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Influence of Pharmacists’ Attitudes on Adverse Drug Reaction Reporting

A Case-Control Study in Portugal


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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Data were supplied by the northern Portugal sections of the National Association of Pharmacies and Hospital Pharmaceutical Association. The authors wish to thank the Programa de Desenvolvimento Educativo para Portugal (PRODEP), Portugal’s Educational Development Programme, for funding the study and the National Association of Pharmacies, the Hospital Pharmaceutical Association and the pharmacists who responded to our questionnaire. Dr Figueiras’ work on this project was funded in part by Health Research Fund (Fondo de Investigation Sanitaria) grants 99/1189 from the Spanish Ministry of Health.

The authors have no conflicts of interest that are directly relevant to the content of this study.

Thanks must also go to Michael Benedict for his help with the English version of this paper.

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Correspondence to Adolfo Figueiras.

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Herdeiro, M.T., Figueiras, A., Polónia, J. et al. Influence of Pharmacists’ Attitudes on Adverse Drug Reaction Reporting. Drug-Safety 29, 331–340 (2006).

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  • Visual Analogue Scale
  • Adverse Drug Reaction
  • Medical Practitioner
  • Community Pharmacy
  • Community Pharmacist