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Ritchie HE, Hegedus E, Ma J, Kennedy D. A descriptive analysis of calls to the NSW Teratogen Information Service regarding use of anti-infectives during pregnancy. PLoS One 2022; 17:e0270940. [PMID: 36201464 PMCID: PMC9536608 DOI: 10.1371/journal.pone.0270940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND MotherSafe is a free telephone-based counseling service for Australian consumers and health-care providers concerned about drug exposures during pregnancy and breastfeeding. Anti-infectives are the most commonly prescribed drugs for pregnant women. This study aims to provide a descriptive analysis of prospectively collected calls received by MotherSafe regarding anti-infective exposures during pregnancy between 2000 and 2020. Aggregate data were examined by type of caller, reason for call, pregnancy category and exposure type. Inductive thematic analysis of the comments recorded by MotherSafe counsellors at the time of call was undertaken. RESULTS Over the study period, 25,890 calls related to exposure to anti-infectives during pregnancy (antibiotic, antiviral, and antifungal medications). Calls from patients were dominated by low-risk exposures (pregnancy category A) to drugs while calls from health care professionals related to drugs with limited human information (pregnancy category B3). Analysis of MotherSafe counsellor comments revealed over 200 instances of concerns relating to health care professional advice to the patient. Three themes emerged: incorrect or conflicting advice, poor counselling, and refusal to treat, prescribe or dispense. It is likely that these comments are biased to the negative as patients would not call MotherSafe if they were happy with HCP advice. However, the findings are concerning as they reveal an underlying lack of knowledge in some health care professionals which may have led to undertreatment of patients. This study reinforced the importance of Teratogen Information Services such as MotherSafe in providing counselling and clear communication of evidence-based information to guide decision-making, reducing potential emotional distress in pregnant women, and optimizing maternal, pregnancy and infant outcomes.
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Affiliation(s)
- Helen E. Ritchie
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Elizabeth Hegedus
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Ma
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Debra Kennedy
- Mothersafe, The Royal Hospital for Women, Sydney, New South Wales, Australia
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Kirubarajan A, Lam A, Yu A, Taheri C, Khan S, Sethuram C, Mehta V, Olivieri N. Knowledge, Information Sources, and Institutional Trust of Patients Regarding Medication Use in Pregnancy: A Systematic Review. J Family Reprod Health 2021; 15:160-171. [PMID: 34721607 PMCID: PMC8536826 DOI: 10.18502/jfrh.v15i3.7133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The objective of our study is to characterize the knowledge, information sources, and institutional trust of patients regarding medication use in pregnancy. Materials and methods: We conducted a review of three databases: MEDLINE, EMBASE, and CINAHL. We included observational studies and knowledge assessments that examined the knowledge, attitudes, beliefs or information sources of pregnant patients related to medication use during pregnancy. Extraction was completed by two independent reviewers, outcomes were summarized descriptively, and appraisal was conducted. Results: Of the 1359 search results, 34 studies met inclusion criteria. Thus, our systematic review encompasses the beliefs of 11,757 pregnant participants. In most studies, participants described apprehension regarding potential risks to the fetus and the inadequacy of safety information. Across the 23 knowledge assessments, the majority of studies reported patient misconceptions about prescription medication in pregnancy. The most preferred information source was a healthcare provider. However, many participants expressed frustration, mistrust, and skepticism regarding physician knowledge. A common source of mistrust was due to perceived physician self-interest as well as a lack of education tailored to pregnancy. Consequently, informal sources of information were also popular. Conclusion: There is a need to improve the health literacy and trust among pregnant patients regarding drug prescribing. There are modifiable risk factors for mistrust that require further attention.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cameron Taheri
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire Sethuram
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vikita Mehta
- Arts and Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Olivieri
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Schjøtt J. Norwegian drug information centres strongly promote person-centred and personalised medicine: a brief report on the achievements and strategy. EPMA J 2019; 10:109-114. [PMID: 31258816 DOI: 10.1007/s13167-019-00167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022]
Abstract
The Norwegian network of drug information centres (RELIS) has achievements in person-centred and personalised medicine. RELIS receive questions from physicians, pharmacists, nurses and other health professionals and provide decision support in all aspects of pharmacotherapy. Questions associated with person-centred medicine often include problems with unrealistic risk perception and poor adherence among patients. Questions associated with personalised medicine frequently concern comorbidity, biomarkers and pharmacogenetics. The questions frequently include a mix of problems related to health and disease care. The RELIS staff addresses each question in a problem-oriented approach with expertise in pharmacology and skills in searching and critical evaluation of the literature. A written answer can describe decision support concerning patient empowerment, further diagnostics and preferences in pharmacotherapy including advice with regard to choice of drug and dose to a patient. Links to online resources and attached references for further reading are often included in the answers. The question-answer service is documented in a full-text, searchable question-answer database. Additional drug information activities towards clinicians and patients, and a multi-professional staff with pharmacists and clinical pharmacologists, are important elements in RELIS drug information strategy, and it is essentially relevant to predictive, preventive and personalised medicine (PPPM).
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Affiliation(s)
- Jan Schjøtt
- 1Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway.,2Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Schjøtt J, Spigset O. Drug information centres and their provision of decision support: The Scandinavian experience. J Clin Pharm Ther 2019; 44:489-492. [PMID: 30710370 DOI: 10.1111/jcpt.12804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Appraisal of drug information centres (DICs) is mainly by word of mouth communication and surveys of overall user satisfaction. Efforts to study the impact of this type of informatics and decision support systematically are generally lacking within the healthcare system. COMMENT Scandinavian DICs question-answering databases are relevant sources for identifying recurring problems in pharmacotherapy, including drug safety questions, and for re-use of previous answers. Recent studies in this setting have shown that high-quality answers demand easily accessible literature sources, skills in literature search and critical assessment of the retrieved documentation. Furthermore, patient-specific advice in clinical cases presented within a requested time frame is appraised by clinicians. WHAT IS NEW AND CONCLUSIONS Effective decision support by Scandinavian DICs depends on skills among staff and technological resources. Our experience could motivate further studies investigating methods and evaluating the impact of DICs in the healthcare system.
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Affiliation(s)
- Jan Schjøtt
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Regional Medicines Information and Pharmacovigilance Centre (RELIS Midt-Norge), Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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Schjøtt J. Physicians' questions concerning drug use among older patients: experience from Norwegian drug information centres (RELIS) in the period 2010-2015. Aging Clin Exp Res 2018; 30:867-870. [PMID: 28929445 DOI: 10.1007/s40520-017-0832-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/05/2017] [Indexed: 02/04/2023]
Abstract
Questions from physicians to regional medicines information and pharmacovigilance centres in Norway (RELIS) concerning older patients were described. Question-answer pairs (QAPs) from the RELIS database indexed with the category "older", and concerning individual patients from the period 01 Jan 2010 to 31 Dec 2015, were analysed. Two-hundred and eight QAPs categorized with "older" were retrieved from a total of 16 710 in the study period, and 122 of 208 QAPs fulfilled the inclusion criteria. The most common categories of drugs in question (n = 228) according to the ATC system were N: Nervous system (30.3%) and C: Cardiovascular system (23.7%). Questions from physicians (n = 122) were most frequently about adverse effects (41.8%) and treatment (39.3%). The majority of questions to RELIS concerning older patients came from general practice (GP). The results suggest drug information efforts to GPs in care of older patients with regard to psychopharmacology and cardiovascular pharmacology.
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Affiliation(s)
- Jan Schjøtt
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, 5021, Bergen, Norway.
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway.
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Widnes SF, Schjøtt J. Risk perception regarding drug use in pregnancy. Am J Obstet Gynecol 2017; 216:375-378. [PMID: 27988271 DOI: 10.1016/j.ajog.2016.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/18/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022]
Abstract
Pregnant women, but also physicians, have unrealistically high perceptions of teratogenic drug effects. This may result in suboptimal treatment of disease and even influence decisions of whether to continue pregnancy. To attain more realistic teratogenic risk perceptions, several factors that influence this issue should be considered, and these are further discussed in this Clinical Opinion. Importantly, drug use may have several benefits, both for the pregnant woman's health and to avoid negative fetal effects of untreated maternal disease. A greater focus on this aspect may act to balance risk perceptions. Furthermore, both pregnant women and physicians need access to drug information sources that provide realistic risk estimates to increase confidence in appropriate drug use and prescribing. We suggest that access to decision support and individually tailored information provided by drug information centers may contribute to this goal.
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Affiliation(s)
- Sofia F Widnes
- Regional Medicines and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway.
| | - Jan Schjøtt
- Regional Medicines and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway; Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway; Section of Pharmacology, Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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