Comparative Perception of Pharmacovigilance by Physicians versus Paramedical Professions in Ivory Coast

Objective: To assess the perception of pharmacovigilance by healthcare professionals practicing at the University Teaching Hospital of Cocody (Ivory Coast) in 2017. Methodology: A descriptive and analytic cross-sectional survey has been conducted in 2017 at the University Teaching Hospital of Cocody. This survey involved a sample of healthcare professionals practicing in 17 services who are prescribing medications and gave their oral consent. Results: A response rate of 54.08% (106/196) among physicians versus 43.87% (86/196) for the nurses and 27.61% (21/76) for the mid-wives. 57.94% (62/107) of paramedics versus 94.33% (100/106) of physicians had already heard about pharmacovigilance, during their basic training (40.18% of paramedics versus 73.58% of doctors). However, the main obstacles to the practice of pharmacovigilance were it teaching hours considered insufficient (94.39% of paramedics versus 75.47% of physicians), the lack of knowledge on the location of the pharmacovigilance unit (80.37% of paramedics versus, 40% of physicians) and the reporting of the adverse drug reactions to a hierarchical supervisor (60.60% of paramedics versus 37.25% of physicians). A regular visit of pharmacovigilance monitors in the hospital services (34.57% of paramedics versus 29.24% of physicians) and the availability of reporting forms (30.84% of paramedics versus 27.35% of physicians) could improve the perception of pharmacovigilance by the healthcare professionals. Conclusion: Our investigational survey has highlighted some factors that may influence the perception of pharmacovigilance by the healthcare professionals in Ivory Coast. How to cite this paper: Eric, B., Auguste, A., Mamadou, T. and Mocket, E. (2019) Comparative Perception of Pharmacovigilance by Physicians versus Paramedical Professions in Ivory Coast. Pharmacology & Pharmacy, 10, 416-426. https://doi.org/10.4236/pp.2019.1010034 Received: September 12, 2019 Accepted: October 8, 2019 Published: October 11, 2019 Copyright © 2019 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Introduction
Pharmacovigilance is an essential element of drug safety. Although it is a wellestablished activity in developed countries, it remains non-functional in Ivory Coast despite the existence of regulatory Acts organizing the National Pharmacovigilance System [1] [2] [3] [4]. The drawback has been the reporting of a small number of adverse drug reactions (ADRs) and the lack of reassessment of the benefit-risk ratio of the drugs commercialized in Ivory Coast. In this context, the Clinical Pharmacology Department of the University Teaching Hospital (CHU) of Cocody-Abidjan has implemented a local pharmacovigilance system which collects, evaluates and prevents ADRs at the CHU of Cocody. To be effective, this pharmacovigilance system requires the voluntary declaration of adverse drug reaction (ADR), especially those that are serious and/or unexpected in hospital. In this perspective, the contribution of health actors and the public to voluntary reporting is necessary. Indeed, when a drug is marketed, its safety profile is poorly known in real life as the drug is used in different subsets of people (children, pregnant women…) or different indications or dosages. So, the spontaneous reporting of ADRs by healthcare professionals would assess the safety profile because it is a surveillance method based on the aggregation, at the level of a territory, of ADR cases subsequent to their marketing authorization. In Ivory Coast, few studies have shown that ADRs are poorly reported by healthcare professionals [5] and our study is the first to focus on the perception of pharmacovigilance at Cocody University Hospital Center (CHU). Also, to increase the number of adverse drug reactions (ADRs) notifications we were interested in the perception of the pharmacovigilance by the doctors, nurses and midwives of the CHU of Cocody. These healthcare professionals were targeted on the basis that: on one hand, they represented in 2017 the majority of healthcare personnel at the CHU of Cocody; on the other hand, because of their key role in prescribing, administering and monitoring the drugs.
Our main objective was to assess the perception of pharmacovigilance by the healthcare professionals practicing at the CHU of Cocody in 2017. The secondary objectives were to describe the professional characteristics of the targeted healthcare personnel, to determine their general knowledge on pharmacovigilance, to determine their expectations after reporting adverse drug reactions (ADRs) and to list the measures to be taken to stimulate such notifications.

Study Population
Our survey targeted the doctors, the nurses and the midwives who were working in those selected services and were prescribing medications (drugs) during 2017.
We sampled the healthcare personnel from the administrative list of the CHU of Cocody. Thus, all the doctors, nurses and midwives assigned to selected services and present during the study period, regardless of their age, sex, nationality, hospital degree, year of professional experience, who gave oral consent were included in the study. On the other hand, the targeted healthcare professionals absent (with the exception of those on night shifts) or unassigned to the selected services at the time of the survey or who did not give consent nor complete the survey form were not included in the study.

Study Process
Firstly, we developed a standardized and anonymized questionnaire in the Department of Clinical Pharmacology from information of the literature reviews.
The said questionnaire, after presentation and explanation to our healthcare pro-

Statistical Analysis
The collected data were entered on the EPI info7.4 software and processed by the statistical programme S.P.S.S. 17.0 (Statistical Package for the Social Sciences version 17.0). A Pearson Chi-square test was used to compare the results obtained with a significance level of less than 5%.

Ethical Considerations
In our study, we respected the anonymity of healthcare professionals and no activity of them was disturbed during working hours. In addition, we obtained the oral consent of all the targeted heads of departments (HODs) and a written authorization from the Director of the Medical and Scientific Department of the University Teaching Hospital of Cocody. Finally, no healthcare professional completed the questionnaire under coercion.

Professional Characteristics
Of  Table 1). These healthcare professionals are working mainly in the medical and surgical services (Table 1) and had a professional experience ranging from 1 to 10 years in most cases (Table 2).

Expectations and Measures to Stimulate Spontaneous Notification
After a report of the adverse drug reactions, a feedback (Table IV) Table 4.    relating to the socio-professional characteristics, the general knowledge on pharmacovigilance, the reporting of the ADRs and lastly, the expectations and measures to stimulate the spontaneous notification.

Socio-Professional Characteristics
In our survey, the physician's response rate (54.08%) was significantly different from that of nurses (43.87%) and of the midwives (27.61%) (p < 0.001). This rate (54.08%) was higher than that of the 2006 Ivorian survey (31.4%) conducted on a random sample of 500 practitioners extracted from the database of the approved drug prescribers of the "Mutuelle Générale des Fonctionnaires de Côte d'Ivoire (MUGEF-CI)" [5]. In contrast, the response rate of the targeted healthcare professionals in our study was lower than that reported in the literature [6]- [13]. This could be explained by the methodological differences and by the level, variables according to countries, and healthcare professional's awareness on pharmacovigilance. Moreover, in our work the physicians response was neither influenced by the service in which they work (p = 0.593) nor their seniority in the profession (p = 0.309); which was not the case for the nurses and midwives regarding their working service (p < 0.001) and years of experience (p < 0.01). ics) was an obsticle to the reporting of the adverse drug reactions and therefore a factor in favor of a poor perception on pharmacovigilance. Our situation was comparable to that described in a Saudi study [7], as well as in an Indian study [8]. In Saudi Arabia, 12.1% of doctors did not know the term "pharmacovigilance" and 62.2% of healthcare professionals did not know of the existence of a national pharmacovigilance center [7]. Similarly, in an Indian study [8]

Reporting of Adverse Drug Reactions
These included the non-compliance with the regulatory reporting procedures [1] [4] and the already known factor (déjà-vu) or the frequent occurence of the adverse drug reactions. In our study, the paramedical personnel (n = 43, 40.18%) and the physicians (n = 73, 68.86%) who had previously come across an adverse event, mainly linked to a drug (

Expectations and Measures to Stimulate the Reporting Process
In our survey (Table 4), the expectations following a report of an adverse drug reaction by the paramedics (n = 107) and or the physicians (n = 106) were primarily a feedback and a specific code of conduct (actions) (66, 33% of the paramedics versus 71.69% of the physicians). These two main expectations, if they were systematically addressed through a personalized newsletter sent to the healthcare professionals would increase the reporting of the adverse drug reactions at the CHU of Cocody. Apart from the feedback, the healthcare professionals in our study recommended essentially a regular visit of pharmacovigilance monitors in hospital services (34.57% of the paramedical versus 29.24% of the physicians, p < 0.30) and the availability of the reporting forms (30.84% of the paramedics versus 27.35% of the physicians, p < 0.50). These measures were comparable to those reported in other studies [6]- [13] and reflected the involvement of healthcare professionals to improve the reporting of the adverse drug reactions at the CHU of Cocody.

Conclusion
Our investigation survey has revealed some factors that could explain the under-reporting of the adverse drug reactions. The main obstacles to the practice of pharmacovigilance were it teaching hours considered insufficient, the lack of knowledge on the location of the pharmacovigilance unit and the reporting of the adverse drug reactions to a hierarchical supervisor. A regular visit of pharmacovigilance monitors in the hospital services and the availability of reporting forms could improve the perception of pharmacovigilance by the healthcare professionals. In addition, a multicenter study with a larger staff size would refine the factors influencing the perception of pharmacovigilance by health professionals.