe use, and common patterns of usage (frequency, dosage). These questions were studied among Bhutanese living in Phuentsholing, a large commercial town at Bhutan-India border. RESULTS Among 441 participants, most (72.1%) reported having used paracetamol in the past 1 year. The mean knowledge score was 57.6%; only 30 participants (6.8%) had what was characterized as "good knowledge." Level of knowledge was positively associated with level of education (p = 0.031). Less than half (41.3%) had a "good attitude" towards use of paracetamol. In practice, few (4.8%) knew the correct dose, including about one in ten who reported exceeding the recommended therapeutic dose. Most knew about side effects (61.2%) and possible allergic reactions (77.3%). Many participants (47.9%) acknowledged that the self-use of paracetamol may not reduce the number of hospital visits.
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Affiliation(s)
- Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Kidu Medical Unit, His Majesty’s Peoples’ Project, Thimphu, Bhutan
| | | | - Krit Pongpirul
- Holistic and Oriental Medicine Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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9
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Ascher J, Stemhagen A, Stender M, Win B, Winter C. Patient Understanding of the Neuropsychiatric Risks Associated with Branded Bupropion Hydrochloride Products Used for Smoking Cessation. Drugs Real World Outcomes 2018; 5:181-191. [PMID: 30105744 PMCID: PMC6119167 DOI: 10.1007/s40801-018-0140-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bupropion hydrochloride (Zyban) is an effective aid to smoking cessation; however, its use has previously been associated with neuropsychiatric adverse events. Here we report results of the patient Knowledge, Attitudes, and Behavior survey that forms part of the Year 7 Risk Evaluation and Mitigation Strategy (REMS) assessment for Zyban. OBJECTIVE Assess participants' understanding of the neuropsychiatric risks associated with branded bupropion hydrochloride products that are used for smoking cessation, as described in the Medication Guides. METHODS A cross-sectional study was conducted among patients ≥ 18 years of age, who had used or filled a prescription for branded bupropion hydrochloride for smoking cessation in the past 6 months. Participants were recruited through an online panel, pharmacy network, or by healthcare provider referral, and invited to complete a survey containing questions regarding the risks associated with the use of branded bupropion hydrochloride products, and whether they had received and read the Medication Guide. The study aimed for ≥ 80% of participants to respond correctly to each question regarding neuropsychiatric risks. RESULTS From the 50,985 survey invitations distributed, 1017 participants responded, of whom 144 were eligible and 142 completed the survey. Over 80% of participants correctly responded to most neuropsychiatric risk questions. Approximately three-quarters of participants received the Medication Guide when they last filled their prescription, of whom over half read the Medication Guide at that time. CONCLUSIONS Participants enrolled in this Year 7 REMS survey had good understanding of the neuropsychiatric risks associated with using branded bupropion hydrochloride products for smoking cessation.
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Affiliation(s)
- John Ascher
- Classic and Established Medicines, US Medical Affairs, GSK, Research Triangle Park, NC, USA.
| | | | - Monika Stender
- Real World Evidence and Epidemiology, GSK, Stockley Park, Uxbridge, Middlesex, UK
| | - Beta Win
- Global Clinical Safety and Pharmacovigilance, GSK, Stockley Park, Uxbridge, Middlesex, UK
| | - Christina Winter
- Global Clinical Safety and Pharmacovigilance, GSK, Stockley Park, Uxbridge, Middlesex, UK
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10
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Chan HW, Russell AM, Smith MY. What is the quality of drug safety information for patients: An analysis of REMS educational materials. Pharmacoepidemiol Drug Saf 2018; 27:969-978. [PMID: 30003610 PMCID: PMC6646909 DOI: 10.1002/pds.4614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/05/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
Background Poor‐quality patient drug information has been identified as a major cause of preventable medication errors in the United States. The US Food and Drug Administration (FDA) has the authority to require marketing authorization holders of medicinal products to implement risk evaluation and mitigation strategies (REMS) to ensure that the benefits of a drug or biological product outweigh its risks. Aside from medication guides, no research has been conducted to assess the quality of patient‐targeted REMS materials, including whether, and to what extent, patients find these materials understandable and actionable. Purpose To describe the readability, understandability, and actionability of patient educational materials in currently approved REMS programs, and to highlight opportunities for improving both the quality and effectiveness of these important drug safety tools. Methods Seventy‐seven REMS programs were identified from the FDA REMS database. We excluded medication guides (MGs) from our analysis because of the fact that there is a mandatory MG template. Based on this, we identified a total of 27 (non‐MG) REMS patient materials on the FDA REMS website for analysis purposes. The materials were tested for readability using the Lexile Measure, the Gunning Fog Index, and Flesch Kincaid and then assessed using the Patient Education Materials Assessment Tool for printable materials, for understandability and actionability. Results Twenty‐three of 77 (30%) REMS programs used educational materials to communicate serious risks to patients, yielding a total of 27 REMS patient materials for analysis. The median readability score for these materials was at a ninth‐grade reading level or higher. While most (89%) of these patient education materials met established criteria for being understandable, less than half (49%) were deemed actionable. Discussion Currently approved REMS patient materials fell short in terms of recommended reading level, and over half did not meet recommended standards for actionability. Developers of these materials should apply plain language principles when design these materials to improve their readability and to assess both understandability and actionability in order to increase the effectiveness when distributed to patients.
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Affiliation(s)
- Hilda W Chan
- Global Patient Safety and Labeling, Amgen, Inc., Thousand Oaks, CA, USA
| | - Andrea M Russell
- Global Patient Safety and Labeling, Amgen, Inc., Thousand Oaks, CA, USA.,Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Meredith Y Smith
- Global Patient Safety and Labeling, Amgen, Inc., Thousand Oaks, CA, USA
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11
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Ponizovsky AM, Marom E, Weizman A, Schwartzberg E. Changes in consumption of opioid analgesics in Israel 2009 to 2016: An update focusing on oxycodone and fentanyl formulations. Pharmacoepidemiol Drug Saf 2018; 27:535-540. [DOI: 10.1002/pds.4415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/11/2018] [Accepted: 02/05/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | - Eli Marom
- Pharmaceutical Administration; Ministry of Health; Jerusalem Israel
| | - Abraham Weizman
- Research Unit; Geha Mental Health Center; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Felsenstein Medical Research Center; Petah Tikva Israel
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12
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Patient and Physician Perceptions of Drug Safety Information for Sleep Aids: A Qualitative Study. Drug Saf 2018; 40:531-542. [PMID: 28247279 DOI: 10.1007/s40264-017-0516-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The US Food and Drug Administration uses drug safety communications (DSCs) to release emerging information regarding post-market safety issues, but it is unclear the extent of awareness by patients and providers of these communications and their specific recommendations. OBJECTIVE We conducted semi-structured interviews with patients and physicians to evaluate their awareness and understanding of emerging drug safety information related to two sleep aids: zolpidem or eszopiclone. METHODS We conducted interviews with 40 patients and ten physicians recruited from a combination of insurer claims databases and online sources. We evaluated (1) sources of drug safety information; (2) discussions between patients and physicians about the two medications; (3) their knowledge of the DSC; and (4) preferences for learning about future drug safety information. Interviews were transcribed and analyzed thematically. RESULTS Patients cited their physicians, pharmacy inserts, and the Internet as sources of drug safety information. Physicians often referred to medical journals and online medical sources. Most patients reported being aware of information contained in the DSC summaries they were read. Almost all patients and physicians reported discussing side effects during patient-provider conversations, but almost no patients mentioned that physicians had communicated with them key messaging from the DSCs at issue: the risk of next-morning impairment with zolpidem and the lower recommended initial dose for women. CONCLUSIONS Some risks of medications are effectively communicated to patients and physicians; however, there is still a noticeable gap between information issued by the Food and Drug Administration and patient and physician awareness of this knowledge, as well as patients' decisions to act on this information. Disseminators of emerging drug safety information should explore ways of providing user-friendly resources to patients and healthcare professionals that can update them on new risks in a timely manner.
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13
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Amend KL, Younus M, Petronis KR, Mo J, Seeger JD, Gately R, Gu X, Enger C. Assessment of Risk Evaluation and Mitigation Strategies (REMS) for varenicline (Chantix): A multistage patient survey. Pharmacoepidemiol Drug Saf 2018; 27:253-262. [DOI: 10.1002/pds.4373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022]
Affiliation(s)
| | - Muhammad Younus
- Epidemiology, Worldwide Safety and Regulatory; Pfizer Inc.; New York NY USA
| | | | - Jingping Mo
- Epidemiology, Worldwide Safety and Regulatory; Pfizer Inc.; New York NY USA
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14
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Brandenburg NA, Bwire R, Freeman J, Houn F, Sheehan P, Zeldis JB. Effectiveness of Risk Evaluation and Mitigation Strategies (REMS) for Lenalidomide and Thalidomide: Patient Comprehension and Knowledge Retention. Drug Saf 2017; 40:333-341. [PMID: 28074423 PMCID: PMC5362654 DOI: 10.1007/s40264-016-0501-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The effectiveness of patient education activities conducted within the lenalidomide and thalidomide risk evaluation and mitigation strategies (REMS) programs was evaluated by measuring understanding of serious risk and safe-use messages. METHODS Results from mandatory knowledge, attitude, and behavior surveys and voluntary patient surveys completed between June 2012 and June 2013 were analyzed, and responses to questions relating to compliance with birth control measures and understanding of safe-use messages are presented by patient risk category. RESULTS In total, 73,645 patients were enrolled into the REMS programs for lenalidomide and thalidomide and completed mandatory surveys prior to medication dispense. Of these, 2790 (3.8%) completed an additional voluntary survey. Among voluntary survey participants, for all patient pregnancy risk categories, reported compliance with birth control requirements was above 90% when starting therapy and at follow-up. At the beginning of therapy, complete compliance was 96.3%; 3 months later it was 96.4%. Patient understanding of safe-use messages was very high in all pregnancy risk groups, notably for messages repeated at each physician visit. Overall, 98.2% of patients knew that lenalidomide and thalidomide could cause birth defects, which is part of the repeated educational messaging. In contrast, 87.1% recalled that unused product should be returned to their healthcare professional, which is not included in repeated messaging. CONCLUSION The lenalidomide and thalidomide REMS programs enhance patient understanding of safe-use messages, resulting in high levels of compliance with the birth control precautions essential to prevent fetal exposure to these known and potential human teratogens. Overall compliance was maintained after 3 months of follow-up and throughout therapy.
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Affiliation(s)
| | - Robert Bwire
- Celgene Corporation, 556 Morris Ave, Summit, NJ, 07901, USA
| | - John Freeman
- Celgene Corporation, 556 Morris Ave, Summit, NJ, 07901, USA
| | - Florence Houn
- Celgene Corporation, 556 Morris Ave, Summit, NJ, 07901, USA
| | - Paul Sheehan
- Celgene Corporation, 556 Morris Ave, Summit, NJ, 07901, USA.
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15
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Davis KH, Asiimwe A, Zografos LJ, McSorley DJ, Andrews EB. Evaluation of Risk-Minimization Activities for Cyproterone Acetate 2 mg/Ethinylestradiol 35 µg: A Cross-Sectional Physician Survey. Pharmaceut Med 2017; 31:339-351. [PMID: 29056853 PMCID: PMC5629244 DOI: 10.1007/s40290-017-0203-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Cyproterone acetate 2 mg/ethinylestradiol 35 µg, an estrogen/progestogen treatment with anti-androgenic properties, shares a thromboembolism risk with combined hormonal contraceptives. Educational materials (i.e., direct healthcare professional communication, patient information card, prescriber checklist) were distributed to physicians to increase risk awareness. Objective The objective of this study was to measure physician knowledge of thromboembolism risk of cyproterone acetate 2 mg/ethinylestradiol 35 µg and ascertain whether physicians received the educational materials. Methods A cross-sectional web-based physician survey of recent prescribers of cyproterone acetate 2 mg/ethinylestradiol 35 µg in Austria, the Czech Republic, France, the Netherlands, and Spain was conducted. Sampling targets for physician specialty were based on country-specific prescribing patterns. Frequency of correct responses was calculated for 14 knowledge questions. Results Among 759 physician respondents (37% of obstetricians/gynecologists, 42% of general practitioners, 20% of dermatologists), 51% received one or more of three educational materials. Knowledge was highest (≥80%) for symptoms of possible deep vein thrombosis, pulmonary embolism, and cerebrovascular accident; most important risk factors for thrombosis; use in smokers; indication for moderate-to-severe acne; and understanding that cyproterone acetate 2 mg/ethinylestradiol 35 µg should not be used for contraception alone. Knowledge varied for contraindications, myocardial infarction symptoms, other risk factors for thrombosis, instructions regarding anticipated prolonged immobilization, and selected concomitant medical conditions. Knowledge was lower regarding prescribing cyproterone acetate 2 mg/ethinylestradiol 35 µg for acne only after failure of topical therapy or systemic antibiotics. Generally, knowledge did not vary by physician specialty, receipt of educational materials, number of patients prescribed cyproterone acetate 2 mg/ethinylestradiol 35 µg in the previous 3 months, and years in practice. Conclusions Knowledge was generally high for thromboembolism risk and varied for more complex or infrequent topics. Electronic supplementary material The online version of this article (doi:10.1007/s40290-017-0203-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kimberly H. Davis
- Surveys and Observational Studies, RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709-2194 USA
| | - Alex Asiimwe
- Epidemiology, Bayer AG, Muellerstrasse 178, Building S157, 04, 409, Berlin, Germany
| | - Laurie J. Zografos
- Surveys and Observational Studies, RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709-2194 USA
| | - David J. McSorley
- Biostatistics, RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, 27709 NC USA
| | - Elizabeth B. Andrews
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, 27709 NC USA
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16
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Blalock SJ. Medication Risk Communication in Rheumatology: Where Are We and Where Do We Go from Here? Curr Rheumatol Rep 2017; 19:7. [PMID: 28164248 DOI: 10.1007/s11926-017-0631-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper reviews findings from recent research examining issues related to the risk communication process within the context of rheumatologic conditions. Five specific questions are addressed. First, to what extent do patients with rheumatic disorders exhibit adequate knowledge relevant to disease and medication risks and risk management? Second, what sources do patients use when attempting to find information about disease and medication risks and risk management? Third, what types of information about disease and medication risks and risk management do rheumatologists provide during routine office visits. Fourth, what governmental regulations attempt to increase consumer access to information about medication risks and risk management? Finally, what other educational resources are available to facilitate patient-provider communication concerning disease and medication risks and risk management? The findings reported identify gaps in patient knowledge concerning medication risks and risk management, highlight areas for improvement, and identify resources that may enhance medication risk communication.
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Affiliation(s)
- Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7573, USA.
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17
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Chen CY, Bussing R, Hartzema AG, Shuster JJ, Segal R, Winterstein AG. Stimulant use following the publicity of cardiovascular safety and the introduction of patient medication guides. Pharmacoepidemiol Drug Saf 2015; 25:678-86. [DOI: 10.1002/pds.3894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 09/11/2015] [Accepted: 09/22/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Chih-Ying Chen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
| | - Regina Bussing
- Division of Child and Adolescent Psychiatry; University of Florida; Gainesville FL USA
- Department of Psychiatry; University of Florida; Gainesville FL USA
- Department of Pediatrics; University of Florida; Gainesville FL USA
- Department of Clinical and Health Psychology; University of Florida; Gainesville FL USA
- Department of Epidemiology and Health Policy Research; University of Florida; Gainesville FL USA
| | - Abraham G. Hartzema
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
| | - Jonathan J. Shuster
- Department of Health Outcomes and Policy, College of Medicine; University of Florida; Gainesville FL USA
- Research Design and Analysis Program; University of Florida Clinical and Translational Science Institutes; Gainesville FL USA
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, Department of Pharmacotherapy and Translational Research; University of Florida; Gainesville FL USA
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions; University of Florida; Gainesville FL USA
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
- Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions; University of Florida; Gainesville FL USA
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