International Journal of Clinical Pharmacy

, Volume 36, Issue 6, pp 1205–1212 | Cite as

Hospital pharmacists’ roles and attitudes in providing information on the safety of non-steroidal anti-inflammatory drugs in Thailand

  • Pacharaporn Phueanpinit
  • Narumol JarernsiripornkulEmail author
  • Juraporn Pongwecharak
  • Janet Krska
Research Article


Background Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for patients to manage pain and inflammation, especially in older adults. Failure to cope with some adverse drug reactions (ADRs) of NSAIDs could lead to more serious symptoms, therefore, providing useful information about medicine is an important step in protecting patients from developing serious ADRs. The pharmacy service should be a frequent source of medicine information for patients, however in Thailand, little is known about pharmacists’ provision of safety information to patients for management and prevention of these ADRs. Objective Aims of this study were to determine Thai hospital pharmacists’ roles in providing drug safety information and to assess their attitudes towards the importance of giving drug safety education to patients. Setting All government hospitals in north-eastern Thailand. Methods This study was a cross-sectional survey. A total of 761 pharmacists in 287 hospitals in north-eastern Thailand were selected by stratified random sampling. Self-administered questionnaires were sent by post, with two reminders. Main outcome measures Proportion of hospital pharmacists providing ADR information on NSAIDs to patients, factors affecting this provision, and pharmacist attitudes towards drug safety education for patients. Results The response rate was 54.8 % (N = 417), the majority of respondents worked in community hospitals (57.2 %). A total of 347 pharmacists (83.6 %) had informed patients about ADRs, although less than half had informed patients about ADR monitoring and management (36.6 % and 44.1 % respectively). The proportion of time spent in direct patient contact, type of hospital, and other routine work were associated with the frequency of drug safety information provision. Pharmacists had moderately good attitudinal scores towards drug safety education (62.2 ± 5.4), with significantly higher scores found in those who provided most ADR information to patients (60.3 ± 5.2 vs. 62.6 ± 5.4, P = 0.002). The majority (82.2 %) agreed that patient information leaflets should be provided. Conclusions Thai hospital pharmacists’ provision of ADR information for NSAIDs may occur less frequently than is desirable. However, their positive attitude towards provision of ADR information suggests that drug safety education by pharmacists should be routinely provided to patients, particularly patients at high risk of NSAID use.


ADRs-Adverse drug reactions Drug information Drug safety Hospital pharmacists Nonsteroidal anti-inflammatory drugs NSAIDs Thailand 



The authors would like to thank all hospital pharmacists who voluntarily participated in this study. In addition, we would like to thank Assist. Prof. Sermsak Sumanont for the support in this research project.


This work received financial support from Khon Kaen University Integrate Multidisciplinary Research Cluster (Grant Number MIH-2554-Ph.D-07) and the Graduate School of Khon Kaen University (Grant Number 55222103).

Conflicts of interest

The authors declare that they have no conflict of interest in relation to this work.


  1. 1.
    Ornbjerg LM, Andersen HB, Kryger P, Cleal B, Hetland ML. What do patients in rheumatologic care know about the risks of NSAIDs? J Clin Rheumatol. 2008;14:69–73.PubMedCrossRefGoogle Scholar
  2. 2.
    Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Shah S, Mehta V. Controversies and advances in non-steroidal anti-inflammatory drug (NSAID) analgesia in chronic pain management. Postgrad Med J. 2012;88:73–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Ibañez-Cuevas V, Lopez-Briz E, Guardiola-Chorro MT. NSAID induced Gastropathy Prevention Programme Group. Pharmacist intervention reduces gastropathy risk in patients using NSAIDs. Pharm World Sci. 2008;30:947–54.PubMedCrossRefGoogle Scholar
  5. 5.
    Amer M, Bead VR, Bathon J, Blumenthal RS, Edwards DN. Use of nonsteroidal anti-inflammatory drugs in patients with cardiovascular disease: a cautionary tale. Cardiol Rev. 2010;18:204–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA. 2001;286:954–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Onder G, Pedone C, Landi F, Cesari M, Della Vedova C, Bernabei R, et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc. 2002;50:1962–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329:15–9.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Brvar M, Fokter N, Bunc M, Mozina M. The frequency of adverse drug reaction related admissions according to method of detection, admission urgency and medical department specialty. BMC Pharmacol Toxicol. 2009;9:8.CrossRefGoogle Scholar
  10. 10.
    Center Health Product Vigilance. Adverse drug reactions reporting 2011: Thai food and drug administration. Bangkok: Ministry of Public Health; 2011.Google Scholar
  11. 11.
    Turajane T, Wongbunnak R, Patcharatrakul T, Ratansumawong K, Poigampetch Y, Songpatanasilp T. Gastrointestinal and cardiovascular risk of non-selective NSAIDs and COX-2 inhibitors in elderly patients with knee osteoarthritis. J Med Assoc Thai. 2009;92(Suppl. 6):S19–26.PubMedGoogle Scholar
  12. 12.
    Tragulpiankit P, Chulavatnatol S, Rerkpattanapipat T, Janwityanujit S, Somjarit S, Sirikhedgon U. Adverse drug events in rheumatoid arthritis and osteoarthritis ambulatory patients. Int J Rheum Dis. 2012;15:315–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Chaikoolvatana A, Chanakit T, Juengrakpong A. The evaluation of a recurrent Adverse Drug Reaction Prevention Program in the north-east region of Thailand. J Med Assoc Thai. 2006;89:699–705.PubMedGoogle Scholar
  14. 14.
    Burapadaja S, Jamroendararasame B, Sanguansermsri J. Determinants of consumer’s drug leaflet reading. CMU J. 2003;2:15–26.Google Scholar
  15. 15.
    Burapadaja S, Tantipathananandh P, Sirithunyalug B. Consumer’s opinions on reading a medicine leaflet. CMU J. 2004;3:155–67.Google Scholar
  16. 16.
    Silvani MC, Motola D, Poluzzi E, Bottoni A, De Ponti F, Vaccheri A, et al. Gastro-intestinal problems and concomitant medication in NSAID users: additional findings from a questionnaire-based survey in Italy. Eur J Clin Pharmacol. 2006;62:235–41.PubMedCrossRefGoogle Scholar
  17. 17.
    Cullen G, Kelly E, Murray FE. Patients’ knowledge of adverse reactions to current medications. Br J Clin Pharmacol. 2006;62:232–6.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Van Hulten R, Blom L, Mattheusens J, Wolters M, Bouvy M. Communication with patients who are dispensed a first prescription of chronic medication in the community pharmacy. Patient Educ Couns. 2011;83:417–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Kimberlin CL, Jamison AN, Linden S, Winterstein AG. Patient counseling practices in U.S. pharmacies: effects of having pharmacists hand the medication to the patient and state regulations on pharmacist counseling. J Am Pharm Assoc. 2003;2011(51):527–34.Google Scholar
  20. 20.
    Svarstad BL, Bultman DC, Mount JK. Patient counseling provided in community pharmacies: effects of state regulation, pharmacist age, and busyness. J Am Pharm Assoc. 2003;2004(44):22–9.Google Scholar
  21. 21.
    Krueger JL, Hermansen-Kobulnicky CJ. Patient perspective of medication information desired and barriers to asking pharmacists questions. J Am Pharm Assoc. 2003;2011(51):510–9.Google Scholar
  22. 22.
    Nair K, Dolovich L, Cassels A, McCormack J, Levine M, Gray J, et al. What patients want to know about their medications. Focus group study of patient and clinician perspectives. Can Fam Physician. 2002;48:104–10.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Ziegler DK, Mosier MC, Buenaver M, Okuyemi K. How much information about adverse effects of medication do patients want from physicians? Arch Intern Med. 2001;161:706–13.PubMedCrossRefGoogle Scholar
  24. 24.
    Chaipichit N, Krska J, Pratipanawatr T, Uchaipichat V, Jarernsiripornkul N. A qualitative study to explore how patients identify and assess symptoms as adverse drug reactions. Eur J ClinPharmacol. 2014;70:607–15.Google Scholar
  25. 25.
    Schmitt MR, Miller MJ, Harrison DL, Farmer KC, Allison JJ, Cobaugh DJ, et al. Communicating non-steroidal anti-inflammatory drug risks: verbal counseling, written medicine information, and patients’ risk awareness. Patient Educ Couns. 2011;83:391–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Tarn DM, Paterniti DA, Williams BR, Cipri CS, Wenger NS. Which providers should communicate which critical information about a new medication? Patient, pharmacist, and physician perspectives. J Am Geriatr Soc. 2009;57:462–9.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Puspitasari HP, Aslani P, Krass I. A review of counseling practices on prescription medicines in community pharmacies. Res Social Adm Pharm. 2009;5:197–210.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Pacharaporn Phueanpinit
    • 1
  • Narumol Jarernsiripornkul
    • 1
    Email author
  • Juraporn Pongwecharak
    • 2
  • Janet Krska
    • 3
  1. 1.Department of Clinical Pharmacy, Faculty of Pharmaceutical SciencesKhon Kaen UniversityKhon KaenThailand
  2. 2.Faculty of Pharmacy, Rangsit CenterThammasat UniversityPathumthaniThailand
  3. 3.Medway School of PharmacyUniversities of Greenwich and KentKentUK

Personalised recommendations