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Prieto-Campo Á, Batista AD, Magalhães Silva T, Herdeiro MT, Roque F, Figueiras A, Zapata-Cachafeiro M. Understanding vaccination hesitation among health professionals: a systematic review of qualitative studies. Public Health 2024; 226:17-26. [PMID: 37980837 DOI: 10.1016/j.puhe.2023.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES In terms of vaccination, people trust healthcare professionals (HCPs) more than any other source of information. They are the cornerstone of vaccination as they can move undecided populations not only towards vaccination but also towards non-vaccination. The aim of this systematic review was to explore the knowledge, beliefs, attitudes, and barriers associated with own vaccination and patient recommendation in HCPs. STUDY DESIGN This study incorporated a systematic review. METHODS A systematic review of studies published from January 1, 2000, to June 1, 2020, was conducted by searching PubMed and EMBASE electronic databases. Qualitative studies reporting outcomes related to knowledge, attitudes, or barriers related to vaccination/recommendation by healthcare personnel were included. The guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. RESULTS From a total of 2916 studies identified, 36 articles met the inclusion criteria. Some of the factors cited by the HCP that may contribute to vaccine hesitancy were (a) concerns regarding safety or efficacy of vaccines (23 articles); (b) time constraints (21 articles); (c) lack of knowledge about the vaccination/vaccine (19 articles); (d) costs (13 articles); (e) distrust of pharmaceutical industry (8 articles); and (f) considering oneself insusceptible (7 articles), stock shortage (7 articles), lack of personnel (5 articles), and feelings of unnecessary vaccination (5 articles). CONCLUSIONS Our review suggests that interventions to combat vaccine hesitancy should increase HCP education on vaccine efficacy and safety, as well as intervene on health system factors such as cost and time per visit. In this way, we could tackle the problem of vaccine hesitancy, which seriously threatens global public health.
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Affiliation(s)
- Á Prieto-Campo
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain
| | - A D Batista
- Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal
| | - T Magalhães Silva
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - M T Herdeiro
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - F Roque
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Avenida Dr. Francisco Sá Carneiro, no. ° 50, 6300-559, Guarda, Portugal; Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Av. Infante D. Henrique, 6200-506, Covilhã, Portugal; Escola Superior de Saúde, Instituto Politécnico da Guarda Rua da Cadeia, 6300-035, Guarda, Portugal.
| | - A Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - M Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
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Visos-Varela I, Zapata-Cachafeiro M, Pintos-Rodríguez S, Bugarín-González R, González-Barcala FJ, Herdeiro MT, Piñeiro-Lamas M, Figueiras A, Salgado-Barreira Á. Outpatient atorvastatin use and severe COVID-19 outcomes: A population-based study. J Med Virol 2023; 95:e28971. [PMID: 37486310 DOI: 10.1002/jmv.28971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/09/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
Evidence of the effect of statins on patients with coronavirus disease (2019) COVID-19 is inconsistent. The aim of this study was to evaluate the association between chronic use of statins-both overall and by active ingredient-and severe outcomes of COVID-19 (risk of hospitalization and mortality), progression to severe outcomes, and susceptibility to the virus. We conducted a population-based case-control study with data from electronic records to assess the risk of (1) hospitalization: cases were patients admitted due to COVID-19 and controls were subjects without COVID-19; (2) mortality: cases were hospitalized patients who died due to COVID-19 and controls were subjects without COVID-19; (3) progression: cases were hospitalized COVID-19 subjects and controls were nonhospitalized COVID-19 patients; and (4) susceptibility: cases were patients with COVID-19 (both hospitalized and nonhospitalized) and controls were subjects without COVID-19. We collected data on 2821 hospitalized cases, 26 996 nonhospitalized cases, and 52 318 controls. Chronic use of atorvastatin was associated with a decreased risk of hospitalization (adjusted odds ratios [aOR] = 0.83; 95% confidence interval [CI]: 0.74-0.92) and mortality (aOR = 0.70; 95% CI: 0.53-0.93), attributable in part to a lower risk of susceptibility to the virus (aOR = 0.91; 95% CI: 0.86-0.96). Simvastatin was associated with a reduced risk of mortality (aOR = 0.59; 95% CI: 0.40-0.87). The wide degree of heterogeneity observed in the estimated odds ratios (ORs) of the different statins suggests that there is no class effect. The results of this real-world study suggest that chronic use of atorvastatin (and to a lesser degree, of simvastatin) is associated with a decrease in risk of severe COVID-19 outcomes.
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Affiliation(s)
- Irene Visos-Varela
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
| | - Samuel Pintos-Rodríguez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rosendo Bugarín-González
- Monforte de Lemos Health Center, Health Area of Lugo, A Mariña and Monforte de Lemos, SERGAS, Monforte de Lemos, Lugo, Spain
| | - Francisco Javier González-Barcala
- Spanish Biomedical Research Networking Centre-CIBERES, Santiago de Compostela, Spain
- Pneumoloxy Department, Santiago de Compostela University Hospital Complex, Santiago de Compostela, Spain
| | - Maria T Herdeiro
- Department of Medical Sciences, iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
| | - Ángel Salgado-Barreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
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Sáenz-Aldea M, Salgado-Barreira Á, Taracido-Trunk M, Piñeiro-Lamas M, Herdeiro MT, Portela-Romero M, Saez M, Figueiras A. RE: Colchicine and risk of hospitalization due to COVID-19: A population-based study. J Med Virol 2023; 95:e28741. [PMID: 37185845 DOI: 10.1002/jmv.28741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Affiliation(s)
| | - Ángel Salgado-Barreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
| | - Margarita Taracido-Trunk
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria T Herdeiro
- Department of Medical Sciences, iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Manuel Portela-Romero
- Centro de Salud Concepción Arenal, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
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Sáenz-Aldea M, Salgado-Barreira Á, Taracido Trunk M, Piñeiro-Lamas M, Herdeiro MT, Portela-Romero M, Saez M, Figueiras A. Colchicine and risk of hospitalization due to COVID-19: A population-based study. J Med Virol 2023; 95:e28496. [PMID: 36639903 PMCID: PMC10107154 DOI: 10.1002/jmv.28496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/23/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
Colchicine is one of the most widely studied and best-known anti-inflammatory treatments. This study aimed to assess the effect of colchicine on risk of hospitalization due to COVID-19; and its effect on susceptibility to and severity of the virus in patients with COVID-19. We carried out a population-based case-control study. The following groups were applied: (1) to assess risk of hospitalization, cases were patients with a positive PCR who were hospitalized due to COVID-19, and controls without a positive PCR; (2) to assess susceptibility to COVID-19, cases were patients with a positive PCR (hospitalized and non-hospitalized), and the same controls; (3) to determine potential severity, cases were subjects with COVID-19 hospitalized, and controls patients with COVID-19 nonhospitalised. Different electronic, linked, administrative health and clinical databases were used to extract data on sociodemographic variables, comorbidities, and medications dispensed. The study covered 3060 subjects with a positive PCR who were hospitalized, 26 757 with a positive PCR who were not hospitalized, and 56 785 healthy controls. After adjustment for sociodemographic variables, comorbidities and other treatments, colchicine did not modify risk of hospitalization due to COVID-19 (adjusted odd ratio [OR] 1.08 [95% confidence interval (CI) 0.76-1.53]), patients' susceptibility to contracting the disease (adjusted OR 1.12 (95% CI 0.91-1.37)) or the severity of the infection (adjusted OR 1.03 [95% CI 0.67-1.59]). Our results would neither support the prophylactic use of colchicine for prevention of the infection or hospitalization in any type of patient, nor justify the withdrawal of colchicine treatment due to a higher risk of contracting COVID-19.
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Affiliation(s)
| | - Ángel Salgado-Barreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Margarita Taracido Trunk
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria T Herdeiro
- Department of Medical Sciences, iBiMED-Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Manuel Portela-Romero
- Centro de Salud Concepción Arenal, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
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Rodrigues DA, Herdeiro MT, Thürmann PA, Figueiras A, Coutinho P, Roque F. [Operationalisation for Portugal of the EU(7)-PIM List for Identification of Potentially Inappropriate Medicines in Older Adults]. ACTA MEDICA PORT 2021; 34:194-200. [PMID: 33226323 DOI: 10.20344/amp.13618] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/16/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In 2015, the EU(7)-PIM List was published, which identifies potentially inappropriate medicines in older patients and resulted from a consensus of experts from seven European countries. Portugal was not part of this group, so it was not originally adapted to the Portuguese reality. With this work, we intend to elaborate a list of potentially inappropriate medicines adapted to the reality of medicines marketed in Portugal, through the operationalization of the EU(7)-PIM List for the national reality and to evaluate the adequacy of its use for clinical practice. MATERIAL AND METHODS Search, in INFARMED's Infomed database, of drugs that are included in the EU(7)-PIM List that have marketing authorization, and analysis of possible new drugs for inclusion in the list. The tool adapted to the Portuguese reality was applied to a sample of 1089 outpatient, polymedicated older patients from 38 primary care units in Central Portugal. RESULTS The final PIM list adapted to the Portuguese reality includes 184 potentially inappropriate medicines (from these, 178 are active substances, five are classes of drugs, and one corresponds to the sliding scale therapeutic scheme used in insulin therapy). Of 1089 polymedicated older patients, 83.7% took at least one drug included in the final potentially inappropriate medicines list or belonging to one of the groups included in the list, and, on average, each patient took 1.74 (IQR 1 - 2). DISCUSSION Even though the availability of drugs on the market is quite diverse, the EU(7)-PIM List has been used in several European countries. With this study, we operationalized the European list for the Portuguese reality, which will enable its application in clinical practice. CONCLUSION The list drawn up is a useful tool for the identification of potentially inappropriate medicines, easy to use in clinical practice and research.
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Affiliation(s)
- Daniela A Rodrigues
- Unidade de Investigação para o Desenvolvimento do Interior. Instituto Politécnico da Guarda (UDI-IPG). Guarda. Portugal
| | - Maria T Herdeiro
- Departamento de Ciências Médicas e Instituto de Biomedicina. Universidade de Aveiro (iBIMED-UA). Aveiro. Portugal
| | - Petra A Thürmann
- Department of Clinical Pharmacology. Helios University Hospital Wuppertal. University Witten/Herdecke. Wuppertal. Alemanha. Germany
| | - Adolfo Figueiras
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP). Santiago de Compostela. Espanha. Spain
| | - Paula Coutinho
- Unidade de Investigação para o Desenvolvimento do Interior. Instituto Politécnico da Guarda (UDI-IPG). Guarda. Centro de Investigação em Ciências da Saúde. Universidade da Beira Interior (CICS-UBI). Covilhã. Portugal
| | - Fátima Roque
- Unidade de Investigação para o Desenvolvimento do Interior. Instituto Politécnico da Guarda (UDI-IPG). Guarda. Centro de Investigação em Ciências da Saúde. Universidade da Beira Interior (CICS-UBI). Covilhã. Portugal
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Costa MJ, Herdeiro MT, Polónia JJ, Ribeiro-Vaz I, Botelho C, Castro E, Cernadas J. Type B adverse drug reactions reported by an immunoallergology department. Pharm Pract (Granada) 2018; 16:1070. [PMID: 29619134 PMCID: PMC5881478 DOI: 10.18549/pharmpract.2018.01.1070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/27/2018] [Indexed: 11/14/2022] Open
Abstract
Objective: Characterization of the adverse drug reactions (ADR) reported by the immunoallergology department (IAD), Centro Hospitalar de São João (Porto), to the Northern Pharmacovigilance Centre (NPC). Methods: An observational, descriptive and retrospective study was conducted, based in a spontaneous report system. Participants were all the patients from the IAD, with suspected ADR, reported to NPC by specialists after the study was completed. Results: Studied population had a median age of 41 years, with the predominance of the female gender (73.2%). Allergic rhinitis and asthma were the most frequent comorbidities. All studied ADR were type B, 89.6% were serious, 86.4% unexpected and 2.6% associated with drugs that presented less than 2 years in the market. The most represented drug classes were the non-steroidal anti-inflammatory drugs (NSAIDs) (52.6%) and antibiotics (25.2%). Skin symptoms represented 61.2% of the reported complaints. About 52.9% of these ADR occurred in less than one hour after intake. The most frequent ADR treatment at the time of the reaction was drug interruption (86.2%), followed by the prescription of anti-histamines (42.2%). Conclusions: Reported ADR to NPC by the Drug Alert Unit were mainly serious, unexpected, associated with NSAIDs and antibiotics and related with marketing authorization medicines older than two years. These results could be very useful to develop strategies to prevent the clinical and economic consequences of ADR.
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Affiliation(s)
- Maria J Costa
- Department of Community Medicine, Information and Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Maria T Herdeiro
- Institute for Research in Biomedicine - iBiMED, Department of Medical Sciences, University of Aveiro. Aveiro (Portugal).
| | - Jorge J Polónia
- Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Inês Ribeiro-Vaz
- Center for Health Technology and Services Research; & Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Cármen Botelho
- Immunoallergology Department, Hospital São João. Porto (Portugal).
| | - Eunice Castro
- Immunoallergology Department, Hospital São João. Porto (Portugal).
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Roque F, Figueiras A, Herdeiro MT. Antibiotic Use In Hospital Setting: Have Pharmacists An Active Role? Clin Ther 2016; 38:e29. [PMID: 27673655 DOI: 10.1016/j.clinthera.2016.07.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- F Roque
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal; Research Unit for Inland Development, Guarda Polytechnic (UDI/IPG), Guarda, Portugal; Consortium for Biomedical Research in Epidemiology & Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal
| | - A Figueiras
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal; Research Unit for Inland Development, Guarda Polytechnic (UDI/IPG), Guarda, Portugal; Consortium for Biomedical Research in Epidemiology & Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal
| | - M T Herdeiro
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal; Research Unit for Inland Development, Guarda Polytechnic (UDI/IPG), Guarda, Portugal; Consortium for Biomedical Research in Epidemiology & Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal
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Herdeiro MT, Bastos PAD, Rodrigues AT, Roque F. Medicinal Product Regulation: Portugal's Framework. Clin Ther 2016; 38:e3-e4. [PMID: 27673656 DOI: 10.1016/j.clinthera.2016.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M T Herdeiro
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal; CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal; Division of Biochemistry, Chemistry Department, University of Aveiro, Aveiro, Portugal; Research Unit for Inland Development, Guarda Polytechnic (UDI/IPG), Guarda, Portugal
| | - P A Dias Bastos
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal; CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal; Division of Biochemistry, Chemistry Department, University of Aveiro, Aveiro, Portugal; Research Unit for Inland Development, Guarda Polytechnic (UDI/IPG), Guarda, Portugal
| | - A Teixeira Rodrigues
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal; CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal; Division of Biochemistry, Chemistry Department, University of Aveiro, Aveiro, Portugal; Research Unit for Inland Development, Guarda Polytechnic (UDI/IPG), Guarda, Portugal
| | - F Roque
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal; CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal; Division of Biochemistry, Chemistry Department, University of Aveiro, Aveiro, Portugal; Research Unit for Inland Development, Guarda Polytechnic (UDI/IPG), Guarda, Portugal
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Herdeiro MT, Soares S, Silva T, Roque F, Figueiras A. Impact of rosiglitazone safety alerts on oral antidiabetic sales trends: a countrywide study in Portugal. Fundam Clin Pharmacol 2016; 30:440-9. [PMID: 27259384 DOI: 10.1111/fcp.12207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 05/12/2016] [Accepted: 06/02/2016] [Indexed: 11/27/2022]
Abstract
Pharmacovigilance systems are important to monitor the safety of on-market drugs after approval. The aim of this study was to assess the impact of rosiglitazone safety alerts on trends in the sale of rosiglitazone and other oral antidiabetic drugs. An ecological study was conducted, using temporally aggregated data and linking safety alerts to countrywide sales of all oral antidiabetic drugs in Portugal from January 2002 to December 2012. Sales figures for oral antidiabetic drugs marketed in Portugal were supplied by IMS Health Portugal with a breakdown by active substance and fixed combinations. The number of defined daily doses per 1000 inhabitants per day (DIDs) of each oral antidiabetic drug sold to the estimated diabetic population using oral antidiabetic drugs in Portugal was calculated. Particular attention was paid to the case of rosiglitazone, with the results being adjusted for changes in rosiglitazone reimbursement policies. A total of four safety alerts were issued about rosiglitazone. Rosiglitazone sales registered an increase of 32.9% (0.202 DIDs; P < 0.001) after the first alert (risk of macular oedema or worsening of pre-existent macular oedema) in January 2006. After subsequent alerts about cardiovascular risks, this trend was not, however, repeated and sales fell. Following the January 2006 and January 2008 safety alerts, rosiglitazone sales described a long-term downward trend, with decreases of 3.75% (-0023 DIDs; P > 0.05) and 0.24% (-0.001 DIDs; P > 0.05), respectively. It is important to promote the dissemination and publication of drug safety alerts.
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Affiliation(s)
- Maria T Herdeiro
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal. .,CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Rua Central de Gandra, 1317 4585-116, Gandra, Portugal.
| | - Sara Soares
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Tânia Silva
- IMS Health Portugal, Lagoas Park Edifício 3-piso, 32740-266, Oeiras, Portugal
| | - Fátima Roque
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.,Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), Av. Dr. Francisco Sá Carneiro n°50, 6300-559, Guarda, Portugal
| | - Adolfo Figueiras
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, R/ de San Francisco, s/n15782, Santiago de Compostela, Spain
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Teixeira Rodrigues A, Ferreira M, Piñeiro-Lamas M, Falcão A, Figueiras A, Herdeiro MT. Determinants of physician antibiotic prescribing behavior: a 3 year cohort study in Portugal. Curr Med Res Opin 2016; 32:949-57. [PMID: 26878083 DOI: 10.1185/03007995.2016.1154520] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives Antibiotic misprescription is a major driver of resistance, which is a worldwide public health problem. Therefore, our aim is to assess the influence of the determinants of physician prescribing on the quality of antibiotic use. Methods A 3 year cohort study including all primary-care physicians working in Portugal's Central Regional Health Administration (n = 1094) was conducted. We assessed the determinants of prescribing using a pre-validated, personally addressed, reply-paid, self-administered questionnaire (sent four times to non-responders, between September 2011 and February 2012) designed to collect information on physicians' attitudes to and knowledge of antibiotic prescribing as well as their socio-demographic and professional data. To evaluate antibiotic prescribing, we've calculated ESAC 12 quality indicators per physician per year, allowing us to stratify them as good or poor prescribers according to their performance on those indicators. Associations between determinants and outcomes were fitted with generalized linear mixed models. Results The overall response rate was 46.1%. Emergency activity (OR [95% CI] = 0.29 [0.16-0.54]; p < 0.05) and workload (number of patients seen per day: OR [95% CI] = 0.97 [0.94-1.00]; p < 0.05; number of patients seen per week in emergencies: OR [95% CI] = 0.98 [0.97-0.99]; p < 0.05) were both related to poor quality of antibiotic prescribing. Statistically significant odds ratios were also obtained for ignorance (IqOR [95% CI] = 2.14 [1.31-3.52]), complacency (1/IqOR [95% CI] = 1.19 [1.01-1.41]) and responsibility of others (1/IqOR [95% CI] = 1.78 [1.10-3.06]). Conclusions The above results serve to emphasize workload, working at emergency departments and physicians' attitudes identified as critical factors affecting antibiotic prescribing. This provides new insights for clinicians, researchers and policy makers when it comes to developing and improving the clinical and economic outcomes of antibiotic use. Key limitations of the study included the difficulty of results extrapolation and the limitations of the stratification method based on the antibiotic prescribing quality indicators.
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Affiliation(s)
- António Teixeira Rodrigues
- a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal
- b Faculty of Pharmacy , University of Coimbra (Faculdade de Farmácia da Universidade de Coimbra - FFUC) , Coimbra , Portugal
| | - Mónica Ferreira
- a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal
| | - Maria Piñeiro-Lamas
- c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP) , Santiago de Compostela , Spain
| | - Amílcar Falcão
- b Faculty of Pharmacy , University of Coimbra (Faculdade de Farmácia da Universidade de Coimbra - FFUC) , Coimbra , Portugal
- d Centre for Neuroscience and Cell Biology, University of Coimbra (CNC/UC) , Coimbra , Portugal
| | - Adolfo Figueiras
- c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP) , Santiago de Compostela , Spain
- e University of Santiago de Compostela , Santiago de Compostela , Spain
| | - Maria T Herdeiro
- a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal
- f CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde , Gandra , Portugal
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Duarte-Silva D, Figueiras A, Herdeiro MT, Teixeira Rodrigues A, Silva Branco F, Polónia J, Figueiredo IV. PERSYVE - Design and validation of a questionnaire about adverse effects of antihypertensive drugs. Pharm Pract (Granada) 2014; 12:396. [PMID: 25035716 PMCID: PMC4100950 DOI: 10.4321/s1886-36552014000200005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 06/16/2014] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to design and validate a questionnaire to measure perceived symptoms associated with antihypertensive drugs (PERSYVE). METHODS THE PERSYVE DEVELOPMENT AND VALIDATION INCLUDED FOUR STAGES: 1) item development (bibliographic review and questionnaire elaboration); 2) face and content validation; 3) field testing (pre-test); and 4) test-retest validation, assessment of internal consistency (Cronbach's alpha) and reproducibility over time (intraclass correlation coefficient and Cohen's kappa coefficient). RESULTS PERSYVE IS DIVIDED INTO SIX SECTIONS ACCORDING TO RESULTS OBTAINED FROM THE LITERATURE REVIEW: (1) drug adherence, (2) perceived symptoms and how they affect quality of life (five-point Likert scale), (3) communication with health professionals, (4) perception of symptoms as adverse reactions, (5) influence on therapy compliance, and (6) adoption of non-pharmacological methods for blood pressure control. Content and face validation of the questionnaire led to some vocabulary changes and the introduction of section 2.1. Field-testing (n=26) revealed high comprehensibility of the questions. The Cronbach's alpha, calculated for section 2 (five-point Likert scale) was 0.850. PERSYVE was reproducible (n=167): kappa values presented fair to substantial reproducibility and, in section 2, ICC values resulted in good to excellent reproducibility. CONCLUSION Results showed that PERSYVE is a well-structured, objective, patient-friendly, valid and reliable questionnaire. PERSYVE can be a very useful instrument in hypertensive patients' monitoring and in the screening of adverse effects.
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Affiliation(s)
- Daniela Duarte-Silva
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra; & CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde. Coimbra ( Portugal ).
| | - Adolfo Figueiras
- Faculty of Medicine, University of Santiago de Compostela; & Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP) . Santiago de Compostela ( Spain ).
| | - Maria T Herdeiro
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde; & Center for Cell Biology, University of Aveiro; & Center for Health Technology . Porto ( Portugal ).
| | - António Teixeira Rodrigues
- Center for Cell Biology, University of Aveiro; & Faculty of Pharmacy, University of Coimbra . Coimbra ( Portugal ).
| | - Fábio Silva Branco
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra . Coimbra ( Portugal ).
| | - Jorge Polónia
- Faculty of Medicine, University of Porto; & Unit of Hypertension, Pedro Hispano General Hospital . Matosinhos ( Portugal ).
| | - Isabel V Figueiredo
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra; & Center for Pharmaceutical Studies, University of Coimbra; & IBILI - Institute for Biomedical Imaging and Life Sciences, Universidade de Coimbra . Coimbra ( Portugal ).
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Gonzalez-Gonzalez C, Lopez-Gonzalez E, Herdeiro MT, Figueiras A. Strategies to Improve Adverse Drug Reaction Reporting: A Critical and Systematic Review. Drug Saf 2013; 36:317-28. [DOI: 10.1007/s40264-013-0058-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A voluntary reporting system of adverse drug reactions (ADRs) is fundamental to drug safety surveillance but under-reporting is its major limitation. This bibliographic review sought to assess the influence of personal and professional characteristics on ADR reporting and to identify knowledge and attitudes associated with ADR reporting. A systematic review was conducted using the MEDLINE and EMBASE databases. We included papers that were published in English, French and Spanish, and covered a study population made up of health professionals. In each case, the following data were extracted: study population; workplace; study type; sample size; type of questionnaire; type of scale for measuring knowledge; response rate; personal and professional factors; and knowledge and attitudes (based on Inman's 'seven deadly sins') associated with reporting. Based on a search of computerized databases, we identified a total of 657 papers in MEDLINE and 973 in EMBASE. In all, the review covered 45 papers that fulfilled the inclusion criteria. Medical specialty was the professional characteristic most closely associated with under-reporting in 76% of studies involving physicians. Other factors associated with under-reporting were ignorance (only severe ADRs need to be reported) in 95%; diffidence (fear of appearing ridiculous for reporting merely suspected ADRs) in 72%; lethargy (an amalgam of procrastination, lack of interest or time to find a report card, and other excuses) in 77%; indifference (the one case that an individual doctor might see could not contribute to medical knowledge) and insecurity (it is nearly impossible to determine whether or not a drug is responsible for a particular adverse reaction) in 67%; and complacency (only safe drugs are allowed on the market) in 47% of studies. While personal and professional factors display a weak influence, the knowledge and attitudes of health professionals appear to be strongly related with reporting in a high proportion of studies. This result may have important implications in terms of public health, if knowledge and attitudes are viewed as potentially modifiable factors.
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Affiliation(s)
- Elena Lopez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
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Herdeiro MT, Polónia J, Gestal-Otero JJ, Figueiras A. Improving the reporting of adverse drug reactions: a cluster-randomized trial among pharmacists in Portugal. Drug Saf 2008; 31:335-44. [PMID: 18366244 DOI: 10.2165/00002018-200831040-00007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Adverse drug reaction (ADR) reporting systems are the basic component for comprehensive postmarketing surveillance of the risk of drug-induced adverse effects. The aim of this study was to evaluate the effectiveness of educational outreach visits aimed at improving ADR reporting by pharmacists. METHODS The study population comprised all pharmacists working in a catchment area covered by Portugal's Northern Regional Health Authority. Using unequal randomization, four spatial-clusters were assigned to the intervention group (n = 342) and eleven to the control group (n = 1091). The intervention took the form of 1-hour long educational outreach visits tailored to training needs detected in a previous study, with a 13- to 16-month follow-up period (March-June 2004 through June 2005). This study is registered as an international standard randomized controlled trial, number ISRCTN45894687. RESULTS At baseline, ADR reporting rates (per 1000 pharmacist-years) did not differ significantly between the intervention and control groups (32.28 vs 29.16). The adjusted increase in ADR reporting attributable to the intervention was 275.63 per 1000 pharmacist-years (95% CI 162.15, 389.12; relative risk [RR] = 5.87, 95% CI 1.98, 17.39). The intervention succeeded in multiplying the reporting rate of: serious ADRs, 10-fold (RR = 9.79; 95% CI 2.24, 42.66); unexpected ADRs, 4-fold (RR = 4.41; 95% CI 1.11, 17.53); high-causality ADRs, 9-fold (RR = 8.67; 95% CI 2.12, 35.42); and new drug-related ADRs, 9-fold (RR = 9.33; 95% CI 2.53, 34.40). While the greatest effect was registered during the first 4 months post-intervention, differences remained statistically significant for 8 months. CONCLUSIONS Educational outreach visits improve ADR reporting by pharmacists in terms of quantity and relevance.
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Affiliation(s)
- Maria T Herdeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
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Herdeiro MT, Figueiras A, Polónia JJ. Improving Reporting of Adverse Drug Reactions: Cluster-Randomised Trial among Portuguese Pharmacists. Drug Saf 2007. [DOI: 10.2165/00002018-200730100-00145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Figueiras A, Herdeiro MT, Polónia J, Gestal-Otero JJ. An educational intervention to improve physician reporting of adverse drug reactions: a cluster-randomized controlled trial. JAMA 2006; 296:1086-93. [PMID: 16954488 DOI: 10.1001/jama.296.9.1086] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
CONTEXT Data on the adverse effects of newly marketed drugs are limited. Voluntary reporting is an important part of postmarketing surveillance but is underused by physicians. OBJECTIVE To evaluate the effectiveness of educational outreach visits for improving adverse drug reaction (ADR) reporting by physicians. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized controlled trial covering all National Health System physicians in the north of Portugal, with intervention in March 2004 through July 2004, and 13 to 16 months of follow-up. A total of 1388 physicians were assigned in 4 spatial clusters to the intervention group, and 5063 were assigned in 11 clusters to the control group. INTERVENTION One-hour educational outreach visits tailored to training needs identified in a previous study. MAIN OUTCOME MEASURES Change in total number of reported ADRs and number of serious, high-causality, unexpected, and new-drug-related ADRs, using generalized linear mixed models adjusted for baseline ADR reporting, age, specialty, and work setting. RESULTS At baseline, ADR reporting rates (per 1000 physician-years) did not differ significantly between the intervention groups and the control groups in reporting ADRs overall (7.6 vs 11.3), nor did they differ significantly by category: serious, 4.3 vs 6.0; high-causality, 5.4 vs 7.6; unexpected, 1.6 vs 3.5; and new-drug-related ADRs, 3.7 vs 3.8. (P>.05 for all comparisons). The control group had no significant increase in ADR reports during follow-up. The adjusted increase in ADR reporting rates attributable to intervention was 90.19 for total ADRs (95% confidence interval [CI], 54.51-125.87; relative risk [RR], 10.23; 95% CI, 3.81-27.51), 30.16 for serious ADRs (95% CI, 18.84-41.47; RR, 6.32; 95% CI, 2.09-19.16), 64.90 for high-causality ADRs (95% CI, 38.38-91.42; RR, 8.75; 95% CI, 3.05-25.07), 28.04 for unexpected ADRs (95% CI, 16.25-39.83; RR, 30.21; 95% CI, 4.54-200.84), and 42.17 for new-drug-related ADRs (95% CI, 21.58-62.76; RR, 8.05; 95% CI, 2.10 -30.83). The greatest difference occurred during the first 4 months after intervention, but differences remained statistically significant for 12 months. CONCLUSION A targeted outreach program may improve high-quality reporting of ADRs among physicians.
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Affiliation(s)
- Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain, Portugal.
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Herdeiro MT, Figueiras A, Polónia J, Gestal-Otero JJ. Influence of pharmacists' attitudes on adverse drug reaction reporting : a case-control study in Portugal. Drug Saf 2006; 29:331-40. [PMID: 16569082 DOI: 10.2165/00002018-200629040-00004] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Pharmacists can play a fundamental role in adverse drug reaction (ADR) reporting, although the factors that affect underreporting among these professionals are unknown. The objectives of this study were to identify (i) professional or demographic characteristics; and (ii) attitudes associated with pharmacists' ADR reporting in northern Portugal. METHODS We conducted a case-control study on a population of pharmacists employed in hospital and community pharmacies across Portugal's Northern Regional Health Authority catchment area in 2003. Cases (n=34) comprised pharmacists who had reported at least one ADR to the northern region's drug surveillance unit, and controls (n=280) were randomly sampled from pharmacists who had never reported an ADR. All were interviewed using a mail questionnaire. Most attitudes were based on Inman's 'seven deadly sins' and were measured using a continuous visual analogue scale. Answers were recorded in a range from 0 (total disagreement) to 10 (total agreement). Logistic regression was used to determine the ADR reporting adjusted odds ratio (OR) for a change in exposure corresponding to the interquartile range for each attitude. RESULTS The response rate was 86.8%. Reporting probability proved higher among hospital versus community pharmacists (adjusted OR 20.0; 95 CI 3.3, 125.0; p<0.001). Attitudes to ADRs were strongly associated with reporting probability. Hence, an interquartile decrease in any of the following attitudes increased the probability of reporting by (i) 223% (95% CI 51, 595; p < 0.05) for "Really serious ADRs are well documented by the time a drug is marketed"; (ii) 240% (95% CI 89, 508; p=0.002) for "I would only report an ADR if I were sure that it was related to the use of a particular drug"; (iii) 316% (95% CI 44, 1104; p=0.010) for "It is only necessary to report serious or unexpected ADRs"; and (iv) 171% (95% CI 13, 549; p=0.020) for "I do not have time to think about the involvement of the drug or other causes in ADRs". CONCLUSIONS ADR under-reporting is strongly associated with certain attitudes, possibly indicating that under-reporting could be minimised through educational interventions targeted at changing such attitudes. Pharmacists' ADR education must be improved and educational programmes should be focused on altering attitudes identified by the study as being associated with under-reporting. Our data also indicate that community pharmacists must be a priority target for this intervention.
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Affiliation(s)
- Maria T Herdeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, SpainNorthern Polytechnic Health Institute (Cooperativa de Ensino Superior Politécnico e Universitário [CESPU]), Gandra, Porto, Portugal
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Abstract
OBJECTIVES Voluntary adverse drug reaction (ADR) reporting is fundamental to medical drug safety surveillance; however, substantial under-reporting exists and is the main limitation of the system. This study sought to identify the knowledge- and attitude-related factors associated with ADR reporting by physicians in Northern Portugal. METHODS Case-control study covering a population of National Health Service medical practitioners. The 88 cases comprised physicians who had reported at least one ADR to the drug surveillance unit from the year 2000 to the date of enrolment in the study. The 771 controls were randomly selected from among the remaining physicians. All interviews were conducted using a self-administered questionnaire. Knowledge and attitudes regarding spontaneous ADR reporting were based on Inman's 'seven deadly sins'. Agreement with the questions included in the questionnaire was measured using a horizontal, continuous visual analogue scale, which was unnumbered. Recorded answers were read in a range from zero (total disagreement) to ten (total agreement). We used logistic regression to determine the ADR reporting adjusted odds ratio (ORadj) for a change in exposure corresponding to the interquartile range for each attitude. RESULTS A total of 397 questionnaires were received from 731 eligible practitioners (54.3%). Physicians who worked in primary versus hospital care (ORadj 7.74 [95% CI 1.85, 32.30]) and in general medicine (ORadj 1.05 [95% CI 0.30, 3.69]) versus medical specialities were more likely to report ADRs. In contrast, physicians working in the medical-surgical/surgical fields were significantly less likely to report ADRs compared with medical specialists (ORadj 0.10 [95% CI 0.02, 0.46]). Attitudes to ADRs were strongly associated with reporting probability. Hence, an interquartile decrease in any of the following attitudes increased the probability of reporting by: (i) 87% (p < 0.05) for complacency (the belief that really serious ADRs are well documented by the time a drug is marketed); (ii) 109% (p < 0.01) for insecurity (the belief that it is nearly impossible to determine whether a drug is responsible for a particular adverse reaction); (iii) 143% (p < 0.001) for diffidence (the belief that one would only report an ADR if one were sure that it was related to the use of a particular drug); (iv) 220% (p < 0.001) for indifference (the belief that the one case an individual doctor might see could not contribute to medical knowledge); and (v) 71% (p < 0.05) for ignorance (the belief that it is only necessary to report serious or unexpected ADRs). CONCLUSION This study shows that there are attitudes strongly associated with under-reporting. The implementation of purpose-designed educational interventions based on the attitudes identified in this study may serve to improve reporting substantially.
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Affiliation(s)
- Maria T Herdeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
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