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Alharbi AB, Berrou I, Umaru N, Al Hamid A, Shebl NA. Understanding factors influencing the implementation of medicine risk communications by healthcare professionals in clinical practice: a systematic review using the Theoretical Domains Framework. Res Social Adm Pharm 2024; 20:86-98. [PMID: 37978010 DOI: 10.1016/j.sapharm.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/20/2023] [Accepted: 10/15/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Adverse drug reactions (ADRs) are known to cause hospitalisation, longer hospital stays, as well as higher healthcare costs and mortality. Unrecognised ADRs are anticipated throughout the medicine lifecycle as, before the medicine reaches the market, clinical trials are conducted for a short period on a limited number of people, who might underrepresent the actual population. After the medicine reaches the market, emergent information that could affect its benefit-to-risk balance is usually shared by regulatory agencies and pharmaceutical companies through medicine risk communications. Medicines risk communications aim to prevent harm to patients by targeting their behaviour, knowledge, and attitudes, as well as those of health care professionals (HCPs). Despite their important role in translating these communications into their clinical practice, HCPs do not always adhere to the recommendations provided in risk communications. Measurement of medicine risk communications' effectiveness does not necessarily guarantee their implementation, cost-effectiveness, or transferability in real-world situations. To enhance the impact of drug regulatory interventions, implementation science has been encouraged. However, implementation science was not previously used to identify factors affecting HCPs' implementation of medicines risk communications. A recently widely used framework is the Theoretical Domain Framework (TDF). In this systematic review, the TDF was employed to categorise a range of different factors that could affect HCPs' implementation of medicine risk communications within their clinical contexts. METHODS The search strategy involved a set of predefined search terms and fifteen databases, such as EMBASE, PubMed, Web of Science and CINAHL PLUS. Searches were conducted from April to May 2018 and updated in June 2021 using PubMed, Scopus, and CINAHL PLUS. A second reviewer independently conducted the screening process of the initial search. The total number of records screened was 10,475. A study was included if it reported any factors influencing HCPs' uptake of medicine risk communications. Only studies with English or Arabic abstracts were included. Those studies that did not include pharmacovigilance-related medicine risk communications were excluded. Additionally, studies only assessing HCPs' practice or evaluating the effectiveness of risk minimisation measures were excluded. Likewise, studies related to occupational hazards, case reports, interventional studies, and studies not involving HCPs were excluded. In case the published information was insufficient to decide whether to include or exclude a study, the authors were contacted. Furthermore, the authors of seven eligible abstracts were contacted for full-text articles. The mixed method appraisal tool (MMAT) was used to evaluate the quality of the included studies. All included studies were assessed by one reviewer, and a total of 16 studies were assessed by two reviewers independently. Disagreements were resolved through discussion. Using thematic analysis and concept mapping, a narrative synthesis was performed, followed by a critical reflection on the synthesis process. This review presents the results of the concept mapping, which involved matching the identified factors to the TDF. RESULTS A total of 28 studies were included. Eleven domains influenced HCPs' implementation of medicine risk communications. A large number of studies included factors related to the "Knowledge" domain (n = 23), followed by "Beliefs about Consequences" (n = 13), "Memory, Attention and Decision Processes" (n = 12) and "Environmental Context and Resources" domains (n = 12). Seven studies reported "social influences" and six studies included factors relating to "Goals", followed by four studies involving factors related to "Social/Professional Role and Identity". Underrepresented domains included "Emotion" (n = 2), "Beliefs about Capabilities" (n = 2), "Behavioural Regulation" (n = 1), and "Reinforcement" (n = 1). On the other hand, none of the identified factors were related to the "Skills", "Optimism", or "Intentions" domains. Except for "Beliefs about Consequences", most studies contributing to the other three most commonly reported domains ("Knowledge"; "Environmental Context and Resources"; and "Memory, Attention and Decision Processes") scored low (1 or 2 out of 5) on the MMAT quality assessment. Moreover, the same number of studies (n = 5) contributing to the "Beliefs about Consequences" domain had low (1 or 2 out of 5), and intermediate (3 out of 5) scores on the MMAT. CONCLUSION Medicines risk communications are important tools for disseminating information that may influence the benefit-to-risk balance of medicines. Even though HCPs are required to implement the recommendations of these communications, they do not always adhere to them. Using the TDF enabled the categorization of the range of factors that affect whether or not HCPs implement the recommendations provided in a medicine risk communication. However, most of these factors relate to four domains only ("Knowledge"; "Beliefs about Consequences"; "Memory, Attention and Decision Processes"; and "Environmental Context and Resources"). Additionally, most of the studies contributing to three of these four domains were of low quality. Future research should focus on using implementation science to identify target behaviours for actionable medicine risk communications. Regulators should use such science to develop cost-effective strategies for improving the implementation of medicines risk communication by HCPs.
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Affiliation(s)
| | - Ilhem Berrou
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Nkiruka Umaru
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Abdullah Al Hamid
- Department of Pharmacy Practice, College of Clinical PharmacyKing Faisal University, Al-Ahsa, Saudi Arabia
| | - Nada Atef Shebl
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Sindahl P, Overgaard-Steensen C, Wallach-Kildemoes H, De Bruin ML, Kemp K, Gardarsdottir H. Impact of a Treatment Guide on Intravenous Fluids in Minimising the Risk of Hospital-Acquired Hyponatraemia in Denmark. J Clin Med 2023; 12:5105. [PMID: 37568506 PMCID: PMC10420267 DOI: 10.3390/jcm12155105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
Hypotonic intravenous (IV) fluids are associated with an increased risk of hospital-acquired hyponatraemia, eventually leading to brain injury and death. We evaluated the effectiveness of a treatment guide to improve prescribing practices of IV fluids. We conducted a before-and-after cross-sectional survey among physicians working at Danish emergency departments. The primary outcome was prescribing practices of IV fluids. Participants were asked which IV fluid they would select in four clinical scenarios. We applied multivariate logistic regression models to estimate the odds ratio of selecting hypotonic fluids. Secondary outcomes included knowledge about IV fluids and hyponatraemia, and the receipt, reading, and usefulness of the treatment guide. After the intervention, about a third (47/154) reported that they would use hypotonic fluids in patients with increased intracranial pressure, and a quarter (39/154) would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. A total of 46% selected the correct fluid, a 3% hypertonic saline solution for a patient with hyponatraemia and severe neurological symptoms. None of the knowledge questions met the predefined criteria of success of 80% correct answers. Of the respondents, 22% had received the treatment guide. Since the implementation failed, we recommend improving distribution by applying methods from implementation science.
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Affiliation(s)
- Per Sindahl
- Danish Medicines Agency, Division of Pharmacovigilance and Medical Devices, 2300 Copenhagen, Denmark;
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.L.D.B.); (H.G.)
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | | | - Helle Wallach-Kildemoes
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Marie Louise De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.L.D.B.); (H.G.)
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kaare Kemp
- Danish Medicines Agency, Division of Pharmacovigilance and Medical Devices, 2300 Copenhagen, Denmark;
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands; (M.L.D.B.); (H.G.)
- Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, 102 Reykjavik, Iceland
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3
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Bahri P, Bowring G, Edwards BD, Anton C, Aronson JK, Caro-Rojas A, Hugman BPJ, Mol PG, Trifirò G, Ilic K, Daghfous R, Fermont I, Furlan G, Gaissmaier W, Geer MI, Hartigan-Go KY, Houÿez F, Neth H, Norgela G, Oppamayun Y, Raynor DKT, Bouhlel M, Santoro F, Sultana J. Communicating for the Safe Use of Medicines: Progress and Directions for the 2020s Promoted by the Special Interest Group of the International Society of Pharmacovigilance. Drug Saf 2023; 46:517-532. [PMID: 37219785 DOI: 10.1007/s40264-023-01285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Priya Bahri
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland.
- European Medicines Agency (EMA) (Coordinator of the ISoP CommSIG in Her Personal Capacity), Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
| | - Geoffrey Bowring
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Uppsala Monitoring Centre (UMC), Uppsala, Sweden
| | - Brian D Edwards
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Husoteria Ltd, Ashtead, UK
| | - Christopher Anton
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Angela Caro-Rojas
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Peter G Mol
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Katarina Ilic
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Takeda, Cambridge, MA, USA
| | - Riadh Daghfous
- Tunisian National Centre of Pharmacovigilance, Tunis, Tunisia
| | - Irene Fermont
- Israel Society for Medication and Vaccine Safety (ERANIM), Jerusalem, Israel
| | - Giovanni Furlan
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- Pfizer s.r.l., Safety Surveillance and Risk Management, Milan, Italy
| | - Wolfgang Gaissmaier
- Department of Psychology, Social Psychology and Decision Sciences, University of Konstanz, Konstanz, Germany
| | - Mohammad Ishaq Geer
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, India
| | - Kenneth Y Hartigan-Go
- Special Interest Group on Medicinal Product Risk Communication of the International Society of Pharmacovigilance (ISoP CommSIG), Geneva, Switzerland
- School of Government, Ateneo De Manila University, Quezon City, Philippines
| | - François Houÿez
- European Organisation for Rare Diseases (EURORDIS), Paris, France
| | - Hansjörg Neth
- Department of Psychology, Social Psychology and Decision Sciences, University of Konstanz, Konstanz, Germany
| | | | - Yaowares Oppamayun
- Thai Food and Drug Administration, Health Product Vigilance Center, Bangkok, Thailand
| | | | - Mehdi Bouhlel
- Tunisian National Centre of Pharmacovigilance, Tunis, Tunisia
- Department of Pharmacology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | | | - Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Msida, Malta
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4
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Bhasale AL, Sarpatwari A, Lipworth W, Møllebaek M, McEwin EJ, Gautam N, Santiago OA, Mintzes BJ. Regulatory authority and clinical acceptability: Physicians' responses to regulatory drug safety warnings. Br J Clin Pharmacol 2021; 88:713-722. [PMID: 34337777 DOI: 10.1111/bcp.15007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022] Open
Abstract
AIM Medicines regulators issue post-market safety warnings to advise of newly uncovered risks, but with mixed impacts. We aimed to identify factors influencing the use of regulatory warnings by primary care and specialist physicians in the US and Australia. METHODS Semi-structured qualitative interviews with 40 primary care physicians, endocrinologists, and other generalist specialists in Boston USA and Australia. Coding and analysis were carried out inductively and iteratively to identify and examine key factors. Analysis centred around four areas; physicians' awareness of drug safety information, preferred information sources, opinion-forming, and sharing of information with patients. RESULTS Uncertainty, trust, and clinical authority emerged as factors influencing use of advisories. Although regulators were trusted as authoritative institutions, they appeared to lack clinical authority, and physicians validated regulatory information against other trusted sources including evidence, expert opinion, and experience. Specialists became aware of drug safety issues through specialised literature, using evidence and clinical consensus to form opinions. Primary care physicians, fielding high volumes of information, relied on convenient, accessible information sources including the media and the 'clinical grapevine' for awareness, and on clinical colleagues, specialists, and experience for interpretation. Communicating risk to patients was complicated by uncertainty; physicians tailored information to patients' health literacy and information needs. US physicians were more aware of their national regulator's post-market safety role than Australian physicians of theirs. CONCLUSION Drug safety warnings may not be optimally received or used. Regulators should consider strategies that increase trust, clinical relevance, and accessibility, and address physicians' needs in communicating risk to patients.
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Affiliation(s)
- Alice L Bhasale
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney
| | - Ameet Sarpatwari
- Program On Regulation, Therapeutics, And Law (PORTAL), Brigham and Women's Hospital and Harvard Medical School
| | - Wendy Lipworth
- Sydney Health Ethics, Faculty of Medicine and Health, The University of Sydney
| | - Mathias Møllebaek
- Centre for Regulatory Science, Department of Pharmacy, University of Copenhagen, Denmark
| | - Eliza J McEwin
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney
| | - Nileesa Gautam
- Program On Regulation, Therapeutics, And Law (PORTAL), Brigham and Women's Hospital and Harvard Medical School
| | - Ortiz A Santiago
- Program On Regulation, Therapeutics, And Law (PORTAL), Brigham and Women's Hospital and Harvard Medical School
| | - Barbara J Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney
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5
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Morales DR, Macfarlane T, MacDonald TM, Hallas J, Ernst MT, Herings RMC, Smits E, Overbeek JA, Mitchell L, Morant S, Mackenzie I, Doney ASF, Robertson C, Bennie M, Wei L, Nicholson L, Morris C, Flynn RWF. Impact of EMA regulatory label changes on hydroxyzine initiation, discontinuation and switching to other medicines in Denmark, Scotland, England and the Netherlands: An interrupted time series regression analysis. Pharmacoepidemiol Drug Saf 2021; 30:482-491. [PMID: 33386650 DOI: 10.1002/pds.5191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/11/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hydroxyzine is indicated for the management of anxiety, skin and sleep disorders. In 2015, the European Medicines Agency (EMA) concluded that hydroxyzine was pro-arrhythmogenic and changes to the product information were implemented in Europe. This study aimed to evaluate their impact in Denmark, Scotland, England and the Netherlands. METHOD Quarterly time series analyses measuring hydroxyzine initiation, discontinuation, and switching to other antihistamines, benzodiazepines and antidepressants in Denmark, England, Scotland and the Netherlands from 2009 to 2018. Data were analysed using interrupted time series regression. RESULTS Hydroxyzine initiation in quarter one 2010 in Denmark, Scotland, England and the Netherlands per 100 000 was: 23.5, 91.5, 35.9 and 34.4 respectively. Regulatory action was associated with a significant: immediate fall in hydroxyzine initiation per 100 000 in England (-12.05, 95%CI -18.47 to -5.63) and Scotland (-19.01, 95%CI -26.99 to -11.02); change to a negative trend in hydroxyzine initiation per 100 000/quarter in England (-1.72, 95%CI -2.69 to -0.75) and Scotland (-2.38, 95%CI -3.32 to -1.44). Regulatory action was associated with a significant: immediate rise in hydroxyzine discontinuation per 100 000 in England (3850, 95%CI 440-7240). No consistent changes were observed in the Netherlands or Denmark. Regulatory action was associated with no switching to other antihistamines, benzodiazepines or antidepressants following hydroxyzine discontinuation in any country. CONCLUSION The 2015 EMA regulatory action was associated with heterogeneous impact with reductions in hydroxyzine initiation varying by country. There was limited impact on discontinuation with no strong evidence suggesting unintended consequences of major switching to other antihistamines, benzodiazepines or antidepressants.
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Affiliation(s)
- Daniel R Morales
- MEMO Research, University of Dundee, Dundee, UK.,Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | | | | | - Jesper Hallas
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | | | | | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Onstitute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Lizzie Nicholson
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | - Carole Morris
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
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6
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Bahri P, Morales DR, Inoubli A, Dogné JM, Straus SMJM. Proposals for Engaging Patients and Healthcare Professionals in Risk Minimisation from an Analysis of Stakeholder Input to the EU Valproate Assessment Using the Novel Analysing Stakeholder Safety Engagement Tool (ASSET). Drug Saf 2020; 44:193-209. [PMID: 33125664 PMCID: PMC7847429 DOI: 10.1007/s40264-020-01005-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Understanding the impact of regulatory actions for medicines and enablers/barriers for positive health outcomes is fundamental to effective risk minimisation measures (RMM). Therefore, the Impact Strategy of the European Union (EU) Pharmacovigilance Risk Assessment Committee (PRAC) includes engagement with patient communities and healthcare professional (HCP) bodies regarding RMM. However, there is uncertainty on how best to obtain stakeholder input. OBJECTIVES The objectives of this study were to (1) analyse stakeholder input at a public hearing and dedicated meeting for the 2017-18 EU procedure on valproate teratogenicity and (2) draw proposals for enhancing PRAC engagement. METHODS For the content analysis, the novel 'Analysing Stakeholder Safety Engagement Tool' (ASSET) was developed with 21 themes in six domains (appropriateness, access, audience, compatibility, integrability, time), based on implementation theories. RESULTS Stakeholders provided a wide range of RMM proposals, some beyond the regulatory remit. Patients and most HCPs converged remarkably, but there was some divergence among HCPs on the informed choice objective, the therapeutic place of valproate, the RMM appropriateness, and RMM delivery to HCPs and patients. Ethical aspects emerged as relevant for regulatory decision making, and crucial input gaps were identified from an RMM implementation perspective. Nine pilotable proposals for PRAC were made regarding: (A) Agreeing on appropriate RMM with stakeholders and catalysing healthcare leadership for implementation; (B) Building-up stakeholder input on all elements critical to RMM implementation guided by the ASSET; and (C) Collaborating with all stakeholders for monitoring implementation and evaluating RMM. CONCLUSIONS New implementation theory-based approaches are promising for enhancing the valuable dialogue between regulators, patients and HCPs and achieving patient safety. EU PAS REGISTER NUMBER EUPAS35947.
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Affiliation(s)
- Priya Bahri
- European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
| | - Daniel R Morales
- Division of Population Health Sciences, University of Dundee, Dundee, UK
- European Medicines Agency, Pharmacovigilance Risk Assessment Committee, Amsterdam, The Netherlands
| | - Adrien Inoubli
- Agence Nationale de Sécurité du Médicament et des Produits de Santé, Paris, France
- European Medicines Agency, Pharmacovigilance Risk Assessment Committee, Amsterdam, The Netherlands
| | - Jean-Michel Dogné
- Federaal Agentschap voor Geneesmiddelen en Gezondheidsproducten-Agence Fédérale des Médicaments et des Produits de Santé, Brussels, Belgium
- European Medicines Agency, Pharmacovigilance Risk Assessment Committee, Amsterdam, The Netherlands
| | - Sabine M J M Straus
- College ter Beoordeling van Geneesmiddelen, Utrecht, The Netherlands
- European Medicines Agency, Pharmacovigilance Risk Assessment Committee, Amsterdam, The Netherlands
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7
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Bhasale AL, Sarpatwari A, De Bruin ML, Lexchin J, Lopert R, Bahri P, Mintzes BJ. Postmarket Safety Communication for Protection of Public Health: A Comparison of Regulatory Policy in Australia, Canada, the European Union, and the United States. Clin Pharmacol Ther 2020; 109:1424-1442. [PMID: 32767557 DOI: 10.1002/cpt.2010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/25/2020] [Indexed: 12/29/2022]
Abstract
In the wake of the withdrawal of the nonsteroidal anti-inflammatory drug rofecoxib, regulators worldwide reconsidered their approach to postmarket safety. Many have since adopted a "life cycle" approach to regulation of medicines, facilitating faster approval of new medicines while planning for potential postmarket safety issues. A crucial aspect of postmarket safety is the effective and timely communication of emerging risk information using postmarket safety advisories, commonly issued as letters to healthcare professionals, drug safety bulletins, media alerts, and website announcements. Yet regulators differ in their use of postmarket safety advisories. We examined the capacity of regulators in the United States, Europe, Canada, and Australia to warn about postmarket safety issues through safety advisories by assessing their governance, legislative authority, risk communication capabilities, and transparency.
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Affiliation(s)
- Alice L Bhasale
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Ameet Sarpatwari
- Program on Regulation, Therapeutics, and Law (PORTAL) Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie L De Bruin
- Copenhagen Center for Regulatory Science, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Ruth Lopert
- George Washington University, Washington, DC, USA
| | - Priya Bahri
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,European Medicines Agency, Amsterdam
| | - Barbara J Mintzes
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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8
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Quality of Reporting on the Evaluation of Risk Minimization Programs: A Systematic Review. Drug Saf 2020; 43:427-446. [DOI: 10.1007/s40264-020-00905-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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9
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Weatherburn CJ, Guthrie B, Dreischulte T, Morales DR. Impact of medicines regulatory risk communications in the UK on prescribing and clinical outcomes: Systematic review, time series analysis and meta-analysis. Br J Clin Pharmacol 2019; 86:698-710. [PMID: 31465123 DOI: 10.1111/bcp.14104] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS Regulatory risk communications are important to ensure medication safety, but their impact is poorly understood. The aim was to quantify the impact of UK risk communications on medication use and other outcomes. METHODS We conducted a systematic review of studies reporting prescribing/health outcome data relevant to UK regulatory risk communication. Data were reanalysed using interrupted time series regression 12 months after each regulatory intervention. Mean changes were pooled using random-effects generic inverse variance examining the following subgroups: drug withdrawals; restrictions/changes in indications; be aware messages without specific recommendations for action; communication via direct healthcare practitioner communications; communication via drug bulletins. RESULTS Of 11 466 articles screened, 40 studies examining 25 UK regulatory risk communications were included. Product withdrawals, restriction in indications and be aware communications were associated with relative mean changes of -78% (95% confidence interval [CI] -60 to -96%), -34% (95% confidence interval [CI] -12 to -55%) and -11% (95%CI -8 to -15%) in targeted drug prescribing respectively. Direct healthcare professional communications were associated with relative mean changes of -47% (95%CI -27 to -68%) compared to -13% (95%CI -6 to -20%) for drug bulletins. Of 7 studies examining unique health outcomes related to the safety concern, risk communications were associated with a mean -10% (95%CI -3 to -16%) decrease in intended and a 7% (95%CI 4 to 10%) increase in unintended health outcomes. DISCUSSION UK regulatory risk communications were associated with significant changes in targeted prescribing and potential changes in clinical outcomes. Further research is needed to systematically study the impact of regulatory interventions.
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Affiliation(s)
| | - Bruce Guthrie
- General Practice, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, UK
| | - Tobias Dreischulte
- Clinical Health Services Research, Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Germany
| | - Daniel R Morales
- Discovery Fellow and General Practitioner, Division of Population Health and Genomics, University of Dundee, UK
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10
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'Engagement' of patients and healthcare professionals in regulatory pharmacovigilance: establishing a conceptual and methodological framework. Eur J Clin Pharmacol 2019; 75:1181-1192. [PMID: 31240364 DOI: 10.1007/s00228-019-02705-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Engagement of patients and healthcare professionals is increasingly considered as fundamental to pharmacovigilance and risk minimisation activities. Few empirical studies of engagement exist and a lack of explicit conceptualisations impedes effective measurement, research and the development of evidence-based engagement interventions. AIMS This article (1) develops a widely applicable conceptualisation, (2) considers various methodological challenges to researching engagement, proposing some solutions, and (3) outlines a basis for converting the conceptualisation into specific measures and indicators of engagement among stakeholders. METHOD We synthesise social science work on risk governance and public understandings of science with insights from studies in the pharmacovigilance field. FINDINGS This leads us to define engagement as an ongoing process of knowledge exchange among stakeholders, with the adoption of this knowledge as the outcome which may feed back into engagement processes over time. We conceptualise this process via three dimensions; breadth, depth and texture. In addressing challenges to capturing each dimension, we emphasise the importance of combining survey approaches with qualitative studies and secondary data on medicines use, prescribing, adverse reaction reporting and health outcomes. A framework for evaluating engagement intervention processes and outcomes is proposed. Alongside measuring engagement via breadth and depth, we highlight the need to research the engagement process through attentiveness to texture-what engagement feels like, what it means to people, and how this shapes motivations based on values, emotions, trust and rationales. CONCLUSION Capturing all three dimensions of engagement is vital to develop valid understandings of what works and why, thus informing engagement interventions of patients and healthcare professionals to given regulatory pharmacovigilance scenarios.
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Møllebæk M, Kaae S, De Bruin ML, Callréus T, Jossan S, Hallgreen CE. The effectiveness of direct to healthcare professional communication - A systematic review of communication factor studies. Res Social Adm Pharm 2019; 15:475-482. [PMID: 31130181 DOI: 10.1016/j.sapharm.2018.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/08/2018] [Accepted: 06/20/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Direct to healthcare professional communication (DHPC) is the prevalent regulatory measure to inform about and potentially mitigate newly identified drug risks in EU and USA. According to multiple studies and reviews, however, the effectiveness of DHPC to reduce risk is less than optimal. Prior systematic reviews have indicated that contextual, qualitative knowledge of communication factors related to the clinical setting is needed to further explain and supplement findings in quantitative effectiveness studies. OBJECTIVES This article systematically reviews studies of DHPC and, on that basis, describes the communication factors that influence the effectiveness of DHPC in order to discuss future research trajectories. METHODS PubMed, Scopus (including Embase) and Web of Science databases were searched for studies on communication about emergent drug risk to healthcare professionals, excluding studies limited to the quantifiable effect of communication. The search results were deductively categorized using the Communication Sequence Model. Then, prevalent themes within categories were identified and described using thematic analysis. RESULTS A total of 16 studies published between 1993 and 2017 were included; 12 based on surveys, 2 on document analysis, and 2 primarily on interviews. The prevalent themes included "Health Care Professionals (HCPs) have less trust in communication from industry than authorities and medical associations", "HCPs have diverse preferences for how to receive drug risk information" and "Clinical usability of the presented information is less than optimal." CONCLUSION Communication factors in DHPCs are multiple, multi-facetted and are examined primarily by surveys. Future research would benefit from identifying nationally dependent factors and employing methods that better provide knowledge on the qualitative reception and handling of drug risk communication.
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Affiliation(s)
- Mathias Møllebæk
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Susanne Kaae
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Torbjörn Callréus
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Christine E Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Bahri P, Rägo L. CIOMS Guide To Vaccine Safety Communication - Executive summary. Vaccine 2018; 37:401-408. [PMID: 30554796 DOI: 10.1016/j.vaccine.2018.11.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND In 2018, the Council for International Organizations of Medical Sciences (CIOMS) issued their Guide to Vaccine Safety Communication. This has been built upon existing guidance and a new review of research and compilation of latest experiences, in order to fill, for the first time at global level, a specific niche for regulatory authorities in the contexts of vaccine hesitancy and informed choice. The Guide was developed by the international multi-stakeholder CIOMS Working Group on Vaccine Safety, formed to assist the Global Vaccine Safety Initiative (GVSI) of the World Health Organization (WHO). SUMMARY Besides the public health authorities responsible for immunization programmes, regulators have their own role in communicating about vaccine safety. As they are responsible for licensing vaccine products, they need to be transparent about their assessments of data on quality, safety and efficacy. Furthermore, they are responsible for continuous safety surveillance and keeping safe use advice to the public up-to-date. The Guide stresses the fundamental importance of regulatory bodies to have a system in place with defined functions and skilled persons who can efficiently run vaccine safety communication in collaboration with stakeholders. This system should take a strategic approach to communication, be integral to safety surveillance and risk assessment, and support vaccine safety communication plans (VacSCPs) adapted to vaccine types in local situations. The Guide provides recommendations and examples for the system components as well as a practical VacSCP template. CONCLUSIONS While the Guide should help strengthening regulatory bodies worldwide with regard to vaccine safety communication, it is meant to help regulators in resource-limited countries in particular. It can also be of interest to other stakeholders and be leveraged to other medicinal products.
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Affiliation(s)
- Priya Bahri
- European Medicines Agency (EMA), Pharmacovigilance Department, Surveillance & Epidemiology Service, 30 Churchill Place, London E14 5EU, United Kingdom.
| | - Lembit Rägo
- Council for International Organizations of Medical Sciences (CIOMS), 20 Avenue Appia, 1211 Geneva 27, Switzerland.
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Mota DM, Vigo Á, Kuchenbecker RDS. Evolution and key elements of the Brazilian pharmacovigilance system: a scoping review beginning with the creation of the Brazilian Health Regulatory Agency. CAD SAUDE PUBLICA 2018; 34:e00000218. [PMID: 30328994 DOI: 10.1590/0102-311x00000218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/25/2018] [Indexed: 11/22/2022] Open
Abstract
This scoping review aims to describe and characterize the Brazilian pharmacovigilance system Brazil (SINAF) and verify to what extent it meets the minimum requirements proposed by the World Health Organization for the functional performance of this type of national system. The literature search strategy used STARLITE recommendations and search terms in MEDLINE/PubMed, Google, the Brazilian National Press, and the website of the Brazilian Health Regulatory Agency (Anvisa), from 1999, when Anvisa was created, to March 2016. The review included 47 publications (4.4%), out of a total of 1,068 identified, in the following order: 14 legal provisions (29.8%), 13 (27.6%) technical documents, and 10 (21.3%) scientific articles. The studies and technical documents covered the creation of the first pharmacovigilance technical unit at the federal level, the reporting system for adverse events, the National Monitoring Center, and the Technical Chambers on Medications. The reporting rate for adverse drug events in Brazil in 2013 was 36 reports per million inhabitants, considerably lower than the target proposed in the international literature, which suggests 300 reports per million inhabitants. This study identified structural and functional aspects that can compromise the performance of SINAF, such as lack of legislation officially establishing the system itself and its objectives.
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Affiliation(s)
| | - Álvaro Vigo
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Bahri P, Castillon Melero M. Listen to the public and fulfil their information interests - translating vaccine communication research findings into guidance for regulators. Br J Clin Pharmacol 2018; 84:1696-1705. [PMID: 29573274 PMCID: PMC6046478 DOI: 10.1111/bcp.13587] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 11/27/2022] Open
Abstract
Regulatory authorities have a crucial role in communicating about the vaccines they license. In terms of content and timing, their communication to the public is usually driven by data on quality, safety and efficacy. However, concerns over safety and vaccine hesitancy have emerged in some communities in various countries, and this demands a new approach to communication, starting with listening to the public debate. Reviewing communication research findings, coming in particular from the cognitive, decision‐making and media sciences, constitutes one mechanism of listening and has led the European Union (EU) regulatory network to developing guidance about which common concerns and information needs of the public to address through proactive and prepared communication. The guidance has been welcomed by EU and international fora. The current article summarizes the recommendations and shares the underlying research findings, as well as a proof of concept that communication research can be valuable for regulators. It is critical that regulators integrate the communication process with product risk assessment in the framework of pharmacovigilance, to ensure that public concerns are addressed in the assessments and that information about evidence and uncertainty relating to safety is provided to the public and vaccination policy makers in a specific, clear and accurate manner. Additionally, information from regulatory authorities should support healthcare professionals in their communication with patients. Meeting the information interests of the public is the principal prerequisite for informed decisions as well as safe and effective use of vaccines and medicines overall. This is also fundamental for trust in the authorities' commitment to patient and population health.
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Affiliation(s)
- Priya Bahri
- Surveillance & Epidemiology Service, Pharmacovigilance Department, European Medicines Agency, London, UK
| | - Mireia Castillon Melero
- Surveillance & Epidemiology Service, Pharmacovigilance Department, European Medicines Agency, London, UK
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15
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Taylor BJ, Stevenson M, McDowell M. Communicating risk in dementia care: Survey of health and social care professionals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e291-e303. [PMID: 29226458 DOI: 10.1111/hsc.12519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk-taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision-making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June-September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low-moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice-based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants' responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10-fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed.
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Affiliation(s)
- Brian J Taylor
- Institute for Social Sciences, Ulster University, Northern Ireland, UK
| | - Mabel Stevenson
- School of Sociology & Applied Social Studies, Ulster University, Northern Ireland, UK
| | - Michelle McDowell
- Harding Centre for Risk Literacy, Max Planck Institute, Berlin, Germany
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Bahri P, Fogd J, Morales D, Kurz X. Application of real-time global media monitoring and 'derived questions' for enhancing communication by regulatory bodies: the case of human papillomavirus vaccines. BMC Med 2017; 15:91. [PMID: 28464900 PMCID: PMC5414293 DOI: 10.1186/s12916-017-0850-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The benefit-risk balance of vaccines is regularly debated by the public, but the utility of media monitoring for regulatory bodies is unclear. A media monitoring study was conducted at the European Medicines Agency (EMA) concerning human papillomavirus (HPV) vaccines during a European Union (EU) referral procedure assessing the potential causality of complex regional pain syndrome (CRPS) and postural orthostatic tachycardia syndrome (POTS) reported to the authorities as suspected adverse reactions. METHODS To evaluate the utility of media monitoring in real life, prospective real-time monitoring of worldwide online news was conducted from September to December 2015 with inductive content analysis, generating 'derived questions'. The evaluation was performed through the validation of the predictive capacity of these questions against journalists' queries, review of the EMA's public statement and feedback from EU regulators. RESULTS A total of 4230 news items were identified, containing personal stories, scientific and policy/process-related topics. Explicit and implicit concerns were identified, including those raised due to lack of knowledge or anticipated once more information would be published. Fifty derived questions were generated and categorised into 12 themes. The evaluation demonstrated that providing the media monitoring findings to assessors and communicators resulted in (1) confirming that public concerns regarding CRPS and POTS would be covered by the assessment; (2) meeting specific information needs proactively in the public statement; (3) predicting all queries from journalists; and (4) altering the tone of the public statement with respectful acknowledgement of the health status of patients with CRSP or POTS. CONCLUSIONS The study demonstrated the potential utility of media monitoring for regulatory bodies to support communication proactivity and preparedness, intended to support trusted safe and effective vaccine use. Derived questions seem to be a familiar and effective format for presenting media monitoring results in the scientific-regulatory environment. It is suggested that media monitoring could form part of regular surveillance for medicines of high public interest. Future work is recommended to develop efficient monitoring strategies for that purpose.
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Affiliation(s)
- Priya Bahri
- European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU UK
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Julianna Fogd
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Daniel Morales
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - on behalf of the ADVANCE consortium
- European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU UK
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
- Division of Population Health Sciences, University of Dundee, Dundee, UK
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The Additional Value of an E-Mail to Inform Healthcare Professionals of a Drug Safety Issue: A Randomized Controlled Trial in the Netherlands. Drug Saf 2016; 36:723-31. [PMID: 23797603 DOI: 10.1007/s40264-013-0079-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The usefulness and the impact of Direct Healthcare Professional Communications (DHPCs, or 'Dear Doctor letters') in changing the clinical behaviour of physicians have been debated. Changes in the current risk communication methods should preferably be based on the preferences of the healthcare professionals, to optimize the uptake of the message. OBJECTIVE The aim of this study was to assess whether safety issues are communicated more effectively with an additional e-mail sent by the Dutch Medicines Evaluation Board (MEB) than with the DHPC only. METHODS A randomized controlled trial was conducted amongst ophthalmologists and hospital pharmacists in the Netherlands, who were the target group of a DHPC that was issued for pegaptanib, a drug that is administered intra-ocularly in patients with macular degeneration. The intervention group (N = 110) received the pegaptanib DHPC, as well as the MEB e-mail. The control group (N = 105) received the traditional paper-based DHPC only. Two weeks later, the study population received an invitation to fill out an online questionnaire. Questions were asked about the respondents' knowledge and attitude regarding the pegaptanib issue, and any action they had consequently taken. Additional questions were asked about their satisfaction with the DHPC and the e-mail, and their preferred source of such information. RESULTS Forty respondents (18.6%) completed the questionnaire. Eighty-one percent of the respondents in the intervention group (N = 21) and 47% of the control group (N = 19) correctly indicated that a serious increase in intra-ocular pressure could be caused by pegaptanib injections (Fishers' exact test, p = 0.046). Nine respondents in the intervention group versus none of the control group respondents indicated that they had taken action in response to the pegaptanib safety issue (Fishers' exact test, p = 0.01). The majority of both the intervention group and the control group confirmed that they would like to receive an MEB e-mail with safety information about drugs in the future (90 and 95 %, respectively). CONCLUSION The results of this study indicate that an additional e-mail might strengthen the uptake of the safety information provided to healthcare professionals, who prefer to receive an e-mail from the MEB as a source of such information, as well as the DHPC. This study may serve as a starting point for new strategies to improve risk communication regarding safety issues associated with drugs and its impact on prescribing.
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18
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Public Knowledge and Desire for Knowledge about Drug Safety Issues: A Survey of the General Public in New Zealand. Pharmaceut Med 2016. [DOI: 10.1007/s40290-016-0164-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McCormack L, Craig Lefebvre R, Bann C, Taylor O, Rausch P. Consumer Understanding, Preferences, and Responses to Different Versions of Drug Safety Messages in the United States: A Randomized Controlled Trial. Drug Saf 2016; 39:171-84. [PMID: 26547718 PMCID: PMC4735220 DOI: 10.1007/s40264-015-0358-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION As part of its mission, the US Food and Drug Administration (FDA) communicates with the public regularly about the benefits and risks of prescription and over-the-counter (OTC) drugs. Effectively communicating risk, however, is a significant public health challenge. OBJECTIVE To better understand how different populations understand information communicated by the FDA about drug safety, we conducted a randomized experiment to examine comprehension and other measures of effectiveness of drug safety messages that occurred in a post-market surveillance phase. METHODS We used an Internet panel survey of 1244 consumers, of whom 58% used prescription drugs in the past year. Half of the sample panel was randomized to read a previous FDA Drug Safety Communication (DSC) with the drug name changed, and the other half was randomized to read a revised version of the same DSC. We examined how making certain modifications to the way drug risk information is communicated has an impact on comprehension and behavioral intentions, including the user's likelihood of discontinuing the drug. We also studied how comprehension varied by respondent characteristics, health literacy skills, risk perceptions, and trust in the message. RESULTS Based on a five-item comprehension index, the revised version of the message was associated with significantly greater comprehension of the information relative to the standard version (63 vs 52% correct, p < 0.001). Significantly more respondents found the revised version to be clear (82 vs 73%, p < 0.000), while fewer in that group reported learning something new (78% vs 84%, p = 0.015). No significant differences emerged between the two groups in terms of the message being informative, convincing, or helpful. We found no significant differences between the two groups in terms of behavioral intentions, risk perception, and trust. CONCLUSIONS We found that making plain language changes to the DSC significantly increased consumers' level of comprehension of its content, providing support for ongoing use and further exploration of these strategies in pharmacovigilance communication research. The study findings have important implications for future drug safety and other communication messages related to prescription drugs.
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Affiliation(s)
- Lauren McCormack
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | - R Craig Lefebvre
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Carla Bann
- Division for Statistics and Data Sciences, RTI International, Research Triangle Park, NC, USA
| | - Olivia Taylor
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Paula Rausch
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Communications, Silver Spring, MD, USA
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Botelho SF, Reis AMM. Pharmacovigilance risk mitigation plans: action in public health to promote the safe use of medication. CIENCIA & SAUDE COLETIVA 2015; 20:3897-905. [PMID: 26691813 DOI: 10.1590/1413-812320152012.16442014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 01/28/2015] [Indexed: 11/22/2022] Open
Abstract
Risk mitigation plans (RMP) are an innovative and important strategy for monitoring the sanitary risks of medication. The scope of the study was to identify RMPs for drugs registered with the Food and Drug Administration (FDA) and the actions to minimize risks established by the Brazilian Health Surveillance Agency (Anvisa) and the manufacturers of these drugs. This is a quantitative and descriptive study including a survey together with the pharmaceutical industries and research on sites and databases of Anvisa, the FDA and pharmaceutical industries. Forty drugs with RMPs filed with the FDA were also registered with Anvisa. Only 4 laboratories (10f%) reported RMPs developed in Brazil. Safety information for 15 drugs (37.5%) were located on the Anvisa site. In 91.4% of Brazilian user package leaflets there is safety information equivalent to actions to promote safe use described in RMPs available on the FDA website. The actions of communication on drug safety and sanitary risk of drugs needs to be expanded by Anvisa. The RMP is an important strategy in public health for managing new risks, monitoring known risks and, especially, for promoting the safe use of medication.
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Radawski C, Morrato E, Hornbuckle K, Bahri P, Smith M, Juhaeri J, Mol P, Levitan B, Huang HY, Coplan P, Li H. Benefit-Risk Assessment, Communication, and Evaluation (BRACE) throughout the life cycle of therapeutic products: overall perspective and role of the pharmacoepidemiologist. Pharmacoepidemiol Drug Saf 2015; 24:1233-40. [DOI: 10.1002/pds.3859] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/26/2015] [Accepted: 07/22/2015] [Indexed: 12/13/2022]
Affiliation(s)
| | - Elaine Morrato
- Colorado School of Public Health; University of Colorado Denver; Denver CO USA
| | | | | | | | | | - Peter Mol
- Department of Clinical Pharmacy and Pharmacology; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | | | - Han-Yao Huang
- Global Pharmacovigilance and Epidemiology; Bristol-Myers Squibb; Pennington NJ USA
| | - Paul Coplan
- Risk Management and Epidemiology; Purdue Pharma L.P.; Stamford CT USA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Hu Li
- Eli Lilly and Company; Indianapolis IN USA
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The ISoP CommSIG for Improving Medicinal Product Risk Communication: A New Special Interest Group of the International Society of Pharmacovigilance. Drug Saf 2015; 38:621-7. [DOI: 10.1007/s40264-015-0301-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jose J, Jimmy B, Al-Mamari MNS, Al-Hadrami TSN, Al-Zadjali HM. Knowledge, Beliefs and Behaviours Regarding the Adverse Effects of Medicines in an Omani Population: Cross-sectional survey. Sultan Qaboos Univ Med J 2015; 15:e250-e256. [PMID: 26052459 PMCID: PMC4450789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/01/2015] [Accepted: 01/29/2015] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES This study aimed to assess the knowledge, beliefs and behaviours of an Omani population with regards to the adverse effects of medicines. METHODS This cross-sectional survey was conducted between February and June 2012. A 17-item questionnaire was designed to assess three aspects: knowledge, beliefs and behaviours related to medicine safety. A total of 740 questionnaires were distributed in three representative governorates of Oman. Median total scores for the three sections were estimated. Associations with participants' demographic variables and medication histories were also assessed. RESULTS A total of 618 participants completed the survey (response rate: 83.5%). Many participants (46.4%) believed that side-effects occurred only with high doses of medication and over 30% believed that they did not occur at all with traditional and over-the-counter medicines. The median total score was 19 (interquartile range: 6) out of a maximum of 30. Inadequate knowledge, incorrect beliefs and good behaviours were observed among the participants. There was a significant association between certain demographic parameters (age, educational qualification, history of chronic use of medicines and employment status) and median total scores. Participants reported obtaining additional information on medication safety from various sources, with doctors as the most widely used source. CONCLUSION Inadequate knowledge and incorrect beliefs among this Omani population indicate a need for interventions to improve public knowledge and address misconceptions regarding medication safety. These interventions could be initiated on both an individual and public scale, with patient interactions by healthcare professionals and mass education activities targeting the larger population.
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Advancing the field of pharmaceutical risk minimization through application of implementation science best practices. Drug Saf 2015; 37:569-80. [PMID: 25005707 PMCID: PMC4134476 DOI: 10.1007/s40264-014-0197-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Regulators are increasingly mandating the use of pharmaceutical risk-minimization programs for a variety of medicinal products. To date, however, evaluations of these programs have shown mixed results and relatively little attention has been directed at diagnosing the specific factors contributing to program success or lack thereof. Given the growing use of these programs in many different patient populations, it is imperative to understand how best to design, deliver, disseminate, and assess them. In this paper, we argue that current approaches to designing, implementing, and evaluating risk-minimization programs could be improved by applying evidence- and theory-based ‘best practices’ from implementation science. We highlight commonly encountered challenges and gaps in the design, implementation, and evaluation of pharmaceutical risk-minimization initiatives and propose three key recommendations to address these issues: (1) risk-minimization program design should utilize models and frameworks that guide what should be done to produce successful outcomes and what questions should be addressed to evaluate program success; (2) intervention activities and tools should be theoretically grounded and evidence based; and (3) evaluation plans should incorporate a mixed-methods approach, pragmatic trial designs, and a range of outcomes. Regulators, practitioners, policy makers, and researchers are encouraged to apply these best practices in order to improve the public health impact of this important regulatory tool.
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Urushihara H, Kobashi G, Masuda H, Taneichi S, Yamamoto M, Nakayama T, Kawakami K, Matsuda T, Ohta K, Sugimori H. Pharmaceutical company perspectives on current safety risk communications in Japan. SPRINGERPLUS 2014; 3:51. [PMID: 24555168 PMCID: PMC3921345 DOI: 10.1186/2193-1801-3-51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/28/2013] [Indexed: 11/13/2022]
Abstract
In 1987, a group infection of hepatitis in patients receiving a contaminated fibrinogen product was first reported to the Japanese regulatory agency. Eventually, this serious drug incident involved more than 10,000 cases of infection. In response, the Government of Japan established a responding inspection committee in 2008 to make recommendations for the restructuring of drug regulatory administration. The final report was issued in 2010. One agenda item of this restructuring was the improvement of drug-related safety risk communications. Our research group on drug safety risk communications, which is funded by the Government of Japan, surveyed pharmaceutical companies regarding their perspective on current risk communications. The survey was conducted using an anonymous questionnaire developed for this study which included the three operational domains of targets, contents, and measures of drug risk communication. Fifty-two of the 74 member companies of the Post-marketing Surveillance Subcommittee of the Japan Pharmaceutical Manufacturer’s Association participated, and this response rate of more than 70% was considered sufficient to ensure the external validity of the survey results. Results showed that the most highly prioritized aspect of risk messaging was the strength of evidence, and that outcome evaluation of risk communication gained recognition. Further, while physicians and pharmacists were the most prioritized communication targets, pharmacovigilance departments devoted the most resources to regulators, at more than 30%. The Internet was recognized as a useful public source of risk information, whereas Drug Guides for Patients delivered on the web were considered under-recognized. Further discussion of these results with the aim of enhancing the restructuring of the Japanese drug regulatory administration system are warranted.
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Affiliation(s)
- Hisashi Urushihara
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Gen Kobashi
- Department of Pharmaceutical and Medical Device Regulatory Science, Graduate School of Medical Science, Yamagata University, Iida-Nishi, Yamagata, Yamagata, 990-9585 Japan
| | - Hideaki Masuda
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Anagawa, Inage-ku, Chiba, 263-8555 Japan
| | - Setsuko Taneichi
- Department of Preventive Medicine, Graduate School of Sports and Health Science, Daito Bunka University, 560 Iwadono, Higashi-Matsuyama-shi, Saitama, 355-8501 Japan
| | - Michiko Yamamoto
- Education Centre for Clinical Pharmacy Practice, Showa Pharmaceutical University, Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Tsutomu Matsuda
- Department of Pharmaceutical and Medical Device Regulatory Science, Graduate School of Medical Science, Yamagata University, Iida-Nishi, Yamagata, Yamagata, 990-9585 Japan
| | - Kaori Ohta
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Anagawa, Inage-ku, Chiba, 263-8555 Japan
| | - Hiroki Sugimori
- Department of Preventive Medicine, Graduate School of Sports and Health Science, Daito Bunka University, 560 Iwadono, Higashi-Matsuyama-shi, Saitama, 355-8501 Japan
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Gallini A, Andrieu S, Donohue JM, Oumouhou N, Lapeyre-Mestre M, Gardette V. Trends in use of antipsychotics in elderly patients with dementia: Impact of national safety warnings. Eur Neuropsychopharmacol 2014; 24:95-104. [PMID: 24126116 PMCID: PMC4094113 DOI: 10.1016/j.euroneuro.2013.09.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
Based on evidence of an increased risk of death, drug agencies issued safety warnings about the use of second generation antipsychotics (SGAs) in the elderly with dementia. The French agency issued a warning in 2004. which was extended to all antipsychotics in 2008. Little is known about the impact of these warnings on use. We conducted a quasi-experimental study (interrupted time-series) in France, for 2003-2011, including subjects aged ≥65 with dementia and subjects aged ≥65 without dementia in the EGB database (1/97th representative random sample of claims from the main Health Insurance scheme). Outcomes were monthly rates of use of antipsychotics (by class and agent) and of five comparison drug classes (antidepressants, benzodiazepines, dermatologicals, antidiabetics, antiasthmatics). Trends were analyzed by joinpoint regression, impact of warnings by linear segmented regression. In patients with dementia (n=7169), there was a 40% reduction in antipsychotic use from 14.2% in 2003 to 10.2% in 2011. The reduction began before 2004 and was unaffected by the warnings. Use of first generation antipsychotics declined over the period, while use of SGAs increased and leveled off from 2007. Use of the five comparison drug classes increased on the period. In subjects without dementia (n=91,942), rates of overall antipsychotic use decreased from 2.3% in 2003 to 1.8% in 2011 with no effect of the warnings. Meanwhile, use of SGAs continuously increased from 0.37% to 0.64%. Antipsychotic use decreased in the elderly between 2003 and 2011, especially in dementia. The timing of the decrease, however, did not coincide with safety warnings.
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Affiliation(s)
- Adeline Gallini
- Université Paul Sabatier, Toulouse III, Faculté de médecine, Département d'épidémiologie, économie de la santé et santé publique, F-31073, Toulouse, France; INSERM, UMR 1027 Epidémiologie et analyses en santé publique, F-31073, Toulouse, France; CHU de Toulouse, Service d'épidémiologie, F-31073, Toulouse, France.
| | - Sandrine Andrieu
- Université Paul Sabatier, Toulouse III, Faculté de médecine, Département d'épidémiologie, économie de la santé et santé publique, F-31073, Toulouse, France; INSERM, UMR 1027 Epidémiologie et analyses en santé publique, F-31073, Toulouse, France; CHU de Toulouse, Service d'épidémiologie, F-31073, Toulouse, France
| | - Julie M Donohue
- University of Pittsburgh, Graduate School of Public health, Department of Health Policy and Management, Pittsburgh, PA, USA
| | - Naïma Oumouhou
- Université Paul Sabatier, Toulouse III, Faculté de médecine, Département d'épidémiologie, économie de la santé et santé publique, F-31073, Toulouse, France; INSERM, UMR 1027 Epidémiologie et analyses en santé publique, F-31073, Toulouse, France
| | - Maryse Lapeyre-Mestre
- INSERM, UMR 1027 Epidémiologie et analyses en santé publique, F-31073, Toulouse, France; Université Paul Sabatier, Toulouse III, Faculté de médecine, Département de pharmacologie, F-31073, Toulouse, France; CHU de Toulouse, Service de pharmacologie médicale et clinique, F-31073, Toulouse, France
| | - Virginie Gardette
- Université Paul Sabatier, Toulouse III, Faculté de médecine, Département d'épidémiologie, économie de la santé et santé publique, F-31073, Toulouse, France; INSERM, UMR 1027 Epidémiologie et analyses en santé publique, F-31073, Toulouse, France; CHU de Toulouse, Service d'épidémiologie, F-31073, Toulouse, France
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Dusetzina SB, Higashi AS, Dorsey ER, Conti R, Huskamp HA, Zhu S, Garfield CF, Alexander GC. Impact of FDA drug risk communications on health care utilization and health behaviors: a systematic review. Med Care 2012; 50:466-78. [PMID: 22266704 PMCID: PMC3342472 DOI: 10.1097/mlr.0b013e318245a160] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To review literature on the impact of The Food and Drug Administration (FDA) drug risk communications on medication utilization, health care services use, and health outcomes. DATA SOURCES The authors searched MEDLINE and the Web of Science for manuscripts published between January 1990 and November 2010 that included terms related to drug utilization, the FDA, and advisories or warnings. We manually searched bibliographies and works citing selected articles and consulted with experts to guide study selection. STUDY SELECTION Studies were included if they involved an empirical analysis evaluating the impact of an FDA risk communication. DATA EXTRACTION We extracted the drug(s) analyzed, relevant FDA communication(s), data source, analytical method, and main outcome(s) assessed. RESULTS Of the 1432 records screened, 49 studies were included. These studies covered 16 medicines or therapeutic classes; one third examined communications regarding antidepressants. Most used medical or pharmacy claims and a few rigorously examined patient-provider communication, decision making, or risk perceptions. Advisories recommending increased clinical or laboratory monitoring generally led to decreased drug use, but only modest, short-term increases in monitoring. Communications targeting specific subpopulations often spilled over to other groups. Repeated or sequential advisories tended to have larger but delayed effects and decreased incident more than prevalent use. Drug-specific warnings were associated with particularly large decreases in utilization, although the magnitude of substitution within therapeutic classes varied across clinical contexts. CONCLUSIONS Although some FDA drug risk communications had immediate and strong impacts, many had either delayed or had no impact on health care utilization or health behaviors. These data demonstrate the complexity of using risk communication to improve the quality and safety of prescription drug use, and suggest the importance of continued assessments of the effect of future advisories and label changes. Identifying factors that are associated with rapid and sustained responses to risk communications will be important for informing future risk communication efforts.
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Affiliation(s)
- Stacie B. Dusetzina
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ashley S. Higashi
- Department of Medicine, University of Chicago Hospitals, Chicago, Illinois
| | - E. Ray Dorsey
- Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Rena Conti
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
- Department of Pediatrics, University of Chicago Hospitals, Chicago, Illinois
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Shu Zhu
- Department of Medicine, University of Chicago Hospitals, Chicago, Illinois
| | - Craig F. Garfield
- Department of Pediatrics, NorthShore University Health System, Evanston, Illinois
| | - G. Caleb Alexander
- Department of Medicine, University of Chicago Hospitals, Chicago, Illinois
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
- Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Illinois
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Bridging the efficacy-effectiveness gap: a regulator's perspective on addressing variability of drug response. Nat Rev Drug Discov 2011; 10:495-506. [PMID: 21720406 DOI: 10.1038/nrd3501] [Citation(s) in RCA: 209] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Drug regulatory agencies should ensure that the benefits of drugs outweigh their risks, but licensed medicines sometimes do not perform as expected in everyday clinical practice. Failure may relate to lower than anticipated efficacy or a higher than anticipated incidence or severity of adverse effects. Here we show that the problem of benefit-risk is to a considerable degree a problem of variability in drug response. We describe biological and behavioural sources of variability and how these contribute to the long-known efficacy-effectiveness gap. In this context, efficacy describes how a drug performs under conditions of clinical trials, whereas effectiveness describes how it performs under conditions of everyday clinical practice. We argue that a broad range of pre- and post-licensing technologies will need to be harnessed to bridge the efficacy-effectiveness gap. Successful approaches will not be limited to the current notion of pharmacogenomics-based personalized medicines, but will also entail the wider use of electronic health-care tools to improve drug prescribing and patient adherence.
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Dusetzina SB, Caleb Alexander G. Drug vs class-specific black box warnings: does one bad drug spoil the bunch? J Gen Intern Med 2011; 26:570-2. [PMID: 21472500 PMCID: PMC3101978 DOI: 10.1007/s11606-011-1714-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stacie B. Dusetzina
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
| | - G. Caleb Alexander
- Department of Medicine, University of Chicago Hospitals, Chicago, IL USA
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL USA
- Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, IL USA
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Théophile H, Miremont-Salamé G, Robinson P, Moore N, Bégaud B, Haramburu F. Relevance of a "Dear Doctor letter" to alert healthcare providers to new recommendations for vitamin D administration. Eur J Clin Pharmacol 2011; 67:681-6. [PMID: 21597972 DOI: 10.1007/s00228-011-1055-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 04/18/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE After reports of malaise in infants immediately after the oral administration of two brands of vitamin D solutions, a "Dear Doctor letter" (DDL) containing recommendations for the administration of vitamin D was sent to all French paediatricians and pharmacies and a large number of French general practitioners (GPs) with a predominantly paediatric practice. The DDL and a press release were published on the French Medicines Agency website and distributed via a mailing list. The objective of this study was to assess the effectiveness of such a DDL and to collect the opinions of healthcare professionals on the best way to provide them with information. METHODS A questionnaire was sent to a national random sample of 145 paediatricians, 680 GPs and 230 pharmacists. RESULTS Only 49% of responding paediatricians, 48% of GPs and 67% of pharmacists were aware of the warning. Among the participating healthcare professionals aware of the warning and who prescribed/dispensed these vitamins, 50% of paediatricians and 68% of GPs stated that they had changed their prescribing behaviour, and 68% of pharmacists stated that they had modified their advice when dispensing. According to the responding healthcare professionals, postal letters remained the best way to issue safety warnings. Some of the respondents suggested that the DDL be more distinctive in terms of being a DDL and that the information be more widely disseminated to other stakeholders involved in the healthcare system. CONCLUSIONS This survey of a national random sample of healthcare professionals revealed that many of the respondents paid little attention to the DDL and were therefore unlikely to change their practices. A potential supplementary method for disseminating recommendations for medicine administration could be to apply stickers on medicine boxes, as this approach has the additional advantage of directly informing the concerned population, i.e. the parents.
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Journal Watch. Pharmaceut Med 2011. [DOI: 10.1007/bf03256846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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