An educational intervention's effect on healthcare professionals' attitudes towards pharmacovigilance

Educational interventions in pharmacovigilance to improve the knowledge, attitude and the report of adverse drug reactions in healthcare professionals: Systematic Review and Meta-analysis

OBJECTIVES

Underreporting of adverse drug reactions (ADRs) limits and delays the detection of signs. The aim of this systematic review with meta-analyses was to synthesize the evidence of educational interventions (EIs) efficacy in health professionals to increase ADR reporting, attitudes, and knowledge of pharmacovigilance.

EVIDENCE ACQUISITION

A systematic literature review was carried out to identify randomized clinical trials evaluating the efficacy of EI in pharmacovigilance in health professionals to improve ADR reports, knowledge, and attitude toward pharmacovigilance. ADR reports were pooled by calculating Odds Ratio (OR) with a 95% confidence interval (95%CI), while pharmacovigilance knowledge and attitude were pooled by calculating a mean difference (MD) with 95%CI. In addition, the subanalysis was performed by EI type. Meta-analysis was performed with RevMan 5.4 software. PROSPERO registry CRD42021254270.

RESULTS

Eight hundred seventy-five articles were identified as potentially relevant, and 11 were included in the systematic review. Metanalysis showed that EI increased ADR reporting in comparison with control group (OR = 4.74, [95%CI, 2.46 to 9.12], I2 = 93%, 5 studies). In subgroup analysis, the workshops (OR = 6.26, [95%CI, 4.03 to 9.73], I2 = 57%, 3 studies) increased ADR reporting more than telephone-based interventions (OR = 2.59, [95%CI, 0.77 to 8.73], I2 = 29%, 2 studies) or combined interventions (OR = 5.14, [95%CI, 0.97 to 27.26], I2 = 93%, 3 studies). No difference was observed in pharmacovigilance knowledge. However, the subanalysis revealed that workshops increase pharmacovigilance knowledge (SMD = 1.85 [95%CI, 1.44 to 2.27], 1 study). Only one study evaluated ADR reporting attitude among participants and showed a positive effect after the intervention.

CONCLUSION

EI improves ADR reports and increases pharmacovigilance knowledge. Workshops are the most effective EI to increase ADR reporting.

The impact of educational interventional session on healthcare providers knowledge about pharmacovigilance at a tertiary Jordanian teaching hospital

OBJECTIVE

A limited number of educational interventions among health care providers and students have been made in Jordan concerning the pharmacovigilance. Therefore, the main aim of this study was to evaluate how an educational workshop affected the understanding of and attitudes toward pharmacovigilance among healthcare students and professionals in a Jordanian institution.

METHODS

A questionnaire was used before and after an educational event to evaluate the pre- and post-knowledge and perception of pharmacovigilance and reporting of adverse drug reactions (ADRs) among a variety of students and healthcare professionals at Jordan University Hospital.

RESULTS

The educational workshop was attended by 85 of the 120 invited healthcare professionals and students (a response rate of 70.8%). The majority of respondents were capable of defining ADRs (n = 78, 91.8%) and pharmacovigilance accurately (n = 74, 87.1%) in terms of their prior understanding of the topic. Around 54.1% of the participants (n = 46) knew the definition of type A ADRs while 48.2% of them (n = 41) knew the definition of type B ADRs. Additionally, around 72% of the participants' believed that only serious and unexpected ADRs should be reported (n = 61, 71.8%), also, 43.5% of them (n = 37) believed that ADRs should not be reported until the specific medication that caused it is known. The majority of them (n = 73, 85.9%) agreed that reporting of ADRs was their responsibility. The interventional educational session has significantly and positively impacted participants' perceptions (p value ≤ 0.05). The most reason for not reporting ADRs as stated by the study participants was the lack of information provided by patients (n = 52, 61.2%) and the lack of enough time to report (n = 10, 11.8%).

CONCLUSION

Participants' perspectives have been greatly and favorably impacted by the interventional educational session. Thus, ongoing efforts and suitable training programs are required to assess the effect of bettering knowledge and perception on the practice of ADRs reporting.

Bibliometric analysis of adverse drug reactions and pharmacovigilance research activities in Nepal

Background:

Bibliometric analyses have been used previously to study the measures of quality and impact of research performed in several health-related areas such as adverse drug reactions (ADRs) and pharmacovigilance (PV), etc. This method can assess the research performance of publications quantitatively and statistically. There is no evidence of bibilometric studies analyzing ADRs and PV from Nepal. Therefore, the present study aimed to assess scientific output on ADRs and PV-related research activities in Nepal using a bibliometric analysis of publications from 2004 January to December 2018, that is, 15 years.

Methods:

A systematic search was conducted in PubMed, Web of Science, Google Scholar, Scopus and Nepal Journal Online (NepJOL) databases. ‘Adverse Drug Reactions‘ or ‘ADRs‘ or ‘ADR‘ or ‘Adverse drug reaction‘ or ‘AE‘ or ‘Adverse Event‘ or ‘Drug-Induced Reaction‘ or ‘Pharmacovigilance‘ or ‘PV‘ and ‘Nepal‘. The search covered 15 years (January 2004 to December 2018) of study on ADRs and PV in Nepal. Only articles retrieved from databases were included, whereas published/unpublished drug bulletins, pharmacy newsletters and thesis were excluded. The articles thus retrieved were recorded, and thereafter analyzed. Word count code was used for the analysis of keywords used in the retrieved articles.

Results:

A total of 124 articles were retrieved, with the highest rate of publications in 2006 and 2007, with 16 papers each. Among the articles, 10 (8.1%) were published in Kathmandu University Medical Journal (KUMJ). Single papers were published in 38 different journals. Brief reports (1.6%), case reports (31.2%), case series (0.8%), education forums (0.8%), letters to the editor (5.6%), original research articles (41.9%), review articles (9.7%), short communications and short reports (8.1%) on ADRs and PV were recorded. Out of 124 papers, 52 (41.9%) were original research publications. The majority (74.1%) of research was done in the category of ADR incidence, types, prevention, and management, followed by policy and suggestions for strengthening national and regional pharmacovigilance centers of Nepal (14.5%).

Conclusions:

During the study years, there was an increase in scientific publications on drug safety. A total of 124 published articles were found during bibliometric analysis of ADRs and PV research activities in Nepal.

Impact of an educational intervention on pharmacovigilance knowledge and attitudes among health professionals in a Nepal cancer hospital

BACKGROUND

Pharmacovigilance (PV) knowledge and attitudes among health care professionals (HCPs) directly affect the practice of PV and reporting of adverse drug reactions (ADRs) in a hospital. The main aim of the study was to assess the impact of an education intervention on the knowledge and attitude of HCPs attached to the regional PV center in an oncology based hospital of Nepal.

METHODS

A pre-post intervention questionnaire-based study was conducted amongst HCPs, i.e. nurses and pharmacists of an oncology based hospital of Nepal. A 21-item pretested PV questionnaire (twelve and four statements for assessing knowledge and attitude respectively) was used before and after an educational intervention among 89 HCPs working in the hospital. SPSS version 21.0 was used to analyze pre- and post-survey data with descriptive and inferential statistics. The knowledge and attitude scores before and after educational intervention were analyzed with Wilcoxon rank-sum test.

RESULTS

After the educational intervention, the mean score for knowledge about PV and ADR increased from [mean ± S.D] 6.90 ± 2.527 (pre-test) to 11.36 ± 1.189 (post-test, p < 0.001). There were significant improvements after an educational intervention in attitude from 1.80 ± 0.932 (pre-test) to 3.61 ± 0.556 (post-test, p < 0.001). Twenty-one (23.6%) of participants responded that they lacked the time to report ADR, while 12 (13.5%) replied that there was no remuneration for reporting ADR. Approximately 24% of them recommended frequent pharmacovigilance awareness programs via continuing medical education or other similar kinds of workshops for improvement of pharmacovigilance.

CONCLUSION

The preliminary findings of this study showed that knowledge and attitude scores were increased following an educational intervention. They also suggested that training on PV and ADR tends to have a positive impact on knowledge and attitude among nurses and pharmacists working at an oncology based hospital in Nepal.

Herbal pharmacovigilance in Nepal: challenges and recommendations

Traditional herbal medicine is widely used globally. Despite its extensive use, there are no proper regulations on standardization and use of herbal medicinal products. Nepal has a rich biodiversity and demography comprising of different socio-ethnic groups. Herbal medicines are utilized prominently in Nepalese communities. These herbal products may cause side effects and adverse effects, such as nephrotoxicity, neurotoxicity with the heavy metal toxicity associated with their powdered dosage forms. The side effects of using herbal products have been documented, such as bleeding with use of Ginkgo biloba and increase in blood pressure with use of Ephedra. Regulation of herbal products is essential to promote their optimal and rational use. Standard tools are available for assessing adverse effects of herbal products from health authorities, like the World Health Organization. In Nepal, self-medication practice using traditional herbal medicines is common and includes the concomitant use of allopathic. There is no focal point to address the regulatory issues on herbal products currently in Nepal. The Department of Drug Administration in Nepal is nominated as a national pharmacovigilance center and there are no reports on adverse events from the use of herbal medicines so far. However, not having any reports does not ensure the absolute safety and effectiveness of herbal products, so vigilance is warranted. Herbal pharmacovigilance is needed for Nepal to ensure safe and effective use of herbal medicines as the current pharmacovigilance ecosystem does not capture those cases. In the Nepalese context, the absence of reporting mechanisms may have underreported adverse cases of herbal products. The present opinion article aims to discuss the use of herbal products in Nepal, the challenges associated with the adverse reaction due to herbal medicines, and recommendations to overcome these challenges

Educational intervention to improve the knowledge, attitude and practice of healthcare professionals regarding pharmacovigilance in South-South Nigeria

Background

Our aim in this study was to evaluate the effect of a combined educational intervention and year-long monthly text message reinforcements via the Short Messaging System (SMS) on the knowledge, attitude and practice (KAP) of healthcare professionals (HCPs) towards pharmacovigilance.

Methods

Six randomly selected teaching hospitals in the South-South zone of Nigeria were randomized in 1:1 ratio into intervention and control groups. The educational intervention consisted of delivering a seminar followed by sending monthly texts message reinforcements via SMS over 12 months. Then a semi-structured questionnaire regarding the KAP of pharmacovigilance was completed by HCPs working in the hospitals after the intervention. Data was analysed descriptively and inferentially.

Results

A total of 931 HCPs participated in the post intervention study (596 in the intervention and 335 in the control). The M:F ratio was 1:1.5. According to the KAP questionnaire, a significant difference was observed between the intervention and control groups, regarding knowledge of the types of adverse drug reactions (ADRs). ADR resulting from pharmacological action of the drug (85.6% versus 77%, p = 0.001), the fact that ADRs can persist for a long time; (60.1% versus 53.4%, p = 0.024) and a higher awareness of the ADR reporting form (48.7% versus 18.8%, p < 0.001). Most respondents in the intervention group (68.5% versus 60.6%, p = 0.001) believed they should report ADRs even if they were unsure an ADR has occurred, a greater proportion of HCPs from the intervention group had significantly observed an ADR (82% versus 73.4%, p = 0.001). Furthermore, of the 188 who had ever reported an ADR, 41% from the intervention group used the national ADR reporting form compared with 19.8% from the controls (p < 0.001).

Conclusion

This educational intervention and the use of SMS as a reinforcement tool appeared to have positively impacted on the knowledge and practice of pharmacovigilance in South-South Nigeria with a less-than-impressive change in attitude. Continuous medical education may be required to effect long-lasting changes.

Effect of educational intervention on healthcare providers knowledge and perception towards pharmacovigilance: A tertiary teaching hospital experience

Objective

Based on the theory on planned behavior, perception or attitude is found to be a well-established predictor of healthcare providers' intentions to perform different behaviors. Also, improving knowledge was proposed to affect their practice as well. In Jordan, many studies have been conducted to evaluate healthcare providers' knowledge and perception towards pharmacovigilance but no intervention or training was provided. Thus, the aim of this study was to evaluate the impact of an educational workshop on the knowledge and perception of healthcare providers towards pharmacovigilance in a Jordanian tertiary teaching hospital.

Methods

An interventional study conducted in Jordan University Hospital on various healthcare providers to assess their pre- and post-knowledge and perception towards pharmacovigilance and adverse drug reactions (ADRs) reporting via questionnaire before and after an educational workshop.

Results

Among the 200 invited healthcare providers, 150 attended the educational workshop (response rate 75.0%). Pre-workshop, healthcare providers showed an overall low knowledge score (7.8/19), where only 8.7% could define pharmacovigilance correctly. On the other hand, they showed a favorable perception score (33.6/39).Following educational workshop, knowledge scores significantly improved by 67.9% (P-value <0.05). A similar finding was obtained for perception scores, where perception scores significantly improved by 10.1% following workshop (P-value <0.05).

Conclusion

Continuous efforts are needed to implement different strategies including education modules and the provision of appropriate training programs to increase awareness and improve perception towards pharmacovigilance among healthcare providers. Future study is needed to evaluate the impact of improving knowledge and perception on ADRs reporting practice.

Effect of an educational intervention on knowledge and attitude regarding pharmacovigilance and consumer pharmacovigilance among community pharmacists in Lalitpur district, Nepal

BACKGROUND

Pharmacovigilance activities are in a developing stage in Nepal. ADR reporting is mainly confined to healthcare professionals working in institutions recognized as regional pharmacovigilance centers. Community pharmacists could play an important role in pharmacovigilance. This study was conducted among community pharmacists in Lalitpur district to examine their knowledge and attitude about pharmacovigilance before and after an educational intervention.

METHODS

Knowledge and attitude was studied before, immediately after and 6 weeks following the intervention among 75 community pharmacists. Responses were analysed using descriptive and inferential statistics. A pretested questionnaire having twelve and nine statements for assessing knowledge and attitude were used. The overall scores were obtained by adding the 'knowledge' and 'attitude' scores and 'overall' scores were summarized using median and interquartile range. Wilcoxon signed-rank test for repeated samples was used to compare the differences between knowledge and attitude of the pharmacists before and after the educational program.

RESULTS

Knowledge scores [median (interquartile range)] improved significantly between pre-test [39 (44-46)], post-test [44 (44-44)] and retention period of 6 weeks after the intervention [46 (43-46)]. Knowledge score improved immediately post-intervention among both males [44 (41-47)] and females [44 (43-45)] but the retention scores (after 6 weeks) were higher [46 (42-48)] among males. Attitude scores improved significantly among females [46 (44-48)]. The overall scores were higher among pharmacists from rural areas.

CONCLUSION

Knowledge and attitude scores improved after the educational intervention. Further studies in other regions of the country are required. The national pharmacovigilance center should promote awareness about ADR reporting among community pharmacists.