4 DISCUSSION
This study was conducted to evaluate the KAP of CPs, which is considered
an essential step to creating awareness about the safety of drugs, the
hazard of dispensing banned medicine, the reporting of ADRs, and the
importance of PV. Majority of our respondents were male, young age, an
employee who is practicing in an independent pharmacy, having a working
experience in a community pharmacy between 1 to 6 years and acquired a
bachelor degree in pharmacy. The extent of the knowledge and attitude of
the CPs reflected the practical aspects. In brief, the findings
indicated a positive attitude towards PV with a reasonable knowledge
level; however, the practical role of CPs should be encouraged and
upraised. Generally, in developing countries and specifically in Yemen,
pharmacists are considered health-care consultants who can be easily
assessed and without payment. Most patients prefer to consult CPs about
health-related problems, including ADRs. Therefore, there is a demand to
involve CPs in the PV system.
The profiles of the CPs e.g. age, employment status, experience, degree,
indicated that they have an adequate level of education and practice.
Thus, it is supposed that they might have acceptable knowledge suitable
for this study. The study also indicated that most of the CPs had good
knowledge about the concept of PV and its purpose as well as the
definition of ADRs and the medical products that may be the main cause
of ADRs. The response rate was comparable with that in a study carried
out in Lebanon [19]. Several studies have indicated that pharmacists
are considered the health care professionals who have the most
comprehensive knowledge of the pharmacological aspects of the drugs, so
they should play an essential role in the identification, detection,
prevention, and management of ADRs [20-23]. Continuous awareness
campaigns should be conducted to install, enhance and increase knowledge
among pharmacists. A meta-analysis study in India indicated that
approximately 81% of Indian pharmacists were unaware of the PV system
in their country [24] (See Table 2).
Regarding the attitude towards PV, about two-third of the pharmacists
had encountered ADRs. The majority of the participants had a positive
attitude about being the health-care professional who was responsible
for the reporting of ADRs, and more than fourth-fifth believed that
reporting should be compulsory process. In addition, close to
fourth-fifth of the participants considered reporting ADRs as one of
their duties. The result is similar to that from studies in India
[25], Korea [26] and other Arab countries [19, 27-31]. One
study in India revealed that the CPs believed that ADR reporting was the
physician’s duty [32]. However, a negative attitude was detected
among pharmacists in New Zealand [22]. Some studies reported that
pharmacists believe that reporting disrupted drug dispensing and not was
included among their main duties [33, 34]. The positive result in
the current study might be due to incomplete knowledge on the ADR
reporting procedure, as there is no active applied PV system in Aden.
This study only reflects attitudes towards PV and ADR reporting, not the
real reporting practice. However, the participants revealed that they
had many challenges that made accessing the reporting system difficult,
such as a lack of knowledge about ADR reporting procedures and
judgments, the need for training to effectively detect ADRs and time
restrictions in addition to work pressure. Similar challenges have been
stated previously; several studies have revealed a positive relationship
between knowledge level and reporting behavior (35-40). Furthermore, a
study in Portugal showed that educational courses increased the number
of ADR reports 10-fold [40]. Most of the pharmacists depended on
drug leaflets to obtain ADR information, followed by the internet and
books. However, the drug leaflets provide information on the most common
ADRs, and some of the rarer and more serious ADRs are usually not
mentioned. Additionally, obtaining information from the internet is not
a good idea because not all websites are trustworthy (See Table 3).
Regarding ADR reporting practices, approximately half of the pharmacists
reported having observed ADRs. They reported them to different
authorities, as shown in Table 4. The outcomes also indicated the
unavailability of the reporting system according to around fourth-fifth
of the CPs, with slightly more than two-third of the CPs indicating that
no information is provided regarding the reporting of ADRs. Most of the
pharmacists felt that they did not have sufficient training, while
nearly half of the CPs encouraged the reporting system and around half
did not. Several problems were mentioned during the reporting
procedures, including the lack of governmental reporting system and the
lack of information from the patient. Additionally, some pharmacists
revealed that work pressure prevents proper reporting, which is in line
with the outcomes from studies in India [32, 41]. Meanwhile, the
fear of legal repercussions was one of the problems that faces the
reporting system in the community pharmacies in Yemen; similar results
have been reported in other studies [245, 32, 41-43]. Patient safety
was the prime concern of most participants. The majority of the
pharmacists had a considerable awareness of the mistakes that may occur
during their duties, and they learned from these mistakes to improve the
quality of CP services.
Regarding the future of ADR reporting in Yemen, slight more than half of
the participants encouraged the idea of self-reporting by the patients.
This finding is comparable to those of previous studies in India
[25], the UK [44] and the Netherlands [45]. Subsequently,
the activation of a “spontaneous reporting system” might be an
essential factor in the future. Approximately fourth-fifth of the
participants encouraged the role of information technology in
facilitating ADR reporting in the country. An identical result was found
in a study carried out in India [46]. Concerning patient access to
an online ADR program/website, nearly half had positive responses.
Approximately three-fourth of the CPs believed that reporting procedures
should be compulsory.
According to this study, more than fourth-fifth of the pharmacists
believed that reporting ADRs will improve patient safety. A similar
finding was reported in other studies [32, 41]. When asked if ADR
reporting causes inconvenience in the working environment, around
two-third of the participants responded no; some of the CPs also
believed that reporting ADRs is an effort by health institutions to
indicate the provision of quality care to the patients, which is a
positive indication of the acceptance of the ADR reporting concept.
Based on the observation from this study, there are a few
recommendations for improving ADR reporting in Yemen:
1. Every governmental or private hospital should create a PV center for
reporting ADRs and save associated data in the database;
2. PV workshops should be carried out to guide pharmacists and other
healthcare professionals in distinguishing and reporting ADRs;
3. Self-reporting by the patients should also be encouraged alongside
reporting by healthcare professionals;
4. National PV programs should be initiated, and PV specialists should
help healthcare professionals;
5. Continuous seminars and training programs should be arranged by PV
professionals to enhance the reporting system;
6. There should be a periodic gathering of ADR data from health centers;
7. New technology should be incorporated to facilitate ADR reporting;
8. PV education should be introduced in pharmacy and other
health-related facility curricula;
9. Pharmacists should not be subjected to legal repercussions if a
mistake is made;
10. ADR reporting should be made compulsory for all pharmaceutical
companies and healthcare professionals; and
11. CPs should be able to obtain the required ADR data from the hospital
database.