Adverse drug reaction reporting among physicians working in private and government hospitals in Kuwait.

INTRODUCTION: To improve patient safety and care, the identification and reporting of adverse drug reactions (ADRs) should be systematic and mandatory for all healthcare professionals (HCPs). Physicians remain the main HCPs with direct patient care whose role in ADRs reporting should not be ignored. OBJECTIVE: To document the awareness and attitude of physicians working in private and government hospitals in Kuwait with regard to pharmacovigilance (PV) and ADR reporting and to identify their practices of reporting ADRs. MATERIAL AND METHODS: A cross-sectional study was conducted using a paper-based 25-item questionnaire. The Statistical Package for Social Science (SPSS) was used for data analysis. RESULTS: A total of 1017 questionnaires were distributed to the eligible physicians in the government and private hospitals, giving a response rate of 84.2% and 83.0%, respectively (an overall response rate of 83.8%). Private physicians exhibited a better knowledge profile with regards to the purpose of PV (75.2% vs 64.8%; p = 0.002) and the correct ADR definition (75.8% vs 65.3%; p = 0.001). The majority of physicians showed good attitude towards reporting ADRs, nevertheless, private physicians had a significantly stronger belief that reporting ADRs is a professional obligation (93.4% vs 85.5%; p = 0.001). Three quarters of the study population (74.6%) had identified an ADR during their daily practice, however, only a small proportion (34.2%) confirms having ever reported ADRs. Regardless, significantly more private physicians had done so (42.4% vs 29.6%; p < 0.001). ADR reporting was significantly higher in physicians who knew the correct ADRs to be reported (adjusted OR = 1.86, p = 0.036), and those who were aware of any center or ADR reporting system in Kuwait (adjusted OR = 2.88, p = 0.020). CONCLUSIONS: A national PV center empowered by clear legislation on "how" and "what" to report should improve physicians' reporting practices and hence is required in the country. This should be combined with constant training and education in this regard.

Physicians' perceptions and expectations of pharmacists' professional duties in government hospitals in Kuwait.

OBJECTIVE: The objectives of this study were to evaluate the perceptions, expectations and experience of physicians with hospital-based pharmacists in Kuwait. MATERIALS AND METHODS: A piloted self-administered questionnaire was hand delivered to 200 physicians practicing in four government hospitals in Kuwait. Main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. RESULTS: One hundred and twenty (60%) questionnaires were returned. At least 57% of physicians in Kuwait appear comfortable with pharmacists carrying out patient-directed roles. In addition, they appeared to have high expectations of pharmacists, with 79% of them regarding pharmacists as knowledgeable drug therapy experts. Less than 60% considered pharmacists as applying their drug knowledge in practice and only 29% agreed that pharmacists routinely counselled their patients. There was no correlation between physician variables such as number of years since graduation from medical school, age, area of practice and their perceptions of pharmacists. CONCLUSION: Physicians in Kuwait appear comfortable with pharmacists providing a broad range of services but appear somewhat less comfortable with pharmacists' provision of direct patient care. Physicians considered pharmacists knowledgeable drug therapy experts, but regarded them as not routinely providing a broad range of higher-level pharmacy services.

Effect of cigarette smoking on sputum smear conversion in adults with active pulmonary tuberculosis.

Although factors influencing sputum smear conversion in tuberculosis have been studied well, the effect of smoking is largely unknown. Excluding those with incomplete history or drug resistant isolates, 339 patients out of the 526 sputum positive patients registered between 1998 and 2000 were studied. At the end of 2 months, smokers and non-smokers converted with almost the same frequency to a negative sputum status {P=0.065, OR (95%CI) 0.47 (0.21-1.06)}. Although gender or age had no effect on sputum conversion with respect to smoking status, expatriate smokers as a whole showed a significant difference. (P=0.039). On applying logistic regression model, smokers with far advanced radiographic abnormalities (P<0.038) or with 3+ smear status (P=0.011), were found to have a less chance of an early smear conversion. In conclusion smoking did not influence sputum smear conversion in tuberculosis. However, as expatriate smokers and smokers with advanced disease showed a delay in smear conversion, smoking should be discouraged in patients with pulmonary tuberculosis.

Dyspepsia and Helicobacter pylori infection: Analysis of 200 Kuwaiti patients referred for endoscopy.

BACKGROUND: Dyspepsia is a very common symptom, and is the reason for most referrals for esophagogastroduodenoscopy (EGD). Peptic ulcer disease (PUD), gastroesophageal reflux and gastric cancer account for a minority of such patients. However, the majority have no significant endoscopic abnormalities (non-ulcer dyspepsia). Recently, infection with Helicobacter pylori (HP) has been implicated in the pathogenesis of PUD and gastric cancer. Since HP can be diagnosed by noninvasive techniques, it has been suggested that endoscopy should be restricted to HP-positive patients who do not respond to empirical therapy with antimicrobials. The aim of this study was to establish the prevalence of HP among Kuwaiti dyspeptic patients referred for endoscopy and to determine whether demographic and clinical screening, or the presence of HP, can help distinguish groups of patients with significant gastroduodenal pathology from those with non-ulcer dyspepsia. PATIENTS AND METHODS: Two hundred randomly selected Kuwaiti patients referred for endoscopy were evaluated prospectively. A detailed personal interview was conducted to establish the demographic and clinical profile of each patient and a diagnostic EGD was performed after the interview. Finally, antral mucosal biopsies were taken to determine the presence of HP. The pre-coded data were analyzed. RESULTS: The main endoscopic findings were normal (32%), non-erosive antral gastritis (26%), duodenitis (17.5%), duodenal ulcer (11.5%), deformed bulb (4%), esophagitis (7%), and erosive gastritis (2%). The demographic and clinical characteristics of patients did not correlate with endoscopic findings. The overall prevalence of HP infection was 88.5%. There were no statistically significant differences in the prevalence of HP among patients with various endoscopic findings. CONCLUSION: HP infection is common in Kuwaiti dyspeptic patients referred for endoscopy, irrespective of their demographic and clinical features or the underlying cause of dyspepsia. Noninvasive methods to detect HP are not valid alternatives to endoscopy in the work-up of dyspeptic patients.