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

Why Pharmacovigilance of Non-steroidal Anti-inflammatory Drugs is Important in India?

BACKGROUND

Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are among the drugs that are most regularly administered to manage inflammation and pain. Over-the-Counter (OTC) NSAIDs are widely accessible, particularly in developing countries like India. This casual approach to using NSAIDs may operate as a magnet for NSAID-related adverse drug reactions (ADRs) among patients.

OBJECTIVES

As patients in India are less informed about the appropriate use of NSAIDs and consumption patttern, adverse drug reactions, and the importance of reporting ADRs, the current study's objective is to promote patient safety by using pharmacovigilance as a tool to educate patients.

METHODS

A targeted literature methodology was utilized to gather the data pertaining to NSAIDs, their ADRs and their pharmacovigilance. Different scientific databases, such as Science Direct, PubMed, Wiley Online Library, Springer, and Google Scholar, along with authentic textbooks, were explored as reference literature.

RESULTS

In general, NSAIDs consumption pattern depends upon the different age groups. Around 1.6 billion tablets of NSAIDs are consumed in India for ailments, such as headaches, arthritis, menstrual cramps, osteoarthritis, back pain, rheumatoid arthritis, gout, osteoporosis, tendinitis, cancer pain and chronic pain. Common ADRs of NSAIDs include nausea, vomiting, headache, gastritis, abdominal pain, and diarrhoea. Also, they can cause renal damage and cardiovascular problems if not consumed in a dose-dependent manner. However, Diclofenac and Ibuprofen have both been linked to depression and dementia. There have been reports of aplastic anaemia, agranulocytosis linked to phenylbutazone, Stevens-Johnson, and Lyell's syndrome linked to isoxicam and piroxicam, as well as the vulnerability of new-borns to Reye's syndrome after aspirin use. Lack of awareness, time constraints and unpredictability, poor training in ADRs identification, etc., are some of the reasons for the under-reporting of ADR of NSAIDs in India.

CONCLUSION

In order to rationally prescribe NSAIDs, it is essential to be aware of probable ADR's and establish prescription guidelines. Prescribers' behaviour can be changed toward excellent prescribing practices by conducting routine prescription assessments dealing with NSAIDs and providing feedback. In the near future, it will be critical to strengthen ADR data management and expand the reach of pharmacovigilance programs, ADR monitoring centers, and healthcare professionals' especially pharmacists' training in rural locations.

What Future Healthcare Professionals Need to Know About Pharmacovigilance: Introduction of the WHO PV Core Curriculum for University Teaching with Focus on Clinical Aspects

Adverse drug reactions (ADRs) can cause serious health problems, as shown in studies about drug-related hospitalizations. To build knowledge of and raise awareness about ADRs among healthcare professionals, more education in the field of ADRs and pharmacovigilance (PV) is needed. No standard exists for teaching PV at universities for medical, pharmacy, dentistry and nursing students, so a core curriculum needs to be developed to teach important aspects of PV to students. In September 2016, a stakeholders' meeting was initiated on behalf of the World Health Organization (WHO) and organized by the Netherlands Pharmacovigilance Centre Lareb. This meeting addressed and agreed on the PV competencies students need to develop and what key aspects of the subject should be taught. Five key aspects were identified: understanding the importance of PV in the context of pharmacotherapy, and preventing, recognizing, managing and reporting ADRs. Since time and resources for PV education are limited, elements of the WHO PV core curriculum for university teaching were designed to be integrated into existing courses but can be used as a stand-alone programme. The basis of and outline for the WHO PV core curriculum for university teaching are addressed in this paper. It is expected that PV competencies for students are vital for their contribution to safe use of medicines in the future. In addition, this article aims to stimulate discussion on this subject and promote collaboration between universities, national PV centres and other stakeholders to integrate key aspects of PV in their educational programmes.

Urgent need to modernize pharmacovigilance education in healthcare curricula: review of the literature

OBJECTIVES

Pharmacovigilance education is essential since adverse drug reactions (ADRs) are a serious health problem and contribute to unnecessary patient burden and hospital admissions. Healthcare professionals have little awareness of pharmacovigilance and ADR reporting, and only few educational interventions had durable effects on this awareness. Our future healthcare providers should therefore acquire an adequate set of pharmacovigilance competencies to rationally prescribe, distribute, and monitor drugs. We investigated the pharmacovigilance and ADR-reporting competencies of healthcare students to identify educational interventions that are effective in promoting pharmacovigilance.

METHODS

The PubMed, EMBASE, Cochrane, CINAHL, PsycINFO, and ERIC databases were searched using the terms "pharmacovigilance," "students," and "education.".

RESULTS

Twenty-five cross-sectional and 14 intervention studies describing mostly medical and pharmacy students were included. Intentions and attitudes on ADR reporting were overall positive, although most students felt inadequately prepared, missed the training on this topic, and lacked basic knowledge. Although nearly all students observed ADRs during clinical rounds, only a few had actually been involved in reporting an ADR. Educational interventions were predominately lectures, sometimes accompanied by small interactive working groups. Most interventions resulted in a direct increase in knowledge with an unknown long-term effect. Real-life learning initiatives have shown that healthcare students are capable of contributing to patient care while increasing their ADR-reporting skills and knowledge.

CONCLUSIONS

There is an urgent need to improve and innovate current pharmacovigilance education for undergraduate healthcare students. By offering real-life pharmacovigilance training, students will increase their knowledge and awareness but can also assist current healthcare professionals to meet their pharmacovigilance obligations.

Identifying Off-Label Prescriptions Through Data Mining in Danish Community Pharmacy Servers: An Exploratory Study on Desmopressin, Diclofenac, Fucidin, Mirtazapine and Quetiapine

The term off-label use describes the prescription and administration of medicines outside of the terms for which it officially has been approved, including age, dose and indication. Off-label data can be generated from the Danish National Prescription Registry through combinations with diagnoses; however, the community pharmacy servers provide equal, local, albeit less data through a faster and less constrained collection process. The data collection for this exploratory study took place at five community pharmacies in Denmark. Five drugs were chosen for the investigation and collection of prescription data across a 2-year period. Off-label use by age was observed to be 1.9% for diclofenac, 1.7% for desmopressin and 2.3% for quetiapine. The percentages were based on total number of 3881, 925, 2712 prescriptions, respectively. Off-label monitored by dosage appeared to be 75% for quetiapine; by box label text analysis, off-label indication was found to be 10-15% and 15-23% for quetiapine and mirtazapine (from a total number of 3178 prescriptions), respectively. By route of administration where fucidin ointment was applied to the nose in 60 patients, 83% were prescribed off-label (non-dermatological). This exploratory study revealed that pharmacy servers represent a reliable and up-to-date source to collect a substantial amount of raw prescription data. The method gives straightforward and simple access to analysis of off-label use by age and dose, whereas it is possible but difficult to interpret off-label indications and route of administration from the box label text.

Perspective of Saudi undergraduate pharmacy students on pharmacovigilance and adverse drug reaction reporting: A National Survey

INTRODUCTION

The purpose of this study was to evaluate Saudi undergraduate pharmacy students' knowledge, attitude, and readiness towards pharmacovigilance and reporting of adverse drug reactions (ADRs).

METHODS

A cross-sectional survey was conducted between January 15, 2016 and February 18, 2016 using a structured, validated and pilot-tested questionnaire among senior (year 4, 5, and 6) undergraduate pharmacy students enrolled at a governmental or private university/college. Students completed an online 27-item questionnaire developed using Google Forms™. The questionnaire consisted of four sections: demographics; knowledge about pharmacovigilance and ADR reporting; attitudes towards ADR reporting; and pharmacy students' readiness towards ADR reporting.

RESULTS

Two hundred and fifty-nine students completed the questionnaire. Most of the participants were females (n=174; 67.2%) and were year 4 (n=128; 49.4%) students. Out of a total possible score of seven, the mean knowledge score (SD) was 4.15 (1.1). Multiple linear regression showed that after adjusting for gender and program of study (BPharm/PharmD), year of the study was found to be an independent predictor (p=0.03) of the total knowledge score. More than half of the respondents (n=166; 64.1%) acknowledged that they do not know how to report ADRs to the relevant authorities in Saudi Arabia. The majority (n=213; 82.2%) of respondents believed that information on how to report ADRs should be taught to senior pharmacy students.

Barriers to reporting of adverse drugs reactions: a cross sectional study among community pharmacists in United Kingdom

Background:

Adverse Drug Reactions (ADRs) are a major public health problem. Prompt reporting of suspected ADRs is fundamental in the post-marketing surveillance of medicines and helps in ensuring medicine safety. However, fewer ADRs are reported in general and in particular by community pharmacists. There is limited knowledge about the factors which are preventing community pharmacists in the UK from reporting an ADR.

Objectives:

To identify the barriers to ADR reporting among community pharmacists practicing in the UK.

Methods:

A cross sectional study using a 25-items questionnaire (both online and paper based) including 10 barriers to ADR reporting was conducted from 1st April 2012 to September 2012. Community pharmacists practicing in the West Midlands, UK, were approached for the participation in this study. Chi-Square and regression were applied to identify covariates for the barriers to ADR reporting. A significant value of 0.05 was assigned for analysis.

Results:

Of the 230 invited community pharmacists, 138 pharmacists responded (response rate 60%). The median age of respondents was 31 years. All pharmacists reported that they would report both serious and mild ADRs from drugs with black triangle among children as well as adults. About 95% (n=131) of the pharmacists were familiar with the paper based ADR reporting system. Store-based pharmacists were more likely to be more confident about which ADRs to report [0.680, 95% Confidence Interval 0.43-3.59]. Lack of time 46.4% (n=64), and pharmacists perception that ADR is not serious enough to report (65.2%; n=90) were identified as barriers to ADR reporting. Majority 63.0% (n=87) of the pharmacists identified training and information about what to report and access to Information Technology (IT) (For example access to internet connection) 61.6% (n=85) as facilitators to ADR reporting process.

Conclusion:

Lack of time and ADRs considered not serious enough by pharmacists to report were barriers to ADR reporting. Further training and education about the types of ADRs to be reported can help to improve the reporting of ADRs.

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.

Pilot testing of checklists to discern adverse drug reactions and adverse drug events

OBJECTIVES

To estimate the prevalence of patient-reported adverse drug events (ADEs)/adverse drug reactions (ADRs) in the community pharmacy setting and determine the prevalence relative to pharmacist judgment.

DATA SOURCES

The 2009 version of the Pharmacy Times top 200 drugs was used to identify the prescription medications most commonly used within the ambulatory population during 2008. All ADEs/ADRs for each medication were obtained by combining the ADEs/ADRs listed in Drug Facts and Comparisons, Lexi-Comp, and Micromedex.

METHODS

Checklists for each pharmacologic class within the top 200 medications (n = 51) were developed, with questions about the five most common ADEs/ADRs in each class. Ten community pharmacies administered the checklists. Patients requesting a prescription refill for a medication listed in the top 200 were asked to complete a class-specific checklist to determine ADEs/ADRs experienced in the previous 4 weeks. Upon completion, pharmacists engaged in routine counseling procedures, including a discussion of patient-reported ADEs/ADRs. Pharmacists indicated if they believed, based on their clinical judgment, whether the ADE/ADR reported was related to the medication.

RESULTS

2,057 checklists were completed, with a total of 10,285 potential ADEs/ADRs. Patients reported 2,185 ADEs/ADRs (21.24%), with 755 (7.3%) definitively confirmed by the pharmacist as being related to their medication.

CONCLUSION

Use of these checklists resulted in the identification of previously unrecognized ADEs/ADRs in the community setting. Routine use of these short, patient-completed checklists may assist pharmacists in earlier identification of ADEs/ADRs, which can have a positive impact on patient safety across settings.

Community pharmacists' knowledge, behaviors and experiences about adverse drug reaction reporting in Saudi Arabia

OBJECTIVE

To assess community pharmacists' knowledge, behaviors and experiences relating to Adverse Drug Reaction (ADR) reporting in Saudi Arabia.

METHODS

A cross-sectional study was conducted using a validated self-administered questionnaire. A convenience sample of 147 community pharmacists working in community pharmacies in Riyadh, Saudi Arabia.

RESULTS

The questionnaire was distributed to 147 pharmacists, of whom 104 responded to the survey, a 70.7% response rate. The mean age of participants was 29 years. The majority (n = 101, 98.1%) had graduated with a bachelorette degree and worked in chain pharmacies (n = 68, 66.7%). Only 23 (22.1%) said they were familiar with the ADR reporting process, and only 21 (20.2%) knew that pharmacists can submit ADR reports online. The majority of the participants (n = 90, 86.5%) had never reported ADRs. Reasons for not reporting ADRs most importantly included lack of awareness about the method of reporting (n = 22, 45.9%), misconception that reporting ADRs is the duty of physician and hospital pharmacist (n = 8, 16.6%) and ADRs in community pharmacies are simple and should not be reported (n = 8, 16.6%). The most common approach perceived by community pharmacists for managing patients suffering from ADRs was to refer him/her to a physician (n = 80, 76.9%).

CONCLUSION

The majority of community pharmacists in Riyadh have poor knowledge of the ADR reporting process. Pharmacovigilance authorities should take necessary steps to urgently design interventional programs in order to increase the knowledge and awareness of pharmacists regarding the ADR reporting process.

[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.

Views of British community pharmacists on direct patient reporting of adverse drug reactions (ADRs)

PURPOSE

To survey British community pharmacists' views and practices concerning direct patient reporting of ADRs.

METHODS

Cross-sectional postal survey of community pharmacists in Britain

RESULTS

Of 1096 questionnaires distributed, 297 usable responses were obtained, (27.1%). Respondents' estimates of the frequency of patients reporting a suspected ADR to them had a median of 1.0 per month. Almost a fifth of respondents (19.6%) do not specifically ask patients about ADRs, and 38.7% do not encourage patients to report. Only 18.5% displayed a poster promoting the YC Scheme in their pharmacy, but 57.9% claimed to have patient YCs available. A quarter (24.9%) of respondents considered that ADR reporting should be restricted to health professionals and 14.4% considered that patients were not at all capable of identifying ADRs.

CONCLUSIONS

The low response rate and overall results suggest that British community pharmacists may lack interest in and do not promote direct patient reporting. Increased awareness of the benefits and mechanisms of patient reporting may be required to ensure that pharmacists can provide the necessary support to facilitate patient reporting.