Active involvement of the general public in pharmacovigilance

The importance of direct patient reporting has been highlighted by recent European legislation on pharmacovigilance, and in addition, there is also an increasing attention worldwide for this subject. In Europe, the legislation directs member states to take all appropriate measures to encourage patients to report suspected adverse drug reactions (ADR) to the relevant national authorities. The introduction of patient reporting in pharmacovigilance indicates a change in attitude in which patient reporting is valued due to their potential to contribute useful information on drug safety. The aim of this project is to give a better understanding of the role of patients in pharmacovigilance systems. The chosen approach during this project intended to lead to a better understanding of the awareness and perception of the risk involved with medicine use and how patients and healthcare professionals can contribute to optimize the current pharmacovigilance system. For the purpose of this study, the project was divided in several parts, for which specific objectives were designed and described below, together with main results of the thesis. The first study described in Chapter 2 discusses the experiences of patient reporting to pharmacovigilance in Portugal and quantifies consumers motivation for reporting ADRs, investigating patient opinions about reporting with a quantitative analysis in a large group of consumers. The objective was to describe the attitudes and knowledge of the general public regarding spontaneous reporting and the reasons and opinions that can influence consumers adverse drug reaction underreporting. The study reveals that consumers are more likely to do spontaneous report about severe reactions or if they are worried about the symptoms. Also, more altruistic motives as the contribution to research and knowledge, the contribution to improvement of drugs and prevent harm to other people are seen as motives to report ADRs by patients. These motives can be classified in reporting for oneself (severity, worried, problems), reporting for others (share experiences, preventing harm, feeling responsible) or reporting for improvement (research and knowledge, patient information leaflet). It appeared that multiple patient characteristics (gender, age and level of education) had an effect on the motives of patients to report their ADR. In Chapter 3 were described the attitudes toward patient reporting systems, and progress toward implementing such systems among national competent authorities participating in the World Health Organization Programme for International Drug Monitoring. The study shows that most countries accept ADR reports from patients by an official reporting system designed for patients or through the existing system for Healthcare Professionals (HCPs). The main reasons for not having a Patient Reporting System (PRS) are financial restraints and a lack of information/education of patients. Attitudes toward a PRS are positive, but some countries fear 181 that they will not be able to handle an increase in reports. Most countries accept ADR reports from the general public. The lack of resources/budget and the lack of information/education for patients are highlighted as the major obstacles to the implementation of PRS. Chapter 4 focused on patient organizations role to promote patient reporting. In Chapter 4.1, it was studied the role of European patient organizations with the objective of understand the role of European patient organizations as stakeholders to optimize patient involvement in pharmacovigilance. There is a wide range of interest in drug safety issues among patient organizations, which appear to have an important role in encouraging patients to talk with their doctors/pharmacists about ADRs experienced, or to help him/her report the ADRs to the pharmacovigilance systems. A lack of resources, budget, and support from National Competent Authorities (NCAs) are seen as the main barriers to being involved in pharmacovigilance. On the other hand, an important part of the organizations appears to not have any activities or involvement related to pharmacovigilance. Bringing pharmacovigilance stakeholders and patient organizations together could create a more optimal patient reporting culture. Members of a patient organization showed more positive opinions related to pharmacovigilance. They would like to have more information about ADRs related to their medication and a higher intention to have information on how to report when compared to other patients. The other study in Chapter 4 described medicines and attitudes and opinions regarding pharmacovigilance in people with diabetes. The study explored the impact of the patient reports being followed by a patient diabetes association. The objective was to assess risk perception of developing adverse drug reactions and knowledge, attitudes and opinions regarding pharmacovigilance in patients with diabetes and to investigate whether being a member of a patient organization for diabetes had an effect on these factors. Patients followed in a diabetes patient association presented a higher score of risk perception, experiences using the medicines, but also by the information received from the patient organization. Being a member of a patient organization seems to have an important role in increasing risk perception since they presented the highest risk perception scores for medicines related to their disease. Those patients affirmed that their doctor explained the possible ADRs of their medication and they have higher intention to report ADRs in the future if they are serious or unexpected. Patient organizations are well positioned to be a source where patients can obtain reliable information, changing their attitudes and perceptions about the disease and drug treatments. An additional chapter was provided, related with HCPs role as active agents to improve the involvement of patients in pharmacovigilance. Chapter 5.1 objective was to describe the attitudes and knowledge of different community pharmacy professional groups regarding the spontaneous reporting of adverse drug reactions to identify the factors that can influence adverse drug reaction under-reporting. Despite HCPs knowledge of the pharmacovigilance system, only a small 182 percentage of Community pharmacy professionals had reported ADRs, and approximately half did not usually encourage consumers to report possible ADRs. In Chapter 5.2, the objective was to evaluate community pharmacy professionals as role players . Reporting of ADRs is fundamental to pharmacovigilance, and consumer reporting is a significant contribution to creating useful information on drug safety. Community pharmacy professionals can play a major role in pharmacovigilance by reporting ADRs directly or encouraging consumers to report them. Measures to overcome under-reporting as encouraging HCPs and consumers to play an active role in pharmacovigilance, namely continuous education and training should be incorporated to increase the level of risk perception and encourage a better attitude about reporting for both HCPs and consumers. Chapter 6 presents a general discussion about the role of general public in pharmacovigilance, providing recommendations that arose from the results with different points of view of patient participation in pharmacovigilance (national competent authorities, HCPs, patient organizations and patients themselves). In conclusion, this thesis has focused on an overview of the participation of different stakeholders in pharmacovigilance, including HCPs, NCAs, Patient Organizations and patients themselves. Further research and developments for pharmacovigilance systems and for patients themselves arose from the results

Topic: Pharmacovigilance and Adverse Drug Reactions
Subfield: Toxicology
Field: Pharmacology, Toxicology and Pharmaceutics
Domain: Life Sciences