Prevalence and Predictors of Self-Medication Among Ophthalmic Patients in Jordan: A Cross-Sectional Analysis

Background: When people decide to treat themselves with medication without going to a physician for a prescription, it is called self-medication (SM). This study aims to detect the prevalence rate of SM among ophthalmic patients in Jordan. Methods: This study applied a cross-sectional study design using a questionnaire tool completed by 1009 ophthalmic patients. Binary logistic regression was used to identify predictors of practicing SM. Results: The prevalence rate of participants practicing SM for ophthalmic conditions was 21.0%. The most common reason for SM was medical recommendations from a pharmacist or optician (55.7%), followed by failure to recognize the severity of the symptoms so that the patients thought they did not need a doctor to treat their eyes (34.4%). Eye symptoms included redness (69.3%), itching (61.3%), and a burning sensation (38.7%). The 24-30 age group was more likely to practice SM (p < 0.05). Other patients who had previously undergone ophthalmic surgery and were currently wearing contact lenses were less susceptible to SM practice (p < 0.05). Conclusions: Younger patients with ophthalmic conditions showed a higher probability of practicing SM. SM for eye diseases carries significant risks and requires careful consideration to avoid harmful consequences.

Observational Evidence of the Prevalence and Association of Polypharmacy and Drug Administration Errors in Hospitalized Adult Patients

Objective To describe the prevalence of polypharmacy and medication administration errors (MAEs) in adult inpatients and explore the association between polypharmacy and MAEs. Polypharmacy and MAEs are common phenomena in hospital settings. Different MAE contributing factors have been suggested by previous studies. Polypharmacy, however, is not always assessed by studies exploring medication error risk factors, and it may deserve further attention. Methods This was a descriptive observational study. The medication administration process in two adult medical wards of a tertiary hospital was recorded by two observers, with parallel review of patients' medication records. Any deviation from prescriber's order, manufacturers' administration instructions, or relevant institutional policies were recorded as errors. Chi square and regression analysis were used to explore associations between polypharmacy and MAEs. Results Six hundred sixty-five medication administrations were observed. The mean number of drugs prescribed per patient was 8.7. Most inpatients were prescribed more than 5 drugs (92.6%). Almost half of the inpatients were prescribed more than 9 drugs (45.1%) and some more than 12 drugs (22.6%). In total, 2,371 errors were detected, and the mean number of errors per administration was 3.5. When patients received more than 9 (the odds ratio is 1.57, [95%] CI 1.08-2.27; P = 0.02) or more than 12 (the odds ratio is 1.53, [95%] CI 1.04-2.30; P = 0.04) drugs, the occurrence of a higher number of errors per administration was significantly increased. Conclusion Polypharmacy is common in adult medical wards and can be associated with the occurrence of a higher number of MAEs. Future interventions aiming for the prevention of MAEs should consider addressing polypharmacy by improving prescribing practices and optimizing pharmacotherapy.

Perceptions and knowledge of nurses on incident reporting systems: Exploratory study in three Northeastern Italian Departments

Reporting of adverse clinical events (IRs) is believed to be an effective methodology for optimizing health care safety, however, only 1%-3% of incidents are reported by healthcare professionals, lack of information resulting from errors/adverse events/near misses limits the development of safety and improvement measures. This study aimed to identify barrier factors/incentives to report adverse events and find possible improvement strategies and possible correlations between the population under examination and the willingness to report through Incident Reporting. An ad hoc questionnaire was used and administered to 122 nurses belonging to three different departments of an Italian hospital. The frequency with which improvement interventions are noted following an IR report (p = 0.014) and the support received from their managers (p = 0.014) in reporting are among the factors that can have the greatest impact on the use of IR among the respondents. The no-blame policies and the attention that nursing managers place on clinical risk management can influence the culture of safety among nurses. Involving nurse managers in the dissemination of the IR can represent a possible strategy to be undertaken by corporate clinical risk managers in order to increase the culture of safety among nurses.

Omissions and Deviations From Safe Drug Administration Guidelines in 2 Medical Wards and Risk Factors: Findings From an Observational Study

OBJECTIVES

This study aimed to record the type and frequency of errors, with an emphasis on omissions, during administration of medicines to inpatients and to investigate associated factors.

METHODS

This was a descriptive observational study. The medication process in 2 medical wards was observed by 2 observers using a structured observation form. χ2 Test, Kruskal-Wallis test, and regression analysis were used to explore associations between factors and errors.

RESULTS

From the 665 administrations observed, a total of 2371 errors were detected from which 81.2% were omissions and 18.8% were errors of commission. Omissions in the infection prevention guidelines (46.6%) and in the 5 rights of medication safety principles (35.8%) were a predominant finding. In particular, omitting to hand wash before administering a drug (98.4%), omitting to disinfect the site of injection (37.7%), and omitting to confirm the patient's name (74.4%) were the 3 most frequently observed omissions. Documentation errors (13.1%) and administration method errors (4.5%) were also detected. Regression analysis has shown that the therapeutic class of the drug administered and the number of medicines taken per patient were the 2 factors with a statistical significance that increased the risk of a higher number of errors being detected.

CONCLUSIONS

Errors during drug administration are still common in clinical practice, with omissions being the most common type of error. In particular, omissions in the basic infection and safety regulations seem to be a very common problem. The risk of a higher number of errors being made is increased when a cardiovascular drug is administered and when the number of medicines administered per patient is increased.

Drug-safety reporting in Polish nursing practice-Cross sectional surveys

INTRODUCTION

Nurses play a significant role in ensuring the safety and quality of drugs. Our aim was to assess significant factors in nurses' participation in ensuring pharmacotherapy safety by reporting adverse drug reactions (ADR) and detecting substandard drugs (SD).

MATERIALS AND METHODS

The study was a cross-sectional, comparative survey, using original questionnaires. Survey questions were grouped to probe the opinions, attitudes and practices of nurses reporting ADRs and SDs. Data were obtained from nurses working in teaching hospitals in Poland (group A) and, for comparison, in the USA (group B). 1200 questionnaires were distributed in Poland (return rate: 55.7%) and 200 questionnaires in the USA (return rate: 73%). Both groups were surveyed during the same period. There were no exclusion criteria. The questionnaires were self-administered. Distribution and collection were anonymous. Participation was voluntary. The Spearman correlation test was used. Both groups' responses were cross-tabulated and compared using Fisher's Exact Test for Count Data.

RESULTS

The study group comprised 669 Polish and 146 American professionally active nurses working in general care and surgical departments. Age range: 18 to 72 years. Median job seniority: 18.3 years (group A) and 20.6 years (group B). Education levels varied. ADR reporting conditions in Poland are unfavorable: shortage of time-83.9% vs 22.6% in the US (p = 0.01); no incentive-58.2% vs 6.1% in the US (p = 0.01); and no equipment-44.7% vs 2.8% in the US (p < 0.01). Both Polish and American nurses indicate they rarely report SDs, with rates of 0.4% and 11% (p < 0.0001) respectively, during the study period.

CONCLUSIONS

Nurses in Poland are insufficiently prepared to ensure drug safety conscientiously and responsibly. Training is required for Polish nurses. Nurses' employers need to improve conditions to enable reporting of ADRs and SDs.

Patients' experiences on adverse drug reactions reporting: a qualitative study

BACKGROUND

Spontaneous reporting of adverse drug reactions (ADRs) is an important source of information for post-marketing drug safety evaluation. Most countries have public access to reporting systems, but patients report only 3% of all ADRs. Little is known about factors affecting patient reporting. Our aim was to explore patients' experiences reporting ADRs and their views on the usability of the Canadian Vigilance reporting forms on MedEffect.

METHODS

An interpretive description qualitative study was used. Adults in Canada, who experienced an ADR, were invited to participate through social media (Kijiji, Facebook, Twitter) and by associations (e.g., Patients Canada or Canadian Arthritis Society). Participants were interviewed in English and French using structured interview guides. Inductive content analysis was used.

RESULTS

Fifteen interviews were conducted from October 2014 to May 2015. Two participants reported ADRs to MedEffect, and others to physicians and/or pharmacists. Motives for reporting were intolerable side effect impacting daily activities and encouragement from others to report (e.g., family, colleagues). Factors that interfered with reporting were physicians normalized or minimized the side effect, confusion on what to report, no feedback after report submission to MedEffect, and previous experience with side effects. MedEffect forms were described as comprehensive and important, but its usability was affected by the number of questions and complexity of some questions.

CONCLUSIONS

Most participants were unaware of MedEffect and reported ADRs to physicians and pharmacists. Several barriers and motives affected patients' reporting of ADRs. MedEffect form could be simplified for use by patients.

Adverse Drug Reaction Monitoring and Reporting Among Physicians and Pharmacists in Pakistan: A Cross-sectional Study

BACKGROUND

The success of a reporting system of adverse drug reaction (ADR) depends on the knowledge, attitudes, and practices of the health care professionals. However, due to a lack of knowledge and poor contribution by healthcare workers, ADR remains underreported. To improve safety, proper identification and ADR reporting is necessary.

OBJECTIVE

This study was carried out to determine knowledge, attitude, and practices of ADR among physicians and pharmacists working in Pakistan and the factors which encourage and discourage effective reporting.

METHODS

A cross-sectional study was conducted using a pretested questionnaire. Questionnaires were distributed among 333 physicians and 34 pharmacists with a 95.5% response rate. The Statistical Package for Social Science (SPSS) was used for data analysis.

RESULTS

Pharmacists have more knowledge regarding ADR compared to physicians (47.1% vs. 13.8%, p < 0.001). Pharmacists also have a positive attitude compared to physicians (97.1% vs. 76.3%, p < 0.001). No significant difference was noticed in ADR practice by physicians and pharmacists (12.3% vs. 11.8, p = 0.92). The seriousness of ADR was the main factor that encouraged nearly all pharmacists to report, whereas among physician's, seriousness and the unusualness of reaction, the new drug involvement, and confidence in diagnosis were the factors which encouraged them to report ADR.

CONCLUSION

Overall, pharmacists had more knowledge and a positive attitude regarding ADR reporting compared to physicians, but practices of ADR reporting remained the same among both. Therefore, it is suggested that educational interventions, along with training programs, should be developed.

Knowledge, Attitude, and Barriers Toward ADRs Reporting Among Health-Care Professionals at Tertiary Care Health Settings in Peshawar, Pakistan: A Web Based Study

Background: Underreporting of adverse drug reactions (ADRs) is considered a major determinant of poor ADR signal detection in Pakistan. Considering this, the study was proposed to evaluate healthcare professionals' (HCPs) knowledge attitude toward and the barriers that discourse ADRs reporting. Methods: A cross-sectional survey was distributed among HCPs in 3 major tertiary care facilities of Peshawar. A self-administered, 31 items questionnaire was circulated online to collect the required information. Relative index ranking was used to identify the top barriers to the ADR reporting process. Results: HCPs (n = 322) were requested, and over one-third (n = 122) responded. Of the total, 97 (79.5%) were males, and by designation, 59(48.4%) were resident medical officers. About 45% of the HCPs did not identify the appropriate pharmacovigilance (PV) definition. More than half of the HCPs (52.2%) distinguished the appropriate PV purpose. Nearly 80% HCPs did not know the acceptable reporting time frame, while 22.1% HCPs knew that regulatory body for ADRs does not exist in Pakistan. The majority (95.08%) of the HCPs either strongly agreed or agreed that reporting an ADRs is a professional obligation and all the HCPs were of the opinion that PV should be taught in detail to HCPs. Exploring the barriers, it was identified that the key barriers to ADRs reporting were "unavailability of professional environment to discuss ADRs," Relative Importance Index (RII) = 0.813, "lack of incentives for reporting" (RII = 0.774), "lack of knowledge regarding reporting" (RII = 0.693), and "insufficient knowledge of pharmacotherapy in detecting ADRs" (RII = 0.662). In addition to these, "complicated reporting forms" (RII = 0.616), "lack of motivation for reporting ADRs" (RII = 0.610), and "absence of professional confidence" were seen as major hindrances in effective reporting of ADRs (RII = 0.598). Conclusion: Concerning PV and ADR reporting poor knowledge was noted. However, the majority of the HCPs showed an explicit attitude regarding ADRs reporting. The majority of the HCPs disclosed unavailability of professional environment to discuss about ADRs, lack of incentives, and how to report the main factors hindering the ADRs reporting. It is emphasized that health authorities carve out a niche for a well purposeful PV center and pledge educational activities and trainings for increasing understanding and approaches regarding reporting of ADR.

Mobile Health Applications for Prenatal Assessment and Monitoring

BACKGROUND

A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care.

METHODS

In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care.

RESULTS

Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable.

CONCLUSIONS

Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.

Medication safety knowledge, attitude, and practice among hospital pharmacists in Lebanon

BACKGROUND

Studies showed that pharmacists have little experience with adverse drug reactions (ADRs) reporting due to insufficient knowledge of the concept of ADR and pharmacovigilance (PV). There is an urge to assess hospital pharmacists' knowledge in medication safety practices.

OBJECTIVE

To evaluate the knowledge, attitude, and practice, among hospital pharmacists in Lebanon concerning ADRs and PV concepts.

METHODS

A cross-sectional study, conducted between March and July 2016, enrolled 187 hospital pharmacists in all Lebanese districts.

RESULTS

Concerning knowledge, 60.8% of the pharmacists said that ADR is an injury caused by appropriate and suboptimal care, while 74.6% of them said it can be preventable and nonpreventable. Moreover, 47.5% of them defined PV as being the study that detects, assesses, understands, and prevents adverse effects. Furthermore, 55.1% believed that PV concerns drug, herbal, medical devices, and vaccine problems. Concerning attitude, 61% of the pharmacists said they do not support direct ADR reporting by the patient. Of them, 78.6% confessed that ADR reporting is a professional obligation to them while 88.2% admitted that it is time-consuming with no outcome. When it comes to practice, 64.2% had been trained to report ADRs. Only 20.8% and 24.2% confessed reporting ADRs more than once a week, respectively. More than half (54.5%) said that they report the ADR to the patient's prescriber.

CONCLUSION

Lebanese hospital pharmacists have little knowledge about the concept and process of PV and spontaneous ADRs reporting system. However, these pharmacists have positive attitudes, but very little practice with reporting systems. Educational programs are urgently needed to emphasize the role and responsibility of pharmacists in PV practices and to raise awareness towards ADR reporting process.

Incidents reporting: barriers and strategies to promote safety culture

OBJECTIVE

The purpose was to identify the barriers of underreporting, the factors that promote motivation of health professionals to report, and strategies to enhance incidents reporting.

METHOD

Group conversations were carried out within a hospital multidisciplinary team. A mediator stimulated reflection among the subjects about the theme. Sixty-five health professionals were enrolled.

RESULTS

Complacency and ambition were barriers exceeded. Lack of responsibility about culture of reporting was the new barrier observed. There is a belief only nurses should report incidents. The strategies related to motivation reported were: feedback; educational intervention with hospital staff; and simplified tools for reporting (electronic or manual), which allow filling critical information and traceability of management risk team to improve the quality of report.

CONCLUSION

Ordinary and practical strategies should be developed to optimize incidents reporting, to make people aware about their responsibilities about the culture of reporting and to improve the risk communication and the quality of healthcare and patient safety.

Lack of Awareness of Pharmacovigilance among Young Health-care Professionals in India: An Issue Requiring Urgent Intervention

BACKGROUND

Young healthcare professionals (HCPs) are the pillar of healthcare system. The objective of the present study was to assess the knowledge, attitude, and practices of young HCPs regarding adverse drug reactions (ADRs) reporting.

METHODS

This cross-sectional questionnaire-based study was conducted on young HCPs in a tertiary care teaching hospital of North India. The study instrument was semi-structured, prevalidated questionnaire. The responses obtained were compared among doctors and nursing professionals.

RESULTS

We obtained response from 84 HCPs (61 doctors and 23 nurses). The mean age of the doctors and nurses was 25.0 ± 2.4 versus 26.3 ± 3.4 years, respectively. No significant difference was observed in questions related to definition of ADR, components of pharmacovigilance (PV), who can report ADRs and medications for which ADRs are to be reported. Only 9.8% doctors and 26.1% nurses were aware of ADR reporting system in India, of which 6 (26%) nurses and none of the doctors were aware of its name. About 16.4% doctors as compared to 61% nurses admitted to have reported an ADR (P < 0.001). The main discouraging factor in ADR reporting was time constraint while lack of knowledge was also highlighted by the HCPs. More nurses as compared to doctors (78.3% vs. 49.2%, P = 0.01) were of the opinion that holding continuing medical education/workshop could encourage reporting.

CONCLUSION

There is an urgent need to increase awareness about PV among young HCPs, and adequate interventions should be instituted to encourage PV practices.

Knowledge of Adverse Drug Reaction Reporting Among Healthcare Professionals in Bhutan: A Cross-Sectional Survey

INTRODUCTION

The Bhutan National Pharmacovigilance Centre (NPC) became an official member of the WHO Programme for International Drug Monitoring in December 2014; however, the number of adverse drug reactions (ADRs) reported is very low (50 reports per 773,722 inhabitants over 10 years). Surveys of healthcare professionals (HCPs) in similar countries have indicated that adequate knowledge of both ADRs and ADR reporting is likely to increase the number of ADR reports submitted.

OBJECTIVE

The aim of this study was to investigate the level of knowledge of both ADRs and ADR reporting among HCPs, including traditional medicine practitioners.

METHODS

A cross-sectional survey was conducted, using a validated self-administered questionnaire. The questionnaires were distributed to 670 HCPs, including clinical doctors, nurses, pharmacists and traditional medicine practitioners from four referral hospitals. The survey consisted of 12 questions pertaining to ADRs and 10 questions pertaining to knowledge of ADR reporting. The collected response was then analysed descriptively and results presented as mean ± standard deviation (SD) using SPSS version 20.

RESULTS

The overall response rate was 434 (65 %) questionnaires, with HCPs consisting of clinical doctors (94, 22 %), nurses (257, 59 %), pharmacists (52, 12 %) and traditional medicine practitioners (31, 7 %). The overall mean ± SD score with regard to the level of knowledge of ADRs was 6.52 ± 2.81 out of a maximum score of 12, among which clinical doctors scored 7.48 ± 2.95, nurses 6.15 ± 2.47, pharmacists 8.15 ± 2.49 and traditional medicine practitioners 4.13 ± 3.18. The mean ± SD score with regard to the level of knowledge of ADR reporting among HCPs was 3.94 ± 1.89 out of a maximum score of 10, among which clinical doctors scored 3.93 ± 1.81, nurses 3.75 ± 1.74, pharmacists 5.00 ± 1.81 and traditional medicine practitioners 4.00 ± 1.77.

CONCLUSION

Clinical doctors and pharmacists have better knowledge of ADRs than nurses and traditional medicine practitioners, while knowledge of ADR reporting was low for all HCPs surveyed.

Adverse drug reaction reporting among physicians working in private and government hospitals in Kuwait

Introduction

To improve patient safety and care, the identification and reporting of adverse drug reactions (ADRs) should be systematic and mandatory for all healthcare professionals (HCPs). Physicians remain the main HCPs with direct patient care whose role in ADRs reporting should not be ignored.

Objective

To document the awareness and attitude of physicians working in private and government hospitals in Kuwait with regard to pharmacovigilance (PV) and ADR reporting and to identify their practices of reporting ADRs.

Material and methods

A cross-sectional study was conducted using a paper-based 25-item questionnaire. The Statistical Package for Social Science (SPSS) was used for data analysis.

Results

A total of 1017 questionnaires were distributed to the eligible physicians in the government and private hospitals, giving a response rate of 84.2% and 83.0%, respectively (an overall response rate of 83.8%). Private physicians exhibited a better knowledge profile with regards to the purpose of PV (75.2% vs 64.8%; p = 0.002) and the correct ADR definition (75.8% vs 65.3%; p = 0.001). The majority of physicians showed good attitude towards reporting ADRs, nevertheless, private physicians had a significantly stronger belief that reporting ADRs is a professional obligation (93.4% vs 85.5%; p = 0.001). Three quarters of the study population (74.6%) had identified an ADR during their daily practice, however, only a small proportion (34.2%) confirms having ever reported ADRs. Regardless, significantly more private physicians had done so (42.4% vs 29.6%; p < 0.001). ADR reporting was significantly higher in physicians who knew the correct ADRs to be reported (adjusted OR = 1.86, p = 0.036), and those who were aware of any center or ADR reporting system in Kuwait (adjusted OR = 2.88, p = 0.020).

Conclusions

A national PV center empowered by clear legislation on “how” and “what” to report should improve physicians’ reporting practices and hence is required in the country. This should be combined with constant training and education in this regard.

Knowledge, attitude and practices of pharmacovigilance and adverse drug reaction reporting among pharmacists working in secondary and tertiary governmental hospitals in Kuwait

Introduction: Pharmacovigilance (PV) is essential to detect and prevent adverse drug reactions (ADR) after a drug is marketed. However, ADRs are significantly underreported worldwide. Objective: The aims of this study were to document the knowledge, attitude and practices (KAP) of pharmacists toward PV and ADR reporting and to explore the barriers to implementing a fully functional PV program in Kuwait. Material and methods: Pharmacists working at governmental hospitals were asked to complete a paper-based 25-item questionnaire. Results: A total of 414 pharmacists received the questionnaire and 342 agreed to participate, giving a response rate of 82.6%. Most pharmacists were knowledgeable about the concepts of PV (61.5%) and ADRs (72.6%) and the majority (88.6%) was willing to implement ADR reporting in their clinical practice. Despite this positive attitude, only 26.8% of participants had previously reported an ADR and the main reason for underreporting was stated as not knowing how to report (68.9%). Barriers that hinder the implementation of a PV center included lack of cooperation and communication by healthcare professionals and patients (n = 62), lack of time and proper management (n = 57), lack of awareness of staff and patients (n = 48) and no qualified person to report ADRs (n = 35). Conclusions: Overall this study shows that hospital pharmacists in Kuwait had good knowledge and positive attitude toward PV and ADRs reporting. However, the majority of them have never reported ADRs. These results suggest that targeted educational interventions and a well-defined policy for ADR reporting may help increase ADR reporting and support the implementation of a fully functional independent PV center in Kuwait.

Factors Associated With the Management of Adverse Drug Reactions Among Community Pharmacists in South Korea

OBJECTIVES

Community pharmacists dispensed 68.4% of all drugs used in Korea, but reported only 2.0% of adverse drug reactions (ADRs) in 2011. This study compared community pharmacists' understanding of the importance of ADR management and their actual practice of it, and identified relevant factors related to their management of ADR.

METHODS

With the use of a modified health belief model (HBM), 800 community pharmacists were surveyed via social network service messaging. A total of 200 usable responses were obtained for an effective response rate of 25.0%. Descriptive analysis was used to quantify the differences between community pharmacists' understanding of the importance of ADR prevention and their practice. A hierarchical regression was performed with the following predictors: (1) demographic factors, (2) social impact of ADR prevention, (3) importance of social support, and (4) cognition about the importance of ADR prevention.

RESULTS

Although community pharmacists clearly recognized the importance of ADR management, their performance was very low. The disparity between cognition and performance was more pronounced for ADR reporting than for patient counseling. Social support was the most powerful predictor of ADR prevention practice, explaining 18.5% of the variance in ADR prevention practice. Social impact of ADR prevention, demographic factors, and cognition about the importance of ADR prevention explained 12.6%, 6.2%, and 1.8% of the variance, respectively.

CONCLUSIONS

Strengthening community pharmacists' performance of population-based ADR management should be prioritized over patient-oriented ADR management. To improve public health, community pharmacists should make an effort at ADR reporting. This can be done with appropriate government support, such as incentives to community pharmacists, public awareness campaigns, education, and establishment of feedback systems.

[Causes for the underreporting of adverse drug events by health professionals: a systematic review]

OBJECTIVE

Identifying the main causes for underreporting of Adverse Drug Reaction (ADR) by health professionals.

METHOD

A systematic review carried out in the following databases: LILACS, PAHO, SciELO, EMBASE and PubMed in the period between 1992 and 2012. Descriptors were used in the search for articles, and the identified causes of underreporting were analyzed according to the classification of Inman.

RESULTS

In total, were identified 149 articles, among which 29 were selected. Most studies were carried out in hospitals (24/29) for physicians (22/29), and pharmacists (10/29). The main causes related to underreporting were ignorance (24/29), insecurity (24/29) and indifference (23/29).

CONCLUSION

The data show the eighth sin in underreporting, which is the lack of training in pharmacovigilance. Therefore, continuing education can increase adherence of professionals to the service and improve knowledge and communication of risks due to drug use.

Comparison of knowledge, attitude and practices of resident doctors and nurses on adverse drug reaction monitoring and reporting in a tertiary care hospital

Background:

Lack of knowledge of pharmacovigilance (PhV) and adverse event (AE) reporting culture among the healthcare providers have been identified as major factors for under reporting of AE in developing countries. Hence, this study was planned to assess and compare the knowledge, attitude, and practices (KAP) of resident doctors and nurses about PhV and AE reporting.

Material and Methods:

This cross-sectional, questionnaire-based study was conducted to compare KAP of 100 doctors and 100 nurses on PhV and AE reporting.

Results:

All the respondents felt that AE reporting is necessary and two-thirds were aware of the existing PhV Program of India. Significantly, higher proportion of doctors had correct understanding regarding PhV (P<0.05) and knew what should be reported (P<0.05) but nurses (75%) knew better about where to report (P<0.001). Significantly (P<0.001), more doctors (98%) felt that the patients are benefited by reporting AE. Nurses (96%) felt the need for information on drugs causing AE and their management strategy (P<0.001). Around 60% of all the respondents were in favor of mandatory PhV and feedback on the submitted AE. Doctors (67%) (P<0.05) had a practice of inquiring patients for any untoward outcome of therapy. Higher proportion (P<0.05) of nurses (55%) mentioned that observed AE are recorded in patient's case record, but random screening of 1000 patients’ record did not reveal it. Nurses mentioned that they never reported any AE (P<0.05) and witnessed discussions on ADRs during the ward rounds (P<0.001). All the respondents preferred phone as the convenient method for reporting AE followed by drop box kept in the ward/OPD and felt the need of frequent workshops and continuing medical education.

Conclusion:

Resident doctors and nurses had good knowledge and awareness on AE reporting and PhV but their practices need to be improved.

Healthcare professionals' self-reported experiences and preferences related to direct healthcare professional communications: a survey conducted in the Netherlands

BACKGROUND

In Europe, Direct Healthcare Professional Communications (DHPCs) are important tools to inform healthcare professionals of serious, new drug safety issues. However, this tool has not always been successful in effectively communicating the desired actions to healthcare professionals.

OBJECTIVE

The aim of this study was to explore healthcare providers' experiences and their preferences for improvement of risk communication, comparing views of general practitioners (GPs), internists, community pharmacists and hospital pharmacists.

METHODS

A questionnaire was developed and pilot tested to assess experiences and preferences of Dutch healthcare professionals with DHPCs. The questionnaire and two reminders were sent to a random sample of 3488 GPs, internists and community and hospital pharmacists in the Netherlands. Descriptive statistics were used to describe demographic characteristics of the respondents. Chi squares, ANOVAs and the Wilcoxon signed rank test were used, when appropriate, to compare healthcare professional groups.

RESULTS

The overall response rate was 34% (N = 1141, ranging from 24% for internists to 46% for community pharmacists). Healthcare providers trusted safety information more when provided by the Dutch Medicines Evaluation Board (MEB) than by the pharmaceutical industry. This was more the case for GPs than for the other healthcare professionals. Respondents preferred safety information to be issued by the MEB, the Dutch Pharmacovigilance Center or their own professional associations. The preferred alternative channels of drug safety information were e-mail, medical journals and electronic prescribing systems.

CONCLUSIONS

Safety information of drugs does not always reach healthcare professionals through DHPCs. To improve current risk communication of drug safety issues, alternative and/or additional methods of risk communication should be developed using electronic methods and medical journals. Moreover, (additional) risk communication coming from an independent source such as the MEB should be considered. Special effort is needed to reach GPs.

[Clinical pharmacy and pharmacovigilance over a period of nine years in hospital]

INTRODUCTION

Underreporting is the main limit in any pharmacovigilance system relying on spontaneous notification. Available data emphasize that pharmacists report few adverse drug reactions (ADRs) in France.

OBJECTIVE

To report how the integration of pharmacists in health care units contributes to reporting of ADRs and to study the validity of the reports.

METHOD

Over a period of nine years we have prospectively collected and analyzed all ADRs collected by pharmacists in a university hospital setting and notified to the regional center of pharmacovigilance.

RESULTS

Over the study period 2017 notifications were sent. Over the past four years the annual number of reports varied between 250 and 350. This amount is approximately ten times the number referred by physicians during the year preceding the beginning of this work. Only 8.6% of the submitted notifications were rejected by the pharmacovigilance center for various reasons: no causal link between the adverse event and taking medication, problem of timing, lack of data...

CONCLUSION

The integration of the adverse reaction reporting in the daily activities of the pharmacist is a mean to increase very significantly the number of reports (factor of increase of 9.6 to 13.4).

Pharmacovigilance teaching in UK undergraduate pharmacy programmes

PURPOSE

Pharmacists in the UK are able to report spontaneous adverse drug reactions (ADRs) to the Medicines and Healthcare Products Regulatory Authority. The level of reporting by UK pharmacists remains low. This could be explained by poor knowledge of ADR reporting. The primary objective of this study was to investigate the level of pharmacovigilance education provided to pharmacy students on undergraduate pharmacy programmes in the UK.

METHODS

A cross-sectional survey was used to obtain data relating to the teaching of pharmacovigilance within schools of pharmacy. The survey was designed to reveal whether core elements pertinent to pharmacovigilance and specifically to spontaneous reporting were taught and to what extent.

RESULTS

All of the respondents taught pharmacovigilance within an assessed compulsory module. A small number (23%) did not include pharmacovigilance law within their syllabus. In 54%, the amount of time devoted to teaching pharmacy students about their role in pharmacovigilance was less than 4 h in the 4-year course; only one respondent spent approximately 20 h, the remaining respondents (38%) spent between 4 and 8 h.

CONCLUSIONS

The amount of time dedicated to the teaching of pharmacovigilance on pharmacy undergraduate degree programmes is low. Considering the importance of spontaneous reporting in drug safety and the shift in the role of the pharmacists, more time may need to be devoted to pharmacovigilance on pharmacy undergraduate courses. By doing so, new pharmacists would be more informed of the important role they play in drug safety and thereby potentially help enhance the level of ADR reporting.

Public pharmacovigilance communication: a process calling for evidence-based, objective-driven strategies

As a contribution to the debate on how best to communicate information on the effective and safe use of medicines to patients, healthcare professionals and the general public, this article proposes to distinguish between communication and transparency purposes, and to test a strategic health communication approach. Any organization aiming to improve medicines use could adapt this approach to its remits and legal obligations. The approach includes agreeing measurable communication objectives through shared problem ownership of all concerned parties, evidence-based design and a cyclic process for planning, implementation and evaluation of communication as a public health intervention. The evidence base, which supplements risk assessment for product- and situation-specific communication on safety concerns, would be derived from research into drug utilization, medical decision making and risk perception, as well as from the participation of patients and healthcare professionals. It is crucial to address the practical questions and concerns of medicine users and to find out why unfavourable patterns of medicine use persist, in order to develop behaviour change models for overcoming these obstacles. For this purpose, appropriate models for facilitating the participation of medicine users in the risk management process will need to be explored. Such two-way communication would inform risk assessment as well as the analysis of risk minimization options, allow for agreement upon communication objectives and enable understandable, attractive communication materials to be designed. The communication programme should use mixed media and repetition of messages for long-term success. This would require cooperation within healthcare and medical information systems. An evaluation of the effectiveness of the communication should support the sustainability of the programme and provide lessons for the future. Given its mission, the pharmacovigilance community has the standing and duty to expand its scale of action and take the initiative in advancing risk management through a scientific approach to improving public communication for the safety of patients.

Pharmacy student driven detection of adverse drug reactions in the community pharmacy setting

PURPOSE

Post-marketing safety studies of adverse drug reactions (ADRs) form an important part of pharmacovigilance. Countries having a formal pharmacovigilance system to a large extent rely on voluntary ADR reporting from health professionals through spontaneous report systems. The contribution of pharmacists in ADR reporting, although varies significantly among countries. Pharmacists in community pharmacies are in a unique position for detection of experienced ADRs by the drug users. The study reports from a study on community pharmacy internship students' proactive role in ADR detection through direct encountering and questioning with drug users.

METHOD

Pharmacy students undertaking internship in a community pharmacy were approached. Thirteen students from nine community pharmacies participated in the project as data collectors. Prior to the study students attended an educational seminar focusing on ADR detection and reporting in general. Ibuprofen was chosen as the drug of study. Pharmacy students approached recurrent drug users purchasing the drug. Participating users were asked about experienced ADRs linked to ibuprofen use. Reported ADRs were collected and analysed.

RESULTS

Hundred and twenty eight ibuprofen users participated in the study out of who thirty three reported forty five ADRs possibly linked to ibuprofen use. The reported ADRs followed earlier reported patterns of distribution with gastric pain showing up as the most commonly reported symptom followed by heartburn, nausea, diarrhoea and constipation.

CONCLUSIONS

Through adequate training community pharmacy internship students get competencies and are capable of detecting and reporting ADRs through direct questions to drug users.

Single-center experience with drug-induced liver injury from India: causes, outcome, prognosis, and predictors of mortality

OBJECTIVES

Although drug-induced liver injury (DILI) is rare, it may result in significant morbidity or death. The causes and outcome vary according to regions, with acetaminophen and complementary medicines common in the West and the Far East, respectively. This study evaluates the causes, outcomes, predictors, and models for 90-day mortality from DILI from India.

METHODS

Consecutive patients with DILI from 1997 to 2008 based on International Consensus Criteria from a medical college hospital setting were studied.

RESULTS

Of the 313 patients, 58% were males. Leading causes were a combination of four anti-tuberculous drugs (ATDs) (58%), anti-epileptics (11%), olanzapine (5.4%), and dapsone (5.4%). The overall 90-day mortality of 17.3% was significantly higher for ATD hepatitis (21.5%) vs. those without (11.4%) (P=0.02). The highest mortality was for leflunomide (75%). Seventy-eight percent of patients received more than one drug. Fulminant hepatic failure developed more commonly in females than in males (23% vs. 17%). Of the 66% of cases with jaundice and/or icterus, mortality was 26%. Multivariable models for mortality using a combination of encephalopathy, ascites, and bilirubin, or a combination of albumin, prothrombin time, and white blood cell count yielded a C-statistic of at least 0.86 by recursive partitioning and 0.92 by logistic regression. Model for end stage liver disease (MELD) scores of 38 and 46 yield probabilities of death of 0.90 (confidence interval (CI): 0.71-0.97) and 0.99 (CI: 0.90-1.00), respectively.

CONCLUSIONS

DILI results in significant overall mortality (17.3%). ATDs, anti-convulsants, sulphonamides, and olanzapine are the leading causes of DILI. Although common in males, more females developed fulminant hepatic failure. High-MELD score or a combination of ascites, encephalopathy, high bilirubin, prothrombin time, and leukocyte count are predictive of mortality.

Assessment of herbal medicinal products: challenges, and opportunities to increase the knowledge base for safety assessment

Although herbal medicinal products (HMP) have been perceived by the public as relatively low risk, there has been more recognition of the potential risks associated with this type of product as the use of HMPs increases. Potential harm can occur via inherent toxicity of herbs, as well as from contamination, adulteration, plant misidentification, and interactions with other herbal products or pharmaceutical drugs. Regulatory safety assessment for HMPs relies on both the assessment of cases of adverse reactions and the review of published toxicity information. However, the conduct of such an integrated investigation has many challenges in terms of the quantity and quality of information. Adverse reactions are under-reported, product quality may be less than ideal, herbs have a complex composition and there is lack of information on the toxicity of medicinal herbs or their constituents. Nevertheless, opportunities exist to capitalise on newer information to increase the current body of scientific evidence. Novel sources of information are reviewed, such as the use of poison control data to augment adverse reaction information from national pharmacovigilance databases, and the use of more recent toxicological assessment techniques such as predictive toxicology and omics. The integration of all available information can reduce the uncertainty in decision making with respect to herbal medicinal products. The example of Aristolochia and aristolochic acids is used to highlight the challenges related to safety assessment, and the opportunities that exist to more accurately elucidate the toxicity of herbal medicines.