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Buabeng RO, Dsane-Aidoo P, Asamoah YK, Bandoh DA, Boahen YA, Sabblah GT, Darko DM, Lwanga CN, Ameme DK, Kenu E. Under-reporting of adverse drug reactions: Surveillance system evaluation in Ho Municipality of the Volta Region, Ghana. PLoS One 2023; 18:e0291482. [PMID: 37699058 PMCID: PMC10497160 DOI: 10.1371/journal.pone.0291482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Adverse Drug Reactions (ADRs) can occur with all medicines even after successful extensive clinical trials. ADRs result in more than 10% of hospital admissions worldwide. In Ghana, there has been an increase of 13 to 126 ADR reports per million population from 2012 to 2018. ADR Surveillance System (ADRSS) also known as pharmacovigilance has been put in place by the Ghana Food and Drugs Authority (FDA) to collect and manage suspected ADR reports and communicate safety issues to healthcare professionals and the general public. The ADRSS in Ho Municipality was evaluated to assess the extent of reporting of ADRs and the system's attributes; determine its usefulness, and assess if the ADRSS is achieving its objectives. METHODS We evaluated the ADRSS of the Ho Municipality from January 2015 to December 2019. Quantitative data were collected through interviews and review of records. We adapted the updated CDC guidelines to develop interview guides and a checklist for data collection. Attributes reviewed included simplicity, data quality, acceptability, representativeness, timeliness, sensitivity, predictive value positive and stability. RESULTS We found a total of 1,237 suspected ADR during the period, of which only 36 (3%) were reported by healthcare professionals in the Ho Municipality to the National Pharmacovigilance Centre (NPC). Only 43.9% of health staff interviewed were familiar with the ADRSS and its reporting channel. Staff who could mention at least one objective of the ADRSS were 34.2%, and 12.2% knew the timelines for reporting ADR. Reports took a median time of 41 (IQR = 25, 81) days from reporter to NPC. Reports sent on time constituted 37.5%. Fully completed case forms constituted 77.1% and the predictive value positive (PVP) was 20%. About 53% of ADRs were reported for female patients. Up to 88.9% of ADRs were classified as drug related. Anti-tuberculosis agents and other antibiotics constituted (40.6%) and (18.8%) of all reports. The ADRSS was not integrated into the disease surveillance and response system of Ghana's Health Service and so was not flexible to changes. A dedicated ADR surveillance officer in regions helped with the system's stability. Data from Ghana feeds into a WHO database for global decision making. CONCLUSIONS There was under-reporting of ADRs in the Ho Municipality from January 2015 to December 2019. The ADR surveillance system was simple, stable, acceptable, representative, had a strong PVP but was not flexible or timely. The ADRSS was found useful and partially met its objectives.
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Affiliation(s)
- Richard Osei Buabeng
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Yaw K. Asamoah
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Delia Akosua Bandoh
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | | | | | - Charles Noora Lwanga
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Donne Kofi Ameme
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Aung AK, Zubrinich CM, Goh MSY, Snyder B, Tang MJ, Khu CYL, Lee JI, Graudins LV. Development and application of Adverse drug reactions reports QUality Algorithm (AQUA-12) score: a single-centre quality improvement initiative. Eur J Clin Pharmacol 2023; 79:513-522. [PMID: 36806970 PMCID: PMC10038939 DOI: 10.1007/s00228-023-03457-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To develop a reliable assessment tool to monitor the quality of adverse drug reaction (ADR) reports and evaluate its performance within a quaternary hospital setting. METHODS Adverse drug reactions report QUality Algorithm (AQUA-12) was developed by a multidisciplinary team with the expertise in the management of ADRs. The design was based on data elements required to establish medication causality. Inter-rater reliability of AQUA-12 was evaluated over three rounds in two phases: development and prospective evaluation phases, by independent assessors both internal and external to the institutional ADR review processes. The characteristics and quality of ADR reports were subsequently assessed, and potential factors contributing to low-quality reports were identified. RESULTS A total of 70 ADR reports were assessed, 20 in development and 50 in evaluation phases. The inter-rater reliability of AQUA-12 was found to be excellent in all three rounds (Cronbach's alpha of ≥ 0.9, p < 0.001 for all). Approximately one in five reports concerned immediate hypersensitivity reactions while delayed hypersensitivity reactions constituted 60% of all reactions. AQUA-12 identified 18 (25.7%) reports as 'low-quality' with a score of < 10. Identification of suspected medications (37.1%), description of index ADR (27.1%), and key events (ADR narrative, 35.7%) were the top data elements incomplete or missing from all reports. Univariable analyses identified the severity of the reaction as a factor associated with low quality of reports (p = 0.008). CONCLUSIONS AQUA-12 is a practical and highly reliable assessment tool that can be utilised in hospital settings to regularly monitor the completeness of ADR reports to guide quality improvement initiatives.
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Affiliation(s)
- Ar Kar Aung
- Department of General Medicine, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Celia M Zubrinich
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Australia
| | | | - Benjamin Snyder
- Department of General Medicine, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Therapeutic Goods Administration, Canberra, Australia
| | - Mei Jie Tang
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Cindy Y L Khu
- Department of General Medicine, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jennifer I Lee
- Department of Medicine, New York-Presbyterian Hospital, New York, USA
- Quality Improvement Academy, Weill Cornell Medicine, New York, USA
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3
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Fossouo Tagne J, Yakob RA, Dang TH, Mcdonald R, Wickramasinghe N. Reporting, Monitoring, and Handling of Adverse Drug Reactions in Australia: Scoping Review. JMIR Public Health Surveill 2023; 9:e40080. [PMID: 36645706 PMCID: PMC9887513 DOI: 10.2196/40080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are unintended consequences of medication use and may result in hospitalizations or deaths. Timely reporting of ADRs to regulators is essential for drug monitoring, research, and maintaining patient safety, but it has not been standardized in Australia. OBJECTIVE We sought to explore the ways that ADRs are monitored or reported in Australia. We reviewed how consumers and health care professionals participate in ADR monitoring and reporting. METHODS The Arksey and O'Malley framework provided a methodology to sort the data according to key themes and issues. Web of Science, Scopus, Embase, PubMed, CINAHL, and Computer & Applied Sciences Complete databases were used to extract articles published from 2010 to 2021. Two reviewers screened the papers for eligibility, extracted key data, and provided descriptive analysis of the data. RESULTS Seven articles met the inclusion criteria. The Adverse Medicine Events Line (telephone reporting service) was introduced in 2003 to support consumer reporting of ADRs; however, only 10.4% of consumers were aware of ADR reporting schemes. Consumers who experience side effects were more likely to report ADRs to their doctors or pharmacists than to the drug manufacturer. The documentation of ADR reports in hospital electronic health records showed that nurses and pharmacists were significantly less likely than doctors to omit the description of the drug reaction, and pharmacists were significantly more likely to enter the correct classification of the drug reaction than doctors. Review and analysis of all ADR reports submitted to the Therapeutic Goods Administration highlighted a decline in physician contribution from 28% of ADR reporting in 2003 to 4% in 2016; however, within this same time period, hospital and community pharmacists were a major source of ADR reporting (ie, 16%). In 2014, there was an increase in ADR reporting by community pharmacists following the introduction of the GuildLink ADR web-based reporting system; however, a year later, the reporting levels dropped. In 2018, the Therapeutic Goods Administration introduced a black triangle scheme on the packaging of newly approved medicines, to remind and encourage ADR reporting on new medicines, but this was only marginally successful at increasing the quantity of ADR reports. CONCLUSIONS Despite the existence of national and international guidelines for ADR reporting and management, there is substantial interinstitutional variability in the standards of ADR reporting among individual health care facilities. There is room for increased ADR reporting rates among consumers and health care professionals. A thorough assessment of the barriers and enablers to ADR reporting at the primary health care institutional levels is essential. Interventions to increase ADR reporting, for example, the black triangle scheme (alert or awareness) or GuildLink (digital health), have only had marginal effects and may benefit from further improvement revisions and awareness programs.
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Affiliation(s)
- Joel Fossouo Tagne
- Department of Health and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Centre for Health Analytics, Murdoch Children's Research Institute, Melbourne, Australia
- MedTechVic, Swinburne University of Technology, Melbourne, Australia
| | | | - Thu Ha Dang
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Behavioural Sciences Unit, Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rachael Mcdonald
- MedTechVic, Swinburne University of Technology, Melbourne, Australia
- Department of Nursing and Allied Health, Occupational Therapy, Swinburne University of Technology, Melbourne, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Nilmini Wickramasinghe
- Department of Health and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
- Epworth Healthcare, Melbourne, Australia
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4
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Aung AK, Walker S, Khu YL, Tang MJ, Lee JI, Graudins LV. Adverse drug reaction management in hospital settings: review on practice variations, quality indicators and education focus. Eur J Clin Pharmacol 2022; 78:781-791. [PMID: 35171316 PMCID: PMC9005418 DOI: 10.1007/s00228-022-03287-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
Purpose Adverse drug reactions (ADRs) contribute significantly to healthcare burden. However, they are largely preventable through appropriate management processes. This narrative review aims to identify the quality indicators that should be considered for routine monitoring of processes within hospital ADR management systems. It also examines the potential reasons behind variation in ADR management practices amongst HCPs, and explores possible solutions, focusing on targeted education programmes, to improve both the quality and quantity indicators of ADR management processes. Methods A comprehensive literature review was conducted to explore relevant themes and topics concerning ADR management, quality indicators and educational interventions. Results Substantial variability exists in ADR management amongst healthcare professionals (HCPs) with regard to reporting rates, characteristics of ADRs reported, quality of assessment, completeness of reports and, most importantly, risk communication practices. These variable practices not only threaten patient safety but also undermine pharmacovigilance processes. To date, quality indicators to monitor ADR management practices within hospital settings remain ill-defined. Furthermore, evidence behind effective interventions, especially in the form of targeted education strategies, to improve the quality of ADR management remains limited. Conclusions The focus of ADR management in hospitals should be to promote patient safety through comprehensive assessment, risk communication and safe prescribing. There is a need to develop a system to define, measure and monitor the quality of ADR management. Educational strategies may help improve the quality of ADR management processes.
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Affiliation(s)
- Ar Kar Aung
- Department of General Medicine, Alfred Hospital, Melbourne, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Steven Walker
- Department of Pharmacy, Alfred Hospital, Melbourne, Australia
| | - Yin Li Khu
- Department of General Medicine, Alfred Hospital, Melbourne, Australia
| | - Mei Jie Tang
- Department of General Medicine, Alfred Hospital, Melbourne, Australia
| | - Jennifer I Lee
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, USA.,Quality Improvement Academy, Weill Cornell Medicine, New York, USA
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Lavallée M, da Silveira CG, Akinola S, Méthot J, Piché ME, Bérard A, Thibault M, Gonella JM, Gimenes FRE, Leclerc J. Reporting Rates of Opioid-Related Adverse Events Since 1965 in Canada: A Descriptive Retrospective Study. Drugs Real World Outcomes 2021; 9:153-163. [PMID: 34529224 PMCID: PMC8844319 DOI: 10.1007/s40801-021-00275-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 12/04/2022] Open
Abstract
Background Patients with chronic or acute/postoperative pain frequently use opioids. However, opioids may cause considerable adverse reactions (ARs), such as respiratory depression, which could be lethal. Unfortunately, only 5% of drug-related ARs (including those to opioids) are reported to health authorities. Therefore, little is known regarding the occurrence of opioid-related ARs at the population level. Objective The aim of this study was to investigate how the rates of reported opioid-related ARs have changed in Canada since 1965. Methods Our retrospective study examined trends of reported opioid-related ARs occurring in hospitalized and outpatients. Data on opioid-related ARs and mortality between 1965 and 2019 were obtained from the Canada Vigilance and Statistics Canada databases. Descriptive and Joinpoint regression analyses were performed. Results Oxycodone and normethadone were the most and least involved opioid agents, respectively, among the 18,407 reported ARs. The highest rate of reported opioid ARs (3.8 per 100,000 person-years) was recorded in 2012, whereas the lowest was recorded in 1965 (0.1 per 100,000 person-years). Between 1965 and 2019, annual rates climbed by 4.2% (95% confidence interval [CI] 3.1–5.2), and many fluctuations were observed: 1965–1974: +22.3% (95% CI 12.0–33.6); 1974–2000: − 4.1% (95% CI − 5.3 to − 2.9); 2000–2008: +30.3% (95% CI 22.6–38.4); 2008–2014: +4.1% (95% CI − 1.5 to 10.1); 2014–2017: −26.0% (95% CI − 44.7 to − 0.9); and, finally, 2017–2019: +35.4% (95% CI 3.8–76.7). Conclusion Reported opioid-related ARs have increased since 1965, although fluctuations were observed in recent decades. The absolute number of opioid-related ARs might be seriously underestimated. Future studies should look into how to close this gap. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-021-00275-2.
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Affiliation(s)
- Maude Lavallée
- Département des Sciences infirmières, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | | | - Samuel Akinola
- Department of Nursing, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Julie Méthot
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Canada.,Faculty of Pharmacy, Université Laval, Quebec City, Canada
| | - Marie-Eve Piché
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Canada.,Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Anick Bérard
- Centre de recherche du Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Magalie Thibault
- Département des Sciences infirmières, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | | | | | - Jacinthe Leclerc
- Département des Sciences infirmières, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada. .,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Canada. .,Faculty of Pharmacy, Université Laval, Quebec City, Canada.
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6
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Sakaniya LR, Plieva KT, Denisova EV, Korsunskaya IM. Acute conditions in dermatology: toxic reactions and their treatment. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.8.201180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute severe conditions caused by the use of various drugs are of particular difficulty in dermatological practice. Toxicodermic reactions include DRESS syndrome, StevensJohnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis and erythroderma of various origins. These disorders are characterized not only by skin lesions, but also toxic reactions in internal organs, which if untreated properly can be life-threatening. The first choice drugs for such reactions are systemic glucocorticosteroids, in particular betamethasone derivatives. Our own experience and numerous studies confirm the effectiveness of such drugs. However, it should be remembered that uncontrolled or prolonged use of systemic glucocorticosteroids can aggravate the patient's condition and lead to unwanted adverse reactions.
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Monteiro C, Dias B, Vaz-Patto M. Headache as an Adverse Reaction to the Use of Medication in the Elderly: A Pharmacovigilance Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052674. [PMID: 33799926 PMCID: PMC7967518 DOI: 10.3390/ijerph18052674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 01/15/2023]
Abstract
There is a consensus that elderly individuals are quite vulnerable to adverse drug reactions (ADRs), and headaches are one of the most frequent clinical presentations of central nervous system problems in the general population, which can be an ADR. The purpose of our work was to analyze reports of "headache" associated ADRs in the elderly sent to the Portuguese Pharmacovigilance System (PPS), and also which drugs were more frequently associated with this adverse reaction. A retrospective analysis of suspected ADR reports involving patients aged 65 years or older received by the PPS in the last 10 years was conducted. A search of all the terms associated with the High Level Term "headache" was performed. All duplicate reports were excluded from the analysis. A total of 155 ADRs reports were included, in which 15 reported isolated "headache" as suspected ADR, while the remaining 140 ADRs reports reported "headache" together with several other adverse reactions. Most reports of "headache" ADR occurred in women (74.8%; n = 116). About half (46.5%; n = 72) of the ADR reports were considered serious. Anti-viral medication, anti-depressants, anti-dyslipidemic agents and central nervous system-acting analgesics were the most frequent drugs associated with "headache" ADR reports in this population. In elderly patients, most ADR reports involving headaches occurred in women and a high percentage (46.5%) were considered serious. Thus, it is important that healthcare professionals pay more attention to headaches reported as ADRs in the elderly and drugs suspected to cause them, in order to increase knowledge about this type of reaction and contribute towards safely using drugs in this age group.
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Affiliation(s)
- Cristina Monteiro
- UFBI—Pharmacovigilance Unit of Beira Interior, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal;
| | - Beatriz Dias
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal;
| | - Maria Vaz-Patto
- UFBI—Pharmacovigilance Unit of Beira Interior, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal;
- CICS UBI—Health Sciences Research Centre-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
- Correspondence:
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Tairova RT, Gaydina TA, Dvornikov AS, Tazartukova AD, Lyang OV. Difficulties in differential diagnosis of cutaneous manifestations in patients with coronavirus infection. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with severe SARS-CoV-2 infection (COVID-19) and multiple comorbidities should be monitored for possible adverse reactions to prescribed drugs, including drug eruptions (DE) at any stage of treatment. Below, we describe a clinical case of a 92-year-old female patient with severe PCR-confirmed COVID-19. The patient was treated with amoxicillin/clavulanic acid, moxifloxacin, acetylcysteine, and sodium enoxaparin. On day 9 into treatment, the patient developed moderately itching macular rashes showing a tendency to coalesce, but overall showed no signs of deterioration. On day 15, the rashes regressed, following a short course of dexamethasone and chloropyramine. This kind of skin reaction might have been provoked by β-lactams and fluoroquinolones included in the treatment regimen, a secondary bacterial infection, compromised immunity due to advanced age, and high viral load associated with dermatological symptoms. Delayed onset of skin symptoms might be regarded as a marker of COVID-19 severity.
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Affiliation(s)
- RT Tairova
- Federal Center for Brain and Neurotechnology of FMBA of Russia, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - TA Gaydina
- Federal Center for Brain and Neurotechnology of FMBA of Russia, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - AS Dvornikov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - AD Tazartukova
- Federal Center for Brain and Neurotechnology of FMBA of Russia, Moscow, Russia
| | - OV Lyang
- Federal Center for Brain and Neurotechnology of FMBA of Russia, Moscow, Russia
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Mazzoni D, Tee HW, de Menezes SL, Graudins LV, Johnson DF, Newnham ED, Kelley PG, Zubrinich CM, Goh MSY, Trubiano JA, Aung AK. A Survey on Knowledge Gaps in Assessment and Management of Severe Drug Hypersensitivity Reactions: Multicenter Cross-Sectional Study of Australian Health Care Providers. J Clin Pharmacol 2020; 61:25-31. [PMID: 32648298 DOI: 10.1002/jcph.1692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/15/2020] [Indexed: 11/08/2022]
Abstract
Severe drug hypersensitivity reactions (DHRs) are often encountered by health care professionals (HCPs). We evaluated knowledge of doctors and pharmacists in the assessment and management of severe DHRs using a structured questionnaire. A cross-sectional study was conducted in 4 metropolitan hospital networks in Melbourne, Australia. A 13-question, scenario-based multiple-choice questionnaire to assess specific knowledge domains in drug hypersensitivity syndrome recognition, causality attribution, cross-reactivity patterns, appropriate diagnostic tests, and therapy was administered to HCPs of various vocation and specialty groups. Data were analyzed according to profession, self-reported experience, and preparedness in managing severe DHRs. Two hundred thirty-eight participants (45.0% senior doctors, 24.4% junior doctors, and 30.7% pharmacists) across a range of subspecialties achieved an overall median score of 7 (IQR, 5-8)-overall 55.6% correct responses to all questions-with senior doctors outperforming junior doctors and pharmacists (P < .001). The best performance by all participants was in DHR syndrome recognition (60.9%), and the poorest was in diagnostics/therapy (52.0%). HCP group and experience level were significantly associated with better performance in the knowledge domains of cross-reactivity and diagnostics/therapy (P = .003 and < .001, respectively), but not in the domains of syndrome recognition and causality attribution (P > .05). Levels of self-reported preparedness in DHR management were not associated with performance rates in any of the knowledge domains. This study demonstrated significant knowledge gaps in the recognition and management of severe drug hypersensitivity reactions. Targeted multidisciplinary education of staff caring for these patients is needed to improve knowledge gaps.
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Affiliation(s)
- Daniel Mazzoni
- Department of Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Hui Wen Tee
- Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Sara Lee de Menezes
- Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia
| | | | - Douglas Forsyth Johnson
- Department of General Medicine and Infectious Diseases, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Evan David Newnham
- Department of General Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Peter Graham Kelley
- Department of Infectious Diseases, Peninsula Health, Melbourne, Victoria, Australia
| | - Celia Mary Zubrinich
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | | | - Jason Anthony Trubiano
- Department of Infectious Diseases and Centre for Antibiotic Allergy and Research, Austin Health, Melbourne, Victoria, Australia.,The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Ar Kar Aung
- Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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10
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Samuelov L, Nathan A, Slutsky E, Fruchter D, Gat A, Sprecher E, Goldberg I. Nested case–control study investigating the diagnostic role of tissue eosinophilia in adverse cutaneous drug reactions. J Eur Acad Dermatol Venereol 2019; 33:1152-1157. [DOI: 10.1111/jdv.15509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/18/2019] [Indexed: 12/21/2022]
Affiliation(s)
- L. Samuelov
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - A. Nathan
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - E. Slutsky
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - D. Fruchter
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - A. Gat
- Institute of Pathology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - E. Sprecher
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - I. Goldberg
- Department of Dermatology Tel Aviv Sourasky Medical Center Affiliated with Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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