Research Article - (2016) Volume 5, Issue 4

Assessment of Knowledge, Attitude and Practices of Adverse Drug Reaction Reporting among Doctors and Pharmacists in Primary Healthcare

Tew MM1*, Teoh BC2, Mohd Baidi AS3 and Saw HL3
1Clinical Research Centre, Hospital Sultan Abdul Halim, Kedah, Malaysia
2Hospital Pulau Pinang, Penang, Malaysia
3Kuala Muda District Health Office, Kedah, Malaysia
*Corresponding Author: Tew MM, Clinical Research Centre, Hospital Sultan Abdul Halim, Kedah, Malaysia

Abstract

Background: Adverse drug reactions (ADRs) are global problems of major concern. Healthcare professional's knowledge and attitudes to ADR and ADR reporting play vital role to report any cases of ADR. Positive attitudes may favour ADR reporting practices by healthcare professionals. Objective: This study was aimed to investigate the KAP towards ADR reporting among HCPs working at primary outpatient care in Kuala Muda District Health Office, Kedah, Malaysia. Methodology: A cross sectional study was done by survey using a self-administered structured questionnaire. The questionnaire was distributed to all healthcare professionals working at primary outpatient care in Kuala Muda District Health Office, Kedah, Malaysia. Result and Discussion: The overall response rate was 87.4%. The mean knowledge score was 66.9% ± 19.86 for doctors and 76.9% ± 13.87 for pharmacists (p=0.03). 43.8% of the healthcare professionals did not aware of the blue card reporting system in Malaysia. Almost all of the respondents agreed that ADR reporting should be made mandatory and they recognized that it's their professional obligation to report any ADR. However, only 51.9% of doctors and 70.8 % of pharmacist had reported. Half of the respondents professed that ADR forms are too complex to fill and almost all of the respondents (90.4% doctors and 87.5% pharmacists) declared that they are lacking of time to fill in the report. 69.2% of doctors expressed that they have not been trained on ADR reporting which was contradicting with the pharmacists (12.5%) (p<0.001). Almost all respondents (82.7 % doctors and 95.8 pharmacists) concurred that ADR reporting should be taught in details to them. Conclusion: Respondents reflected inadequate knowledge on ADR reporting. The prevalence of unsatisfactory practices and attitudes among these HCPs contributed to failure to report ADR even if the ADR was identified. Educational intervention strategies can be introduced in order to promote ADR reporting.

Keywords: Adverse drug reaction; Doctors; Pharmacists; Primary health care; Knowledge; Attitude; Practice

Abbreviations

ADRs: Adverse Drug Reactions; KAP: Knowledge, Attitude, Practice; HCPs: Health Care Professionals; MADRAC: Malaysian Adverse Drug Reactions Advisory Committee

Introduction

Adverse drug reactions (ADRs) are global problems of major concern. They are one of the common causes of morbidity and mortality in both hospital and community settings and affecting many with varying magnitudes; as well as leading to morbidity and mortality [1-3]. World Health Organization (WHO) definesADRas “any response to a drug which is noxious and unintended, and which occurs at doses normally used in man for prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function” [4].

When a drug is being approved by the Food and Drug Administration, there is a little known about serious and rare adverse effects associated with that drug while a post marketing surveillance is important and it rely much upon the spontaneous and voluntary reporting of ADR by the health care professionals [5]. The spontaneous and voluntary reporting of ADR is inexpensive and easy to operate. It encompasses all drugs and patient populations, including special groups. However, under-reporting and an inability to calculate the incidence of ADRs are the inherent disadvantages of this method [6-8]. Worldwide, 95% of serious ADRs do not get reported to the health authorities [9].

In Malaysia, ADR reporting also adhered to spontaneous reporting and it is done via Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) [10]. According to MADRAC annual report 2012, there were a total of 10,102 ADR reports received in the year 2012 [11]. Out of this, only 342 reports were from Kedah state and only 10 reports were done by Kuala Muda District Health Office in the year 2012.

Healthcare professional’s knowledge and attitudes towards ADRs and ADRs reporting play vital role to report any cases of ADRs. Knowledge of health care providers about ADRs reporting can impact their attitude towards patient care and issues on patient safety. Positive attitudes may favour ADRs reporting practices by healthcare professionals. Since ADRs reporting is spontaneous and is done voluntary by health professionals, to improve the participation of health professionals in spontaneous reporting, it might be necessary to design strategies that modify both the intrinsic (knowledge, attitude and practices) and extrinsic (relationship between health professionals and their patients, the health system and the regulators) factors. The operational definition of knowledge means theoretical or practical understanding of the subject matter. Attitude means predisposition or a tendency to respond positively or negatively towards a certain idea, object, person, or situation while practice means the application of knowledge or practical approach to the subject matter. A “KAP” study will be able to measure the Knowledge, Attitude and Practices of a community where it will serves as an educational diagnosis of the community. Thus, a knowledge, attitude, and practice (KAP) analysis may provide an insight into the intrinsic factors and help understand the reasons for under-reporting [12].

Knowledge, attitude, and practice regarding ADR reporting have not been studied extensively in Malaysia, especially in primary care in Kedah state. A few studies carried out in Malaysia have shown poor knowledge, attitude, and deficient practices of ADR reporting among the doctors [13-15]. A study in Kuala Lumpur Malaysia reported that 81.4% out of 350 respondents indicated that they had suspected an ADR but did not report it, while about 40% of the respondents were not aware of the existence of the national reporting system in Malaysia [16].

General objective

To provide a current profile of knowledge, attitude and practices of ADR reporting among primary outpatient care pharmacists and doctors in Kuala Muda District Health Office, Kedah, Malaysia.

Specific objective

• To assess primary outpatient care pharmacists and doctors’ knowledge of ADR reporting at their workplace

• To assess primary outpatient care pharmacists and doctors’ attitude towards ADR reporting

• To assess primary outpatient care pharmacists and doctors’ practices of ADR reporting

Materials And Methods

Study design

This is a cross-sectional questionnaire-based survey.

Questionnaires development

The survey instrument was developed based on existing literature on medication safety [14,17-19]. Modification was made to suit the local situation such as we modified the questions to test the respondents’ knowledge towards the Malaysian ADR reporting system. The survey instrument consisted of 2 parts, part 1 involve the collection of participant demographic data, while part 2 consisted of 3 domains which included respondents’ knowledge, attitude and practices towards ADR reporting. The domain which assesses knowledge of respondents in ADR reporting will be in true and false and the other two domains (attitude and practices) will be in 4 point likert scale (1-Strongly Disagree, 2-Disagree, 3-Agree and 4-Strongly Agree). The survey instructions stated that there are no correct or incorrect responses and instructed participants to rate the response that best reflects their perceptions. The questionnaire was prepared in English language. The survey instrument will be reviewed for its face and content validity by a group of experts in the field of medication safety. Moreover, a pilot study was conducted with 15 pharmacists and 15 physicians from outpatient care clinics, Hospital Sultan Abdul Halim, Kedah, Malaysia. Some minor revisions were made based on the comments during the pilot study. The study had been approved by the local medical research ethical committee (MREC).

Study setting, population and sampling

All 9 primary outpatient care clinics under Kuala Muda District Health Office, Kedah, Malaysia were included in this study. The targeted population was all pharmacists and doctors working under primary outpatient care of Kuala Muda District Health Office. This is a census study as data is gathered on every member of the population. This study included all registered pharmacists and doctors working in primary outpatient care clinics in Kuala Muda District Health Office. The exclusion criteria were provisional registered pharmacists (PRP), pharmacy students attached to the relevant health facilities, doctors under housemanship and doctors or pharmacists on long leave/sick leave.

Survey administration

A mail containing the questionnaires was sent in November 2015 to all the participants. Before sending the mail, a meeting with all the head of department of each clinic will be held to inform the relevant study. The survey instrument was accompanied by an addressed envelope (for returning the completed questionnaire) and a cover letter explaining the aim of the study, definition of ADR reporting and confidentiality of all responses from participants. The participants were asked to complete the questionnaires and return them in two weeks time. The first reminder was sent to each pharmacist and doctor approximately after first week. The second reminder was sent after one week of the first reminder.

Data analysis

All the data received from this survey were entered in the SPSS version 20 for statistical analysis. Appropriate descriptive and inferential statistics were used for data analysis. Descriptive analysis was used to analyse the demographic data, attitude and practice domain of the survey. Independent t-test was used to analyse the knowledge between doctors and pharmacists towards ADR reporting.

Result And Discussion

A total of 76 respondents have answered the questionnaires. The response rate was 87.4%. They were 52 doctors and 24 pharmacists involved in the study. Out of the 76 respondents, 17 were male and 59 were female. The mean working experience for doctors was 7.9 ± 5.14 years while pharmacists recorded 5.2 ± 2.51 years. The mean age for the doctors was 34.7 ± 5.86 while the mean age for the pharmacist was 29.2 ± 3.13 years old (Table 1).

Variables n[%] Mean[SD]
Occupation
Doctors 52(68.4) -
Pharmacists 24(31.6) -
Gender - -
Male 17(22.4) -
Female 59(77.6) -
Working Experience - -
Doctors - 7.9(5.14)
Pharmacists - 5.2(2.51)
Age -  
Doctors - 34.7(5.86)
Pharmacists - 29.2(3.13)
SD: Standard Deviation

Table 1: Demographic data.

Pharmacist has higher mean score 76.9 ± 13.87 compare to doctors 66.9 ± 19.86 for knowledge of ADR reporting, p=0.03 (Table 2). Most respondents (43.8%) do not aware of the blue card reporting system in Malaysia. Among this, 46.9% of doctors do not aware of the system while 37.5% pharmacists do not aware about this system. 37.3% of the total respondents felt that only doctors and pharmacists are responsible for ADR reporting. Among this, 43.1% of doctors and 25% of pharmacists has the same thought. The existing system of ADR monitoring in Malaysia, similar to other country rely upon the spontaneous reporting of health professionals as a main source for information and it requires a good knowledge of health care professionals to report.

  Knowledge Score
Mean [SD]
Std Error p valuea
Doctors 66.9(19.86) 2.755 0.03
Pharmacists 76.9(13.87) 2.831  
a: Independent t-test; SD:Standard Deviation

Table 2: Comparing mean knowledge score between doctors and pharmacists using independent t-test

Results on attitude of ADR reporting

In a review article by Lopez-Gonzalez et al., attitude of HCPs was concluded to be one of the major determinants to ADR reporting [20]. By understanding attitudes, proper remedial action can be taken to rectify and subsequently to improve participation of HCPs in pharmacovigilance. In our study, almost all doctors and pharmacists felt that ADR reporting is necessary and is part of their professional obligation. Similar finding has been cited in various studies [13,19,21,22]. However, in a study in India, only 40% of pharmacists agreed that ADR reporting is their professional obligation as compared to 83% of doctors [18]. In the field of healthcare industry, medication safety is always the utmost emphasis. Thus, all healthcare providers must integrate pharmacovigilance into their daily practice and aware that ADR reporting is an important source of information contributing to drug safety database.

Currently, Malaysia is practising voluntary ADR reporting system as many countries in the world. As defined earlier, a major and wellrecognized setback associated with this system is the underreporting of ADR [21]. An interesting finding in our study was almost all study participants agreed that ADR reporting should be made mandatory. This was found to be much higher as compared to other studies, where only 60% doctors, 40% of pharmacists and 53% of physicians agreed on the mandatory ADR reporting [18,23]. Despite the positive attitude of our study population towards ADR reporting, the reporting rate remains low. Thus, the reasons for underreporting or non-reporting reserve further investigation.

More pharmacists than doctors (50% pharmacists and 30.7% doctors) in this study assumed that reporting of just one ADR makes no significant contribution to the ADR reporting scheme. One study in Malaysia illustrated that 25.5% of private practitioners in Klang Valley was being indifference in assuming that one ADR reported did not contribute to medical knowledge [13]. This assumption among the HCPs is possibly one of the obstacles to the low reporting of ADR in Kuala Muda District Health Office. It is important to raise the awareness that the occurrence of ADR from a drug might differ in different populations and ethnicities. Thus, every single ADR reported to MADRAC does contribute to the local database of ADR in Malaysian population.

Majority of doctors and pharmacists in this study agreed that pharmacovigilance should be taught in detail to HCPs. This finding is consistent with another same study in which the participants revealed their willingness to learn and to improve their pharmacovigilance knowledge in order to improve ADR reporting [23]. Education is known to serve as the leading factor to empowerment. In Malaysia, a study conducted by Elkalmi et al. had shown the positive impact of educational intervention in improving the pharmacists’ perception on pharmacovigilance [24]. Thus, it was suggested that pharmacovigilance should be included into undergraduate curriculum [13,23].

Almost half of the study population (48.1% of doctors and 50% of pharmacists) felt that the ADR form is too complex to fill. This finding is slightly higher compared to another study in Malaysia with only 39.1% of the doctors agreed that the ADR form is difficult to fill [13]. Further investigation is needed to explore the difficulties in filling ADR form so that feedback can be channelled to MADRAC for the improvement of the form.

Larger proportion of pharmacists and doctors (70.8% vs. 52.0%) felt that ADR reporting should hide the identity of HCPs. This is agreeable to the finding by another study in Malaysia where the private practitioners in Klang Valley, Malaysia preferred to keep their identity anonymous due to the fear of any untoward investigation and legal liabilities which might jeopardous their career [13]. Similar result has also been reported in India [18]. In fact, the identity of reporters is important for MADRAC to secure traceability of missing information ensuring the quality of the reports received.

Majority of the participants agreed that lack of time to fill in ADR report and to actively look for ADR while at work resulting in low reporting rate of ADR. Similar finding has been reported by other studies where the respondents revealed that ADR reporting is time consuming and busyness is the barrier to ADR reporting [13,25]. In Malaysia, in the effort to encourage pharmacists to report ADR, Pharmacy Board has offered the incentive whereby for every ADR accepted and approved by MADRAC, the pharmacist will be entitled for one CPD credit point up to a maximum of 10 points per year (a minimum of 40 CPD point is prerequisite to renew annual practice certificate).

Table 3 showed the comparison of attitude of ADR reporting among doctors and pharmacists in the Kuala Muda District Health Office, Kedah, Malaysia.

  Questions Doctors Pharmacists Chi Sq p valuea
Disagree n[%] Agree
n[%]
Disagree n[%] Agree
n[%]
1 Reporting ADR is necessary 0 (0.0) 52 (100.0) 1 (4.2) 23 (95.8) 2.334 0.311
2 ADR reporting should be made mandatory 5 (9.6) 47 (90.4) 0 (0.0) 24 (100.0) 5.293 0.071
3 ADR reporting is our professional obligation 2 (3.8) 50 (96.2) 1 (4.2) 23 (95.8) 0.996 0.608
4 ADR form is too Complex to fill 27 (51.9) 25 (48.1) 12 (50.0) 12 (50.0) 0.178 0.915
5 Pharmacovigilance should be taught in detail to healthcare professionals 9 (17.3) 43 (82.7) 1 (4.2) 23 (95.8) 2.568 0.463
6 ADR reporting should hide the identity of health care professionals 25 (48.0) 27 (52.0) 7 (29.2) 17 (70.8) 3.007 0.391
7 Lack of time to fill in report resulting in low reporting rate of ADR 5 (9.6) 47 (90.4) 3 (12.5) 21 (87.5) 6.586 0.086
8 Lack of time to actively look for ADR while at work leading to non reporting of ADR 11 (21.2) 47 (78.8) 4 (16.7) 20 (83.3) 3.935 0.269
9 I assume that reporting of only one ADR makes no significant contribution to the ADR reporting scheme 36 (69.2) 16 (30.7) 12 (50.0) 12 (50.0) 2.709 0.439
a: Chi Square Test

Table 3: Comparing attitude on ADR reporting among doctors and pharmacists.

Results on practices of ADR reporting

Both Doctors (75.0%) and Pharmacist (91.7%) in Kuala Muda District Health Office disagreed that they only report life threatening or serious ADR which in contradict with other study carried out in a tertiary hospital where the respondents mentioned that they were encouraged to report ADR if only the reaction was serious [23]. The same study also revealed that 73.7% from their respondents reported ADR if only the reaction was serious [23]. Thus, healthcare professionals in the Kuala Muda District Health Office have higher awareness on the need to report for ADR despite on its severity.

Education and training on ADR reporting is fundamental to improve the overall ADR reporting rate [15,23]. Educational intervention had been found to improve ADR reporting in Portugal [26] and Rhode Island [27] in USA. One study reported that an initial 148% increase in the number of ADR reports was observed immediately after the educational intervention [26]. In our study, we found a significant different in term of education in training received by Doctors and Pharmacists in Kuala Muda District Health Office. 69.2% of Doctors in Kuala Muda District Health Office had never being trained on how to report an ADR while only 12.5% Pharmacists claimed not being trained. The differences found might be due to an early introduction of pharmacovigilance in the undergraduate curriculum study in pharmacy courses which contradictory to the doctor population. Thus, educational intervention is mandatory to be introduced in the undergraduate curriculum of HCPs or during their practice in the health care setting. A study in Nepal also convinced that the knowledge of healthcare profession regarding ADR monitoring and pharmacovigilance programme shall be increased via educational intervention as it is one of better means of overcoming under reporting [28].

In our study, although we found that the mean working experience was 8 years for doctors and 5 years for pharmacists, there were still small populations of respondents (26.9% of doctors and 4.2% of pharmacists) have never came across with any ADR cases. Lack of knowledge [29] might led to failure to detect the ADR even when it is occurring. Inman has summarized a major reason for under-reporting which is complacency (only safe drug are marketed), this may be one of the reason for the undetected ADR during practices [30].

Our study illustrated that most of the doctors did came across with ADR (73.1%) but did not take action as majority of them (48.1%) admitted that they had never been done at least 1 ADR reporting for past the 1 year. The lack of practices on ADR among doctors also been reported in various studies across different countries and regions [13,31-33].

Table 4 showed the comparison of practices on of ADR reporting among doctors and pharmacists in the Kuala Muda District Health Office.

  Questions Doctors Pharmacists Chi Sq p valuea
Disagree n[%] Agree n[%] Disagree n[%] Agree n[%]
1 I have came across with an ADR 14 (26.9) 38 (73.1) 1 (4.2) 23  (95.8) 5.784 0.123
2 I havebeen trained on how to report ADR 36 (69.2) 16 (30.8) 3 (12.5) 21 (87.5) 22.794 <0.001
3 I amfollowing approaches in preventing ADRs/prevented ADRs during my practise 10 (19.2) 42 (80.8) 3 (12.5) 21 (87.5) 0.865 0.834
4 I only report severe or life threatening ADR 39 (75.0) 12 (25.0) 22 (91.7) 2 (8.3) 3.26 0.353
5 I mention the ADR on patients' record 9 (17.3) 43 (82.7) 8 (33.3) 16 (66.7) 5.579 0.061
6 I have done ADR reporting at least once for the past 1 year 25 (48.1) 27 (51.9) 7 (29.2) 17 (70.8) 4.384 0.223
7 I have seen ADR reporting form 8 (15.4) 44 (84.6) 0 (0.0) 24 (100.0) 5.204 0.157
a: Chi Square Test

Table 4: Comparing practices on ADR reporting among doctors and pharmacists.

Conclusion

Spontaneous reporting required good knowledge among the key personnel to make the report and in this study, the knowledge among the health care professionals in the current setting is however still moderate. The prevalence of unsatisfactory practices and attitudes among these primary health care doctors and pharmacists contributed to failure to report ADR even if the ADR was identified.

Educational intervention strategies either introduce from the undergraduate levels or to have more campaign on ADR reporting organized by the regulatory authorities will help to improve ADR reporting. A most recent implementation of CPD point awarded to those pharmacist we has reported an ADR may be one of the strategy to improve the number of ADR reporting in the country. More similar rewarding practice can be implemented in different health care setting for the overall improvement of the reporting system.

Study limitation

The limitation of this study rely upon the single centre of result may not represent to the whole nation. Therefore, its findings cannot be generalized to the whole country. However, given the paucity of data regarding adverse drug reaction reporting in primary care in Malaysia, we believe these preliminary findings are useful for future guidance for health authorities. Moreover, the current findings warrant a large scale study to further study this adverse drug reaction reporting practices in primary care.

Acknowledgement

The authors would like to acknowledge the Director General of Health Malaysia for his permission to publish this study.

References

  1. Lazarou J, Pomeranz BH, Corey PN (1998). Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 279: 1200-1205.
  2. Pirmohamed M, James S, Meakin S (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ 329:15.
  3. Martinez MI, Garcia LM, Palop V, Ferrer JM, Rubio E, et al. (1999) A prospective study of adverse drug reactions in hospitalized children.Br J Clin Pharmacol 47: 681-688.
  4. World Health Organization (1972) Definitions. WHO International Drug Monitoring: The role of national centres. Tech Rep SerNo. 498.
  5. Rawlins MD (1988) Spontaneous reporting of adverse drug reactions. I: the data. Br J Clin Pharmacol 26: 1-5.
  6. Montastruc JL, Sommet A, Lacroix I, Olivier P, Durrieu G, et al. (2006) Pharmacovigilance for evaluating adverse drug reactions: value, organization, and methods. Joint Bone Spine 73: 629-632.
  7. Edwards IR, Aronson JK (2000). Adverse drug reactions: definitions, diagnosis, and management. The Lancet 356: 1255-1259.
  8. Cosentino M, Leoni O, Banfi F, Lecchini S, Frigo, G (1997) Attitudes to adverse drug reaction reporting by medical practitioners in a Northern Italian district. Pharmacol Res 35: 85-88.
  9. Malaysia: National Pharmaceutical Control Bureau (2002) MADRAC Malaysian Adverse Drug Reactions Advisory Committee Bulletin.
  10. Annual Report of The Malaysian Adverse Drug Reactions Advisory Committee [MADRAC] (2012) National Pharmaceutical Control Bureau
  11. du Monde M (2011) Data Collection Quantitative Methodes–The KAP Survey Model (Knowledge, Attitude & Practices).
  12. Agarwal R, Daher AM, Ismail NM (2013) Knowledge, practices and attitudes towards adverse drug reaction reporting by private practitioners from Klang Valley in Malaysia. Malays J Med Sci 20: 52.
  13. Mohamed IN, Borhanuddin B, Shuid AN, Fozi NFM (2013). Attitudes, perception and knowledge of general practitioners towards adverse drug reaction (ADR) reporting in Malaysia–A pilot study. J Res Med Sci.
  14. Abdullahi RAB, Simbak, N, Mainul H (2014). A systematic review of KAP on ADR and Pharmacovigilence among doctors. J App Pharm Sci 4: 117-127.
  15. Aziz Z, Siang TC, Badarudin NS (2007) Reporting of adverse drug reactions: predictors of under-reporting in Malaysia. Pharmacoepidemiol Drug Saf 16: 223-228.
  16. Reddy VL, Pasha SJ, Rathinavelu M, Reddy YP (2014) Assessment of knowledge, attitude and perception of pharmacovigilance and adverse drug reaction (ADR) reporting among the pharmacy students in south India. IOSR J Pharm Biol Sci 9: 34-43.
  17. Chenchu S, Rathinavelu M (2012). Healthcare Professionals Knowledge Attitude and Practices towards Pharmacovigilance and Adverse Drug Reactions (ADRs) in India. IJSR.NET2319-7064
  18. Suyagh M, Farah D, Farha RA (2015) Pharmacist’s knowledge, practice and attitudes toward pharmacovigilance and adverse drug reactions reporting process. Saudi Pharm J 2023: 147-153
  19. Lopez GE., Herdeiro MT, Figueiras A (2009) Determinants of under-reporting of adverse drug reactions. Drug Saf 32: 19-31.
  20. Goldman SA (1998) Limitations and strengths of spontaneous reports data. Clin Ther 20: 40-44.
  21. Necho MW, Worku A (2014) Assessment of knowledge, attitude and practice of health professionals towards adverse drug reaction reporting and factors associated with reporting. J Pharmacovigilance 2: 135-141.
  22. Adhikary J, Bhandare B, Adarsh E, Satyanarayana V (2013) A study to assess knowledge, attitude and practice of adverse drug reaction reporting among physicians in a tertiary care hospital. Journal of Evolution of Medical and Dental Sciences 2: 1027-1034.
  23. Elkalmi RM, Hassali MA, Ibrahim MI (2011) Impact of educational intervention for improving pharmacist knowledge in adverse drug reactions (ADR) reporting: Experience from Malaysia.The Open Drug Safety Journal 2: 47-53.
  24. Aithal S, Hooli TV, Varun HV (2014) Knowledge and attitude about adverse drug reaction reporting among doctors at a tertiary care hospital. Int J Pharm Biol 5: 108-113.
  25. Figueiras A, Herdeiro MT, Polónia J, Gestal OJJ (2006) An educational intervention to improve physician reporting of adverse drug reactions: a cluster-randomized controlled trial. JAMA 296:1086-1093.
  26. Scott HD, Thacher RA, Rosenbaum SE, Waters WJ, Green M, et al. (1990) Physician reporting of adverse drug reactions: results of the Rhode Island adverse drug reaction reporting project. JAMA 263: 1785-1788.
  27. Palaian S, Ibrahim MI, Mishra P (2011) Health professionals' knowledge, attitude and practices towards pharmacovigilance in Nepal. Pharm Pract 9: 228-235.
  28. Sencan N, Altinkaynak M, Ferah I, Özyildirim A, Ceylan EM (2010) The knowledge and attitudes of physicians and nurses towards adverse event reporting and the effect of pharmacovigilance training: a hospital experience. Journal of the Faculty of Pharmacy 30: 25-40.
  29. Inman WH (1996) Attitudes to adverse drug reaction reporting. Br J Clin Pharmacol 41: 434-435.
  30. John LJ, Arifulla M, Jayadevan SJC (2012) Reporting of Adverse Drug Reactions: A Study Among Cinicians. Journal of Applied Pharmaceutical Science 2: 135.
  31. FarcasA, Macavei C, Bojita M (2008) Physicians’ attitude towards voluntary reporting of adverse drug reactions. FARMACIA 56: 563-570.
  32. Awodele O, Akinyede A, Adeyemi OA, Awodele DF (2011) Pharmacovigilance amongst doctors in private hospitals in Lagos West Senatorial District, Nigeria. Int J Risk Saf Med 23: 217-226.
Citation: Tew MM, Teoh BC, Mohd Baidi AS, Saw HL (2016) Assessment of Knowledge, Attitude and Practices of Adverse Drug Reaction Reporting among Doctors and Pharmacists in Primary Healthcare. Adv Pharmacoepidemiol Drug Saf 5:206.

Copyright: © 2016 Tew MM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.