Effective communication of drug safety information to patients and the public: a new look

Factors Contributing to Best Practices for Patient Involvement in Pharmacovigilance in Europe: A Stakeholder Analysis

Introduction

Involving patients in decision making adds value in the context of pharmacovigilance (PV). This added value goes beyond participation in spontaneous reporting systems for adverse drug reactions. However, there is a gap between allowing patients to report and actual patient involvement. Views regarding best practices from regulators, patient organizations and pharmaceutical companies could help increase and improve patient involvement in PV.

Objective

The aim of this study was to investigate the factors contributing to best practices for patient involvement in PV and to develop a definition of patient involvement based on a qualitative multistakeholder study across Europe.

Methods

A literature review was conducted to map the field of study and obtain insights for the elaboration of an interview guide. Subsequently, patient representatives, members of the pharmaceutical industry and regulators were invited to participate in interviews. These interviews were analyzed using NVIVO^® software and employing reflective thematic analysis.

Results

A total of 20 interviews were conducted with representatives at both the national and European levels. The best practices identified were engagement from the start, face-to-face communication, a full circle of feedback, same-level partners, structured involvement and guidelines, establishing common goals, patient education and empowerment, and developing trust and balance. These activities can be implemented via deep collaboration among stakeholders. A definition of patient involvement was constructed in accordance with the input of all stakeholder groups, which reflects the involvement of all types of patients at all levels of the decision-making process.

Conclusion

In this study, we developed a definition for patient involvement based on qualitative interviews. The factors contributing to best practices for patient involvement were mentioned across stakeholder groups and aimed to stimulate patient involvement in PV. Patients are eager to become equal partners and to engage effortlessly in the same manner as other stakeholders.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40264-022-01222-y.

Problem-based training improves recognition of patient hazards by advanced medical students during chart review: a randomized controlled crossover study

BACKGROUND

Patient chart review is the gold standard for detection of potential patient hazards (i.e. medication errors or failure to follow up actionable results) in both routine clinical care and patient safety research. However, advanced medical students' ability to read patient charts and to identify patient hazards is rather poor. We therefore investigated whether it is possible to teach advanced medical students how to identify patient hazards independent of context (i.e. cancer versus cardiac failure) in patient charts.

METHODS

All fifth-year medical students in one semester (n = 123) were randomized into two groups. One group (IC) received a patient chart review-training first and then a control-intervention and the other group (CI) received the control-intervention first and then the patient chart review-training. Before and after the teaching sessions, students reviewed different scenarios with standardized fictional patient charts containing 12 common patient hazards. Two blinded raters rated the students' notes for any patient hazard addressed in the notes using a checklist. The students were blinded to the study question and design. There was no external funding and no harm for the participating students.

RESULTS

A total of 35 data sets had to be excluded because of missing data. Overall, the students identified 17% (IQR 8-29%) of the patient hazards before the training and 56% (IQR 41-66%) of the patient hazards after the training. At the second assessment students identified more patient hazards than at the first. They identified even more in the third. The effect was most pronounced after the patient chart review training (all p<.01).

CONCLUSION

Patient chart review exercises and problem-based patient chart review training improve students' abilities to recognize patient hazards independent of context during patient chart review.

Responding to a bioterrorism attack--one scenario: part 1

This article continues the discussions introduced in an earlier article submitted to The Health Care Manager entitled "Epidemic Simulation for Syndromic Surveillance," wherein a format for analysis of the incidence of a bioterrorist attack was presented. This article outlines a simulation conducted as part of a federal grant award administered through the Center for Biological Defense at the University of South Florida. The disease entity simulated was an attack of anthrax introduced into the Central Florida region. The spread, effects, and eventual control of the disease entity are highlighted.

Safety and risk communication to patients

Comprehensive and accurate information about the medicines available to them is a key issue for patients to participate in the decision making process of their own healthcare. One aspect of this information is the patient information leaflet provided by the manufacturer, according to national and international guidelines. The comprehensibility and user-friendliness of these manufacturers' leaflets has been tested and criticised. In addition to this information under the laws of national and international authorities, consumer-oriented websites of self-help groups are becoming a more and more relevant source of information. For most patients, the primary sources of information are healthcare professionals, such as the prescribing physicians and/or nurses or the dispensing pharmacist. The information provided for by healthcare professionals has to be tailored according to the patients' needs, where law suits against physicians often address the comprehensiveness and a lack of documentation. Improvement of individualised drug information has been shown to increase patients' satisfaction and treatment adherence, whereas the overall influence on outcome (i.e., reduction of adverse drug events) has still to be demonstrated. However, in order to achieve such a goal, striking changes in the whole system of pharmacovigilance have to be implemented with special emphasis on patients and consumers representation.

How Changes In Drug-Safety Regulations Affect The Way Drug And Biotech Companies Invest In Innovation

Changes in the economics of product development resulting from heightened safety regulations could have a sizable negative impact on drug and biotechnology companies' decisions about investing in innovation. We developed a model to compare the potential economic effects of pre- and postmarketing strategies to identify safety problems with new drugs. Although expanding Phase III clinical testing and postmarketing safety surveillance are not perfect substitutes, our findings suggest that even a large increase in funding for the latter will have a relatively small adverse impact on investment decisions by drug companies and venture capital firms, compared with the former.

Survey of medication knowledge and behaviors among college students in Taiwan

OBJECTIVES

To survey the knowledge, attitudes, and practices towards safe medication use of first-year college students in Taiwan.

METHODS

One hundred forty-seven departments in 27 universities were sampled by stratified randomization. Three sections of the questionnaire were developed, including 10 true/false questions to measure knowledge, 4 questions for attitude in a 5-point scale, and 10 questions for practice in a 5-point scale.

RESULTS

A total of 6270 subjects completed the survey instrument for a valid response rate of 91.9%. Students who were health science majors had safer medication practices than non-health science majors. However, students in both groups had low scores on appropriate antibiotics use, with a correctness rate of 45.8%. Knowledge relating to antacid use had the lowest number of correct responses among the 10 items included in the survey. Overall, the students showed positive attitudes toward (12.6 +/- 2.2) and trusted (3.6 +/- 0.7) pharmacists' consultation.

CONCLUSIONS

College students lack appropriate knowledge, attitudes, and practices related to the safe use of medications, and efforts are warranted in Taiwan.

Pharmacovigilance during the Pre-Approval Phases

Pharmacovigilance science has traditionally been a discipline focussed on the postmarketing or post-authorisation period, with due attention directed towards pre-clinical safety data, clinical trials and adverse events. As the biological sciences have evolved, pharmacovigilance has slowly shifted toward earlier, proactive consideration of risks and potential benefits of drugs in the pre- and peri-approval stages of drug development, leading to a maturing of drug safety risk management. Further advances in biology, pharmacology and improvements in computational applications to medicine have led to the development of more complex medicines previously unobtainable and have also permitted a more thorough assessment of risks and potential benefits even earlier in the development process. Elevated public concern with the safety of more sophisticated medicines, combined with new science, have led pharmaceutical innovators, regulators and healthcare professionals to collaborate to develop guidelines, which drive enhanced pharmacovigilance and safety risk management earlier in drug development. In this paper, we review international guidelines on pharmacovigilance planning applicable to the pre-approval phases of medicines development and provide author opinion on these guidelines' potential drug safety implications. We discuss the possible evolution of a pharmaceutical industry model to respond to these guidelines; a view on multidisciplinary safety management teams is provided to encourage refinement of safety-signal identification and risk assessment early in drug development and to communicate important safety concerns to internal research efforts, patients, investigators and regulators. We further describe these functions in the context of the complexities of vulnerable populations, including the example of medicines research for paediatric populations. We also discuss the special role of epidemiology in pre-approval drug development and the impact on epidemiological science of changes to the pharmacovigilance paradigm.

The role of drug and therapeutics committees

PURPOSE

Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers.

DESIGN/METHODOLOGY/APPROACH

Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. "Patient awareness" was studied by content analysis.

FINDINGS

In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development.

ORIGINALITY/VALUE

The importance of "patient awareness" within DTCs must be further explored.

Risque médicamenteux : prévention

Effective prevention of drug-induced risks depends on an accurate understanding of their triggering or predisposing factors, and the quality of information on these available to prescribing practitioners and users. All preclinical and clinical data available on the proprietary medicinal product concerned should facilitate identification of a risk, and these data should be compared with existing data on drugs sharing the same mode of action or therapeutic strategy. This information should be based on a communication plan adapted to the context of the disease under treatment, the therapeutic alternatives available and the benefits expected.