A qualitative exploration of knowledge, attitudes and practices of hospital pharmacists towards adverse drug reaction reporting system in Lahore, Pakistan

An Awareness of Pharmacovigilance Among Healthcare Professionals Due to an Underreporting of Adverse Drug Reactions Issue: A Systematic Review of the Current State, Obstacles, and Strategy

BACKGROUND

Healthcare professionals play an essential role in reporting adverse drug reactions as part of pharmacovigilance activities. However, adverse drug reactions reported by healthcare professionals remain low.

OBJECTIVE

The aim of this systematic review was to investigate healthcare professionals' knowledge, awareness, attitude, and practice on pharmacovigilance and adverse drug reaction reporting, explore the causes of the underreporting issue, and provide improvement strategies.

METHODS

This systematic review was conducted using four electronic databases for original papers, including PubMed, Scopus, Google Scholar, and Scholar ID. Recent publications from 1st January 2012 to 31st December 2022 were selected. The following terms were used in the search: "awareness", "knowledge", "adverse drug reaction", "pharmacovigilance", "healthcare professional", and "underreporting factor". Articles were chosen, extracted, and reviewed by the two authors.

RESULTS

Twenty-five studies were selected for systematic review. This review found that 24.8%-73.33% of healthcare professionals were unaware of the National Pharmacovigilance Center. Around 20%-95.7% of healthcare professionals have a positive attitude toward pharmacovigilance and adverse drug reaction reporting, while 12%-60.8% of healthcare professionals have experience reporting any adverse drug reaction in their practice. The most frequently highlighted barriers to pharmacovigilance were a lack of awareness and knowledge regarding what, when, and to whom to report.

CONCLUSION

Underreporting issues require immediate attention among healthcare professionals due to a lack of awareness and knowledge of pharmacovigilance and adverse drug reaction reporting. Educational and training program interventions have been suggested by most studies to address these issues.

Barriers and facilitators to pharmacovigilance activities in Pakistan: A healthcare professionals-based survey

The timely reporting of adverse drug reactions (ADRs) could improve pharmacovigilance (PV) in a healthcare system. However, in almost all healthcare systems barriers exist that lead to the underreporting of ADRs. The objective of this study was to identify the barriers and facilitators regarding PV activities from the point of view of healthcare professionals (HCPs) in Lahore, Pakistan. A cross-sectional questionnaire-based survey was conducted between September 2018 to January 2019. The data was collected through convenience sampling of physicians, pharmacists, and nurses at tertiary care public hospitals in Lahore. A total of 384 questionnaires were distributed, and 346 HCPs responded to the survey. Over 62% percent of physicians and 54.8% of nurses agreed that they did not know how to report an ADR in their workplace. About 43.2% of pharmacists and 40.1% of nurses disagreed that they were not aware of the need for ADR reporting. Furthermore, 41.6% of nurses identified a lack of financial reimbursement and 51.8% highlighted a lack of support from a colleague as a reason that could lead to the underreporting of ADR. The majority of participants, including 69.6% physicians, 48.6% pharmacists, and 55.3% nurses identified the lack of knowledge about the existence of a national PV centre. Extra time for ADR reporting, incentives, continuous medical education, reminders, and availability of an online ADR reporting system was classed as the facilitators and were agreed upon by the majority of HCPs.

Community pharmacists' challenges regarding adverse drug reaction reporting: a cross-sectional study

OBJECTIVE

The effectiveness of the national drug safety monitoring program directly depends on the active participation of healthcare professionals in reporting suspected adverse drug reactions (ADRs). The aim of the study was to explore community pharmacists' comprehension of pharmacovigilance, their perspectives toward reporting ADRs and investigate the current practice of ADR reporting among pharmacists in Serbia.

METHODS

This descriptive cross-sectional study was performed on a sample of pharmacists in Serbia between November 2019 and March 2020 using a pre-tested questionnaire distributed online. Eligible participants were community pharmacists in Serbia who were willing to participate in the study during the data collection period. Non-parametric statistical tests were performed in the analysis of knowledge, perspectives and ADR reporting. The validity and reliability of the survey were measured by exploratory factor analysis.

RESULTS

The median knowledge score was 6 out of 10 (interquartile range 5-7, range 2-10). No significant differences in the knowledge scores of pharmacists were found based on weekly working hours (U = 24,805, p = .374), working experience (χ² = 4.011, DF = 2, p = .135), being a member of a professional organization (U = 24,312, p = .209), or highest level of pharmacy qualification obtained (χ² = 3.233, DF = 3, p = .506). Only 28.8% of pharmacists reported ADR at least once a year, while the majority of them have never reported any ADRs.

CONCLUSIONS

Despite the community pharmacists' positive attitude toward adverse drug reporting and their role in the process, they show limited knowledge regarding the issue and highly prevalent under-reporting of ADRs. Educational programs are necessary to increase ADRs reporting.

A Qualitative Study of Stakeholders' Views on Pharmacovigilance System, Policy, and Coordination in Pakistan

Objectives: Due to the absence of necessary rules, poor coordination, and various challenges, the pharmacovigilance system of Pakistan is not optimally functional at all levels of the health system. The objective of the study was to assess the stakeholders’ perceptions of the current ADR reporting system and to identify the pharmacovigilance policy issues and problems of effective coordination.

Methodology: Stakeholders from a broad range of disciplines, academia, regulatory authorities, the pharmaceutical industry, international health organizations, as well as pharmacovigilance experts, and healthcare professionals were included in the study. A total of 25 stakeholders throughout Pakistan were interviewed during exploratory semi-structured interviews. The interviews were recorded digitally, transcribed, coded, compared, and grouped according to their similarity of themes. Participants provided insights into gaps, limitations, and challenges of Pakistan’s current ADR reporting system, issues with proposed pharmacovigilance rules, and coordination difficulties.

Results: The majority of the participants considered the ADR reporting system in Pakistan to be improving but in a nascent phase. The identified gaps, challenges, limitations of the system, and barriers to reporting were labeled as reasons for limited functioning. Almost all stakeholders were aware of the existence of draft pharmacovigilance rules; however, participants in the industry were familiar with the contents and context of draft pharmacovigilance rules. Bureaucratic red tape and lack of political will appeared to be the top reasons for delaying the approval of the pharmacovigilance rules. Wider consultation, advocacy, and awareness sessions of policymakers and HCPs were suggested for early approval of rules. Participants unanimously agreed that the approval of rules shall improve the quality of life and reduce the economic burden along with morbidity and mortality rates. The need for greater and collaborative coordination among the stakeholders in promoting medicines’ safety was highlighted. All participants suggested the use of media and celebrities to disseminate the safety information.

Conclusion: Participants showed partial satisfaction with the way pharmacovigilance in Pakistan is moving forward. However, stakeholders believed that engagement of multi-stakeholders, approval of pharmacovigilance rules, and the establishment of pharmacovigilance centers in provinces, hospitals, and public health programs (PHPs) shall support in achieving the desired results.

Exploring the factors and barriers of healthcare professionals in tertiary care hospitals toward pharmacovigilance: a multicenter study from Khyber Pakhtunkhwa, Pakistan

BACKGROUND

Spontaneous Adverse drug reactions (ADRs) reporting is a cornerstone for a successful pharmacovigilance program as under-reporting of ADRs remains a major issue around the globe. The current study aimed to assess the knowledge attitude and practices of health care professionals regarding pharmacovigilance along with barriers and factors to encourage ADR reporting at tertiary care hospitals of Khyber-Pakhtunkhwa, Pakistan.

METHODS

A questionnaire-based cross-sectional survey was conducted, using the convenience sampling method to collect the data from doctors, nurses, and pharmacists working in seven tertiary care hospitals from seven districts of Khyber-Pakhtunkhwa province, Pakistan, between July 2019 and March 2020.

RESULTS

During the study, a total of 830 questionnaires were distributed, out of which 669 were returned (response rate 80.6%). Overall, Healthcare professionals exhibited poor knowledge (79.5%) about ADR reporting and pharmacovigilance however, 73.5% of pharmacists were more knowledgeable as compared to 18.7% doctors and 13.8% nurses (p < .001). Moreover, poor reporting practices were displayed by 95.6% doctors, 94.4% nurses, 94.4 and 75.5% pharmacists (p < .001). However, the majority of healthcare professionals showed an overall positive attitude (94%) toward ADR reporting. The most frequently cited barriers were unavailability of reporting forms (92.5%), absence of a professional environment to discuss ADRs (82.5%), and lack of training (81.8%) whereas, most common factors to encourage ADR reporting were obligatory reporting (85.9%) and provision of ADR management guidelines and training (84.3%). A significant relation was found between the healthcare professionals and their professional status with the overall knowledge, attitude, and practice (KAP) scores (p < .001) whereas a medium, positive correlation was found between the knowledge and practice of pharmacovigilance and ADR reporting by the healthcare professionals (r = 0.321, n = 669, p < .001).

CONCLUSION

There is an overall lack of knowledge and poor reporting practices among health care professionals on ADR reporting and pharmacovigilance. Hence the study suggests that strategies should be devised by all the stakeholders to properly educate and train the healthcare professionals in this area to enhance overall patient safety and safe use of medicines.

Assessment of the Current State of Pharmacovigilance System in Pakistan Using Indicator-Based Assessment Tool

Objectives: Pakistan felt the need for an effective and robust pharmacovigilance (PV) system after one of the deadliest drug-related tragedies causing more than 300 deaths in 2012. The country set up its national PV center in 2015 and joined WHO’s Program for International Drug Monitoring (PIDM) in 2018 as a full member. The current study was aimed to evaluate the PV system’s functionality, identify the gaps, areas of improvement, and a strategy to lead a functional PV system in Pakistan.

Methods: The descriptive cross-sectional study was conducted by providing an interviewer-administered questionnaire of the PV system across Pakistan by utilizing the Indicator based Pharmacovigilance assessment tool (IPAT). By a convenience sampling method 36 study participants were selected from the Drug Regulatory Authority of Pakistan (DRAP), drug administration of provincial health departments of 4 provinces and federally affiliated areas, 5 national public health programs, and 23 public and private hospitals. The assessment includes document review, interviews of the key informants by structured open-ended questions, and a review of websites of relevant organizations.

Results: Drug Regulatory Authority of Pakistan (DRAP) with a national PV center received a 75% overall performance score on IPAT. To be regarded as “minimally functioning,” a country’s PV and drug safety system must meet all core indicators. DRAP scored 80.76% on the core indicators so cannot be deemed functional at this time. The only province with a regional PV center, Punjab, had scored 72.13% on relevant parameters. Despite receiving funding from the Global Fund, none of the National Public Health Programs (PHPs) have PV centers or associated activities. All hospitals except two private hospitals could not qualify the minimum requirements for functional PV. The absence of a legal framework for mandatory ADR reporting, lack of drug information center, budgetary constraints, no active surveillance activities, the nonexistence of pharmacovigilance risk assessment expert committee, and insufficient coordination among stakeholders were identified as major gaps.

Conclusion: The results of the study reveal that Pakistan’s PV system is not fully functional at all levels. A two-phased strategy encompassing the non-financial and financial interventions is proposed to improve the PV systems at the national, provincial, PHPs, and hospitals levels.

The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review

BACKGROUND

The pharmacist's role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists' clinical roles in improving Pakistani patients' therapeutic, safety, humanistic, and economic outcomes.

METHODS

We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed.

RESULTS

The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions.

CONCLUSIONS

The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients' health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.

Practice and Attitude Towards COVID-19 Prevention and Divine Belief Among Residents in Ethiopia: Cross-Sectional Survey

PURPOSE

Coronavirus disease-2019 is an emerging disease that threatens the world. With the absence of successful treatment precipitated by the lack of health infrastructures in developing countries including Ethiopia, efforts to enhance the attitudes and practice of people are critical for managing the pandemic. Hence, this study aimed to assess the practice, attitude towards COVID-19, and divine belief among residents in Ethiopia.

PATIENTS AND METHODS

A community-based cross-sectional study combining qualitative design was conducted in August 2020. The qualitative design was employed to explore the respondents' divine belief towards the COVID-19 pandemic. Chi-square analysis was computed to identify factors associated with practice against COVID-19 prevention measures. The calculated chi-square greater than the tabulated value at a degree of freedom ((row total-1) * (column total)) and P-value <0.05 were considered statistically significant.

RESULTS

In this study, a total of 508 respondents participated. The mean age of the participants was 38.4 ± 11.2 (SD) years. The overall practice of prevention measures and attitude towards COVID-19 was 53.3% (95% CI: 49.0-57.6%) and 49.6% (95% CI: 45.3-53.9%), respectively. Age, residency, educational status, monthly income of the household, having a child, and attitude towards COVID-19 were statistically significant predictors of COVID-19 prevention measures (P< 0.05).

CONCLUSION

As the global threat of COVID-19 continues, it is critical to improving the respondents' practice and attitude towards the precautionary measures, especially some religious followers.

Exploring healthcare professionals' knowledge, attitude, and practices towards pharmacovigilance: a cross-sectional survey

Background

Spontaneous reporting of adverse drug reactions (ADRs) is a method of monitoring the safety of drugs and is the basic strategy for the post-marketing surveillance of the suspected drugs. Despite its importance, there is very little reporting of ADRs by healthcare professionals. The present study has evaluated the knowledge, attitude and practices of health care professionals (HCPs) regarding pharmacovigilance activities in Lahore, Pakistan.

Methods

A cross-sectional questionnaire-based survey was employed, and a convenience sampling was opted to collect the data among physicians, pharmacists and nurses working in tertiary care public hospitals of Lahore, Pakistan from September 2018 to January 2019.

Results

Of the 384 questionnaires distributed, 346 health care professionals responded to the questionnaire (90.10% response rate). Most participants had good knowledge about ADR reporting, but pharmacist had comparatively better knowledge than other HCPs regarding ADR (89.18%) pharmacovigilance system (81.08%), its centres (72.97%) and function (91.89%). Most of the participants exhibited positive attitude regarding ADR reporting, such as 49.1% of physicians (P < 0.05), 70.2% pharmacists and 76.1% nurses showed a positive attitude that they are the most important HCPs to report an ADR. About 64.3% of physicians (P < 0.05) emphasized that consulting other colleagues is important before reporting an ADR. Of all, 77.7% physicians, 75.7% pharmacists and 68% of nurses had positive attitude that ADR reporting is a professional obligation and 67.6% of the pharmacists stated that they have reported ADRs in their workplace and 77.2% nurses have verbally reported ADRs to the concerned personnel or department.

Conclusion

Among all HCPs, pharmacists had better knowledge about ADR reporting and pharmacovigilance. All HCPs had positive attitude and inclination towards ADR reporting. The discrepancies were observed in the practices related to ADR reporting, whereas most of the participants including physicians and nurses did not report any ADR. Based on the above, strategies are needed to educate, train, and empower the HCPs in the domain of pharmacovigilance.

Adherence to the Core Elements of Outpatient Antibiotic Stewardship: A Cross-Sectional Survey in the Tertiary Care Hospitals of Punjab, Pakistan

BACKGROUND

There is a growing global interest in hospital-based antibiotic stewardship programs (ASPs). Centers for Disease Control and Prevention (CDC) recommends clinicians and facilities in outpatient department (OPD) to adhere to a set of stewardship activities called the Core Elements of Outpatient Antibiotic Stewardship (CEOAS). CEOAS includes 4 core elements for OPD facilities and clinicians each, ie, commitment, action, tracking and reporting, and education and expertise.

AIM

The aim of this study was to evaluate the adherence of OPDs in tertiary care hospitals to CEOAS.

DESIGN AND SETTING

A cross-sectional study in the hospitals in Punjab, Pakistan.

METHODS

Study was reported as per STROBE guidelines. Data were collected from hospitals based on purposive sampling on the CEOAS framwork. On a summative scale, positive response to each core element worthed a score and higher the score better the adherence. Descriptive statistics was used for categorical variables while independent t-test computed group differences.

RESULTS

Fifty-three tertiary care hospitals (n=22 public, n=31 private) participated (response rate=86.9%). No hospital reported "perfect" adherence. Overall, facilities and clinicians in OPDs were moderately adherent. Subgroup analysis indicated that hospitals in public and private were poorly (4.9) and moderately (6.0) adherent to CEOAS respectively, however, private clinicians scored significantly higher in action, and tracking and reporting. Tracking and reporting of antibiotics and education of patients and clinicians emerged as top deficiency areas in facilities and clinicians respectively.

CONCLUSION

Significant gaps exist in the adherence to CEOAS. The deficiency areas highlighted in the study should be given priority in future policy shift.

Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: An online-based cross-sectional study

In Bangladesh, an array of measures have been adopted to control the rapid spread of the COVID-19 epidemic. Such general population control measures could significantly influence perception, knowledge, attitudes, and practices (KAP) towards COVID-19. Here, we assessed KAP towards COVID-19 immediately after the lock-down measures were implemented and during the rapid rise period of the outbreak. Online-based cross-sectional study conducted from March 29 to April 19, 2020, involving Bangladeshi residents aged 12-64 years, recruited via social media. After consenting, participants completed an online survey assessing socio-demographic variables, perception, and KAP towards COVID-19. Of the 2017 survey participants, 59.8% were male, the majority were students (71.2%), aged 21-30 years (57.9%), having a bachelor's degree (61.0%), having family income >30,000 BDT (50.0%), and living in urban areas (69.8). The survey revealed that 48.3% of participants had more accurate knowledge, 62.3% had more positive attitudes, and 55.1% had more frequent practices regarding COVID-19 prevention. Majority (96.7%) of the participants agreed 'COVID-19 is a dangerous disease', almost all (98.7%) participants wore a face mask in crowded places, 98.8% agreed to report a suspected case to health authorities, and 93.8% implemented washing hands with soap and water. In multiple logistic regression analyses, COVID-19 more accurate knowledge was associated with age and residence. Sociodemographic factors such as being older, higher education, employment, monthly family income >30,000 BDT, and having more frequent prevention practices were the more positive attitude factors. More frequent prevention practice factors were associated with female sex, older age, higher education, family income > 30,000 BDT, urban area residence, and having more positive attitudes. To improve KAP of general populations is crucial during the rapid rise period of a pandemic outbreak such as COVID-19. Therefore, development of effective health education programs that incorporate considerations of KAP-modifying factors is needed.

Strengthening the Bolivian pharmacovigilance system: New surveillance strategies to improve care for Chagas disease and tuberculosis

Chagas disease (CD) and tuberculosis (TB) are important health problems in Bolivia. Current treatments for both infections require a long period of time, and adverse drug reactions (ADRs) are frequent. This study aims to strengthen the Bolivian pharmacovigilance system, focusing on CD and TB. A situation analysis of pharmacovigilance in the Department of Cochabamba was performed. The use of a new local case report form (CRF) was implemented, together with the CRF established by the Unidad de Medicamentos y Tecnología en Salud (UNIMED), in several healthcare centers. Training and follow-up on drug safety monitoring and ADR reporting was provided to all health professionals involved in CD and TB treatment. A comparative analysis of the reported ADRs using the CRF provided by UNIMED, the new CRF proposal, and medical records, was also performed. Our results showed that out of all patients starting treatment for CD, 37.9% suffered ADRs according to the medical records, and 25.3% of them were classified as moderate/severe (MS). Only 47.4% of MS ADRs were reported to UNIMED. Regarding TB treatment, 9.9% of all patients suffered ADRs, 44% of them were classified as MS, and 75% of MS ADRs were reported to UNIMED. These findings show that the reinforcement of the Bolivian pharmacovigilance system is an ambitious project that should involve a long-term perspective and the engagement of national health workers and other stakeholders at all levels. Continuity and perseverance are essential to achieve a solid ADR reporting system, improving patient safety, drug efficacy and adherence to treatment.

Knowledge, attitude, practice and perceived barriers among healthcare workers regarding COVID-19: a cross-sectional survey from Pakistan

A self-administered validated (Cronbach's alpha=0.077) questionnaire was used to assess knowledge, attitude and practice among healthcare workers (HCWs) in Pakistan regarding coronavirus disease 2019 (COVID-19). Findings showed that HCWs have good knowledge (93.2%, N=386), a positive attitude [mean 8.43 (standard deviation 1.78)] and good practice (88.7%, N=367) regarding COVID-19. HCWs perceived that limited infection control material (50.7%, N=210) and poor knowledge regarding transmission (40.6%, N=168) were the major barriers to infection control. Regression analysis indicated that pharmacists were more likely to demonstrate good practice than other HCWs (odds ratio 2.247, 95% confidence interval 1.11-4.55, P=0.025). This study found that HCWs in Pakistan have good knowledge, but there are gaps in specific aspects of knowledge and practice that warrant attention.

A Qualitative Evaluation of Adverse Drug Reaction Reporting System in Pakistan: Findings from the Nurses' Perspective

The contribution of all key healthcare professionals is vital to promote an efficient adverse drug reaction (ADR) reporting system. In this context, nurses are important as they are in a better position to observe a patient's response regarding the drug therapy and to report an ADR. The aim of the study was to explore the perspectives of nurses about ADR reporting system in Lahore, Pakistan. A total of 21 nurses were interviewed. The thematic content analysis of the qualitative interviews yielded six major themes and eight subthemes. Major themes included: (1) Knowledge about the concept of the medication safety & the ADR; (2) Knowledge regarding pharmacovigilance activities; (3) Willingness to report; (4) Practices related to the ADR reporting; (5) Barriers to the ADR reporting; (6) Facilitators to the ADR reporting. The majority of the nurses were aware of medicine safety and ADRs, but in many cases, they were unable to report these ADRs. The study pointed out considerable concerns regarding the knowledge and practices of nurses about pharmacovigilance activities in their workplace, mainly due to increased workload, due to the absence of a reporting system and legal liability. The main challenges turned out to be the lack of knowledge and training, as well as the implementation of guidelines. Based on the findings, it is suggested that outcome of this study can serve as a guide to design policies that support ADR reporting by nurses in Pakistan.

Physicians' Understanding and Practices of Pharmacovigilance: Qualitative Experience from A Lower Middle-Income Country

Developed countries have established pharmacovigilance systems to monitor the safety of medicines. However, in the developing world, drug monitoring and reporting are facing enormous challenges. The current study was designed to explore the challenges related to the understanding and practices of physicians in reporting adverse drug reactions in Lahore, Pakistan. Through the purposive sampling technique, 13 physicians were interviewed. All interviews were audio-recorded, transcribed verbatim, and analyzed for a thematic content analysis. The thematic content analysis yielded six major themes: (1) Familiarity with medication safety and adverse drug reaction (ADR) concept, (2) Knowledge about pharmacovigilance activities, (3) Practices related to ADR reporting, (4) Barriers impeding ADR reporting, (5) Acknowledgement of the pharmacist’s role, and (6) System change needs. The majority of the physicians were unaware of the ADR reporting system; however, they were ready to accept practice changes if provided with the required skills and training. A lack of knowledge, time, and interest, a fear of legal liability, poor training, inadequate physicians’ and other healthcare professionals’ communication, and most importantly lack of a proper reporting system were reported as barriers. The findings based on emerging themes can be used to establish an effective pharmacovigilance system in Pakistan. Overall, physicians reported a positive attitude towards practice changes, provided the concerned authorities support and take interest in this poorly acknowledged but most needed component of the healthcare system.

Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: An online-based cross-sectional study

In Bangladesh, an array of measures have been adopted to control the rapid spread of the COVID-19 epidemic. Such general population control measures could significantly influence perception, knowledge, attitudes, and practices (KAP) towards COVID-19. Here, we assessed KAP towards COVID-19 immediately after the lock-down measures were implemented and during the rapid rise period of the outbreak. Online-based cross-sectional study conducted from March 29 to April 19, 2020, involving Bangladeshi residents aged 12-64 years, recruited via social media. After consenting, participants completed an online survey assessing socio-demographic variables, perception, and KAP towards COVID-19. Of the 2017 survey participants, 59.8% were male, the majority were students (71.2%), aged 21-30 years (57.9%), having a bachelor's degree (61.0%), having family income >30,000 BDT (50.0%), and living in urban areas (69.8). The survey revealed that 48.3% of participants had more accurate knowledge, 62.3% had more positive attitudes, and 55.1% had more frequent practices regarding COVID-19 prevention. Majority (96.7%) of the participants agreed 'COVID-19 is a dangerous disease', almost all (98.7%) participants wore a face mask in crowded places, 98.8% agreed to report a suspected case to health authorities, and 93.8% implemented washing hands with soap and water. In multiple logistic regression analyses, COVID-19 more accurate knowledge was associated with age and residence. Sociodemographic factors such as being older, higher education, employment, monthly family income >30,000 BDT, and having more frequent prevention practices were the more positive attitude factors. More frequent prevention practice factors were associated with female sex, older age, higher education, family income > 30,000 BDT, urban area residence, and having more positive attitudes. To improve KAP of general populations is crucial during the rapid rise period of a pandemic outbreak such as COVID-19. Therefore, development of effective health education programs that incorporate considerations of KAP-modifying factors is needed.

Current status and future prospects of pharmacovigilance in Pakistan

Countries all around the globe are working to establish robust pharmacovigilance systems. Whereas the majority of the developed countries have established well-organized pharmacovigilance systems, the developing countries still lack the basic infrastructure to establish such systems. This commentary focuses on the need of pharmacovigilance and its current status and future trends in Pakistan.

Attitude, perception, willingness, motivation and barriers to practice-based research: A cross-sectional survey of hospital pharmacists in Lahore, Punjab, Pakistan

Background and objectives

Practice-based research (PBR) is of pivotal importance for hospital pharmacists which not only up-grades the profession but also improves the patient care. This study aimed to evaluate the attitude, perception, willingness, motivation and barriers to PBR among hospital pharmacists in Pakistan.

Methods

A descriptive, cross sectional study design was employed. Data were collected between 1^st December, 2017 and 1^st March, 2018 from 130 hospital pharmacists employed in 41 hospitals of Lahore, Pakistan. A survey instrument comprising of six sections was designed to determine the attitude, perception, willingness, motivation and barriers to PBR. Data were analyzed by using Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, version 21.0, Armonk, NY: IBM Corp.). The normality of the data was determined through Shapiro-Wilks and Kolmogorov-Smirnov tests. Independent Samples Mann-Whitney U Test and Independent Samples Kruskal-Wallis Test were carried out to test if there were differences among the characteristics of the hospital pharmacists. Logistic regression analysis was used to figure out the factors associated with attitude, perceptions, willingness and motivation towards PBR. A p-value <0.05 was used for statistical significance of differences.

Results

A total of 141 pharmacists were approached. Among them, 130 responded to the survey (response rate 92%). Out of a maximum score i.e., 5 (100%) the respondents obtained a median score of 4 (IQR = 0) for attitude, perception and motivation towards PBR; whereas, a median score of 4 (IQR = 1) was obtained for willingness thus demonstrating fair positive attitude, good perceptions, increased motivation and willingness towards PBR. The most common barrier limiting the pharmacists’ participation in PBR was lack of time (23.8%) followed by lack of incentives (16.2%) and lack of support (14.6%). Results of the logistic regression analysis revealed that hospital pharmacists practicing in the inpatient settings had 4.56 times more positive attitude towards PBR (OR = 4.56, 95%CI = 1.07─19.42, p-value = 0.040) as compared to those practicing in the outpatient settings. The male hospital pharmacists (OR = 8.86, 95%CI = 1.15–53.74, p-value = 0.017), those practicing in the outpatient (OR = 23.51, 95%CI = 2.04─271.53, p-value = 0.011) and inpatient settings had increased motivation towards PBR (OR = 12.24, 95%CI = 1.61─94.66, p-value = 0.016).

Conclusion

Despite the presence of several barriers, the respondents had fair positive attitude, good perceptions, increased motivation and willingness towards PBR which is a promising finding.