Monitoring adverse drug reactions in children using community pharmacies: a pilot study

Evidence of support used for drug treatments in pediatric cardiology

BACKGROUND AND AIMS

Clinical support systems are widely used in pediatric care. The aim of this study was to assess the support for drug treatments used at pediatric cardiac wards and intensive care units in Sweden.

METHODS

Drug information, such as type of drug, indication, dose, and route of administration, for all in-hospital pediatric cardiac patients, was included in the study. Treatments were classified as either on-label (based on product information) or off-label. Support for off-label treatment was stratified by the use of clinical support systems (the national database on drugs, local, or other clinical experience guidelines).

RESULTS

In all, 28 patients were included in the study. The total number of drug treatments was 233, encompassing 65 different drugs. Overall, 175 (75%) treatments were off-label. A majority of off-label drug treatments were supported by other sources of information shared by experts. A total of 7% of the drug treatments were used without support.

CONCLUSION

Off-label drug treatment is still common in Swedish pediatric cardiac care. However, the majority of treatments were supported by the experience shared in clinical support systems.

KEY POINTS

Seventy-five percent of all prescriptions in pediatric cardiology care were off-label.A majority of patients received three or more drug treatments off-label.Use of clinical support systems and guidelines was common, but in 7% of all drug treatments, no support was found for the chosen treatment.

Community Pharmacy Use by Children across Europe: A Narrative Literature Review

The use of community pharmacies across Europe has potential to alleviate the burden on overstretched healthcare providers. Children and young people (0–18 years) account for a large number of primary care attendances. This narrative literature review between January 2000 and December 2017 examines the use of community pharmacy by paediatric patients in Europe. The results report both positive and negative perceptions of community pharmacy by parents and children, opportunities for an extended role in Europe, as well as the need for further training. The main limitations were the inclusion of English language papers only and an initial review of the literature carried out by a single researcher. It remains to be seen whether a ‘new-look’ role of the community pharmacist is practical and in alignment with specific European Commission and national policies.

Experiences relating to adverse drug reactions in the community: a cross-sectional survey among patients and the general public in Thailand

OBJECTIVE

To determine the frequency and characteristics of adverse drug reactions (ADRs), experiences of receiving and desire for information about medicines, and attitudes toward ADR knowledge and reporting among the community-dwelling Thai population.

METHODS

A cross-sectional self-administered survey conducted during October 2013 to December 2014 by convenience sampling. The study was conducted in three settings in the second-largest city, North-eastern Thailand: primary care units, community pharmacies and public areas.

RESULTS

Of 2400 respondents, 414 (17.3%) reported experiencing an ADR; two-thirds of which involved mild symptoms (66.7%) and 55.6% occurred within the last year. Self-reported ADR knowledge was low (4.1 ± 2.5 on a scale of 0 to 10). Pharmacists and physicians were the most common sources of information about medicines, but only 28.5% had received information about ADRs. Over 40% wanted information about ADRs and drug interactions, with healthcare professionals and information leaflets being desirable sources. The majority of individuals had positive views towards both receiving information and reporting their ADR experiences.

CONCLUSIONS

To enable the Thai public to report their experiences of ADRs more effectively, they require more medicines information. Information leaflets should be more widely available, while healthcare professionals should provide more detailed information of ADRs.

Adverse Drug Reactions in Pediatric Emergency Medicine

BACKGROUND

The pediatric population displays its own pharmacological characteristics, making children vulnerable to adverse drug reactions (ADRs).

OBJECTIVE

To determine the incidence of ADRs among the pediatric emergency department (PED) population.

METHODS

This is a descriptive, noncontrolled, prospective, and single-center study, during 4 consecutive months in the PED of Nantes University Hospital.

RESULTS

Setting up active gathering of data on ADRs enabled 121 reports of 11 095 consultations at the emergency department, which corresponds to an ADR incidence of 1.09%. Digestive and cutaneous reactions made up the majority of reactions judged as being nonserious (53%) and were mainly found in children between 2 -11 years old. Of the serious ADRs, 25% were found in the 12-15-year-old age range because of the drug overdose. The main medications administered, which were responsible for the majority of the ADRs, were an equimolar mix of oxygen and nitrogen monoxide, amoxicillin, and acetaminophen. Three means of collecting data were possible: collecting files data, oral communication, or filling a form, the last being the most used method.

CONCLUSIONS

This active data gathering shows the incidence and nature of the adverse effects as well as the age distribution in the PED population. It highlights the considerable misuse of medications among young teenagers and the high incidence of overmedication in the younger age group. This work also revealed the need for a better reporting system. Future joint studies should be carried out between clinical and pharmacological departments to optimize communication and the correct use of medications in children.

'The more you link, the more you risk …' - a focus group study exploring views about data linkage for pharmacovigilance

AIMS

The aim of this study was to assess opinions of frontline healthcare professionals on the linking of routinely collected national (Scottish) paediatric data for the purpose of identifying earlier signals of adverse drug reactions.

METHODS

Stratified purposive sampling led to profession-specific focus groups with pharmacists, nurses and medical doctors from primary and secondary care in different Scottish Health Boards. A topic guide was used to explore the proposed data linkage of routinely collected paediatric data. Discussions were audio recorded and transcribed verbatim. Transcripts were analysed using a framework approach to identify themes. Ethical approval was obtained from the North of Scotland Research Ethics Service.

RESULTS

Six focus groups were conducted in 2011 with 22 participants. Views of the proposed data linkage were generally positive. Several issues were identified, including lack of clarity on data ownership and concerns about diversion of funding. Identified issues were at a practical rather than a strategic level.

CONCLUSIONS

This study identified that professional stakeholder groups are likely to find linkage of paediatric patient data acceptable. Barriers identified could be addressed. Focus group participants commented on the importance of informing patients and members of the public about the benefits of linking healthcare data. These findings clarify the steps that should be taken to ensure the acceptability of data linkage for pharmacovigilance.

Linking NHS data for pediatric pharmacovigilance: Results of a Delphi survey

BACKGROUND

Adverse drug events are a major cause of patient safety incidents. Current systems of pharmacovigilance under-report adverse drug reactions (ADRs), especially in children, leading to delays in their identification. This is of particular concern, as children especially have an increased vulnerability to ADRs.

OBJECTIVES

The objective was to seek consensus among healthcare professionals (HCPs) about barriers and facilitators to the linkage of routinely collected health data for pediatric pharmacovigilance in Scotland.

METHODS

A Delphi survey was conducted with a random sample of HCPs including nurses, pharmacists and doctors, working in primary or secondary care, in Scotland. Participants were identified from sampling frames of the target professionals such as an NHS workforce list for general practitioners and recruited by postal invitation. A total of 819 HCPs were invited to take part. Those agreeing to participate were given the option of completing the questionnaires online or as hard copy. Reminders were sent twice at a fortnightly interval. Questions content included description of professional role as well as testing for the willingness to support the proposed project and was informed by the Theoretical Domains Framework of Behavior Change (TDF) and earlier qualitative work. Three Delphi rounds were administered, including a first round for item generation.

RESULTS

121 of those invited agreed to take part (15%). The first round of the Delphi study included 21 open questions and generated over a 1000 individual statements from 61 participants that returned the questionnaires (50.4%). These were rationalized to 149 items for the second round in which participants rated their views on the importance (or not) of each item on a 9-point Likert scale (strongly disagree - strongly agree). After the third round, there was consensus on items that focused on professional standards, and practical requirements, overall there was support for data linkage and a multi-professional approach.

CONCLUSIONS

It would be acceptable to stakeholders to introduce a data linkage system for pharmacovigilance as long as identified concerns are addressed. Concerns included adherence to current professional, legal and ethical standards, as well resolving practical issues.

Self-assessment tool for screening patients at risk for drug therapy problems

OBJECTIVE

To describe the development, use, and evaluation of a patient self-assessment tool for screening patients at risk for drug therapy problems (DTPs) and potentially interested in receiving a personal consultation with a pharmacist.

DESIGN

Quasi-experimental, nonrandomized, controlled study.

SETTING

Area Agency on Aging-affiliated senior centers in Florida from April 2005 to December 2005.

PARTICIPANTS

175 clients of an Area Agency on Aging.

INTERVENTION

While attending a free seminar on obtaining the best value from their medications, participants completed a 12-item self-assessment tool. The tool was designed to (1) identify participants who were at risk for a DTP and (2) motivate those at risk to participate in a personal pharmacotherapy consultation with a pharmacist on a fee-for-service basis.

MAIN OUTCOME MEASURE

Relationship between total score on self-assessment tool and patient acceptance of offer of personal pharmacotherapy consultation.

RESULTS

Of 175 participants who attended a free seminar, 69 (39.4%) accepted the offer of a personal pharmacotherapy consultation. The median score on the self-assessment tool in these participants was significantly higher compared with participants who declined a consultation (3 vs. 1, P = 0.0489). The number of DTPs eventually identified during the personal pharmacotherapy consultation was significantly and positively correlated with the total score on the self-assessment tool (ρ = 0.3259, P = 0.0110).

CONCLUSION

The self-assessment tool appeared to be of use in predicting individuals who were likely to accept the offer of a personal consultation. Higher scores on the self-assessment tool may also predict patients who are likely to have a higher number of DTPs.

Perceived adverse drug reactions among non-institutionalized children and adolescents in Germany

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Drug safety in paediatric medication is a public health concern. According to previous studies, the incidence of adverse drug reactions (ADRs) varies greatly from 0.7% to 2.7% among paediatric outpatients and from 2.6% to 18.1% among paediatric inpatients. Little has been reported on the risks of drug use in the general child population.

WHAT THIS STUDY ADDS

Our study showed that the prevalence of perceived ADRs in Germany was 0.9% among non-institutionalized children in general and 1.7% among children who had used at least one medicine within the 7 days before the medical interview. Perceived ADRs in the general child population were clustered with gastrointestinal disorders and subcutaneous tissue disorders. They appeared to be mild and at the lower limits of the range reported in other studies. Health surveys covering the use of a diverse range of drugs might be suitable for computing ADR prevalence and for identifying risk factors among non-institutionalized children. They should be taken into account together with other pharmacovigilance systems.

AIMS

Little has been reported on the risks of drug use in the general child population. This study investigated perceived adverse drug reactions (ADRs) among non-institutionalized children in Germany.

METHODS

All medicines used in the last 7 days before the medical interview were recorded among the 17 450 children aged 0-17 years who participated in the 2003-06 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Perceived ADRs were reported by the children's parents and confirmed by trained medical professionals during the medical interview.

RESULTS

One hundred and fifty-seven medicines were involved in the occurrence of 198 perceived ADRs in 153 patients. This corresponded to 1.1% of total used drugs, 0.9% (95% confidence intervals 0.7, 1.1%) of all children, and 1.7% (1.4, 2.1%) of children treated with medications. About 40% of all perceived ADRs involved gastrointestinal disorders and 16% involved skin tissue disorders. Perceived ADRs were most frequently reported in relation to drugs acting on the nervous system (25.8%), followed by systemic anti-infectives (18.7%) and drugs acting on the respiratory system (16.2%). Risk factors for perceived ADRs included older age groups, polypharmacy (>or=2) and a poor health status.

CONCLUSION

Perceived ADRs in the general child population were clustered with gastrointestinal disorders and subcutaneous tissue disorders. They appeared to be mild and at the lower limits of the range reported in other studies. Health surveys covering the use of a diverse range of drugs might be suitable for computing ADR prevalence and identifying risk factors among non-institutionalized children. They should be taken into account together with other pharmacovigilance systems.

Pharmacists' perceived knowledge and expertise in selected pediatric topics

OBJECTIVES

The purpose of this study is to determine pharmacists' perceived knowledge and expertise required to make recommendations regarding selected pediatric topics.

METHODS

A questionnaire was distributed to 400 pharmacists practicing in community, hospital, and home care settings. This instrument explored their perceived knowledge, expertise, and comfort in providing recommendations related to 38 pediatric topics. The impact of responder demographics on differences in perceived knowledge and expertise for each topic were evaluated.

RESULTS

Ninety-five of 400 (24%) questionnaires were returned completed or partially completed. Forty-seven and 36 of responders practiced in the community or inpatient hospital setting, respectively. Seventy percent of responders reported that ≤ 40% of their patients were children. In general, responders believed they had the knowledge and expertise to make recommendations for the frequently occurring conditions or topics but not for the less familiar. Formal pediatric training was the most influential responder characteristic with a larger proportion having training that they believed enables them to have knowledge and expertise to make recommendations. Although less impressive, experience of more than 5 years and a community-based practice were also important factors.

CONCLUSION

Additional training is beneficial in increasing the perceived knowledge and comfort of pharmacists making recommendations regarding pediatric patients.

Pharmacists' Perceived Knowledge and Expertise in Selected Pediatric Topics

OBJECTIVES

The purpose of this study is to determine pharmacists' perceived knowledge and expertise required to make recommendations regarding selected pediatric topics.

METHODS

A questionnaire was distributed to 400 pharmacists practicing in community, hospital, and home care settings. This instrument explored their perceived knowledge, expertise, and comfort in providing recommendations related to 38 pediatric topics. The impact of responder demographics on differences in perceived knowledge and expertise for each topic were evaluated.

RESULTS

Ninety-five of 400 (24%) questionnaires were returned completed or partially completed. Forty-seven and 36 of responders practiced in the community or inpatient hospital setting, respectively. Seventy percent of responders reported that ≤ 40% of their patients were children. In general, responders believed they had the knowledge and expertise to make recommendations for the frequently occurring conditions or topics but not for the less familiar. Formal pediatric training was the most influential responder characteristic with a larger proportion having training that they believed enables them to have knowledge and expertise to make recommendations. Although less impressive, experience of more than 5 years and a community-based practice were also important factors.

CONCLUSION

Additional training is beneficial in increasing the perceived knowledge and comfort of pharmacists making recommendations regarding pediatric patients.

A pilot study to evaluate a community pharmacy-based monitoring system to identify adverse drug reactions associated with paediatric medicines use

INTRODUCTION

Current pharmacovigilance systems are limited by spontaneous reporting of adverse drug reactions (ADRs), lack of a denominator, and lower than expected reporting rates. The aim of our study was to undertake a formal pilot evaluation of a community pharmacy-led ADR monitoring system.

METHODS

The setting was community pharmacies in five Health Boards areas of Scotland. Subjects were parents, guardians, or children presenting prescriptions for children 16 years and under prescribed serotonin specific reuptake inhibitors (SSRI), anticonvulsants, or medicines for the treatment of attention deficit hyperactivity disorder (ADHD). All pharmacies (n = 827) were invited to participate. Over a 3-month period they were asked to identify prescriptions for targeted medicines and give out an ADR questionnaire. Questionnaire content included child demography, duration of medicine use, indication, perceived ADRs, and their description and severity. The study was approved by the North of Scotland Research Ethics Committee.

RESULTS

Seventy-two community pharmacists (8.7%) agreed to take part. Two hundred and twenty-nine questionnaires were distributed and 55 (24%) completed and returned by parents. Forty-one questionnaires related to ADHD medications, 13 to anticonvulsants, and 1 to an SSRI. Thirty questionnaires reported 44 possible ADRs, 19 of which were related to methylphenidate.

CONCLUSIONS

The proposed ADR monitoring system identified expected ADRs thus demonstrating face and content validity for our approach. However the process was limited by low community pharmacist participation rates and low questionnaire return rates.

Recent Publications on Medications and Pharmacy

Hospital Pharmacy presents a new feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics.