title: Promoting spontaneous adverse drug reaction reporting in hospitals using a hyperlink to the online reporting form: an ecological study in Portugal.
abstract: BACKGROUND
  Spontaneous adverse drug reaction (ADR) reporting has been described as an efficient method to detect drug safety signals. However, under-reporting is a major issue undermining the effectiveness of spontaneous reports. Among hospitalized patients, ADRs are a particularly serious problem because these patients are often treated with more than one drug, and these drugs are often new and aggressive.
  
  
  OBJECTIVE
  To promote spontaneous ADR reporting by healthcare professionals working in hospitals in the northern regions of Portugal, we propose the inclusion of a hyperlink to an online ADR reporting form on hospitals' electronic patient records (EPRs). The main aim of this study was to evaluate the impact of these hyperlinks on the number of spontaneous ADR reports to the Northern Pharmacovigilance Centre (UFN - Unidade de Farmacovigilância do Norte). We also assess the number of daily UFN website visits before and after the inclusion of the hyperlinks.
  
  
  METHODS
  An ecological study was performed in northern Portuguese hospitals from 2006 to 2010. The hyperlinks were included in either EPRs or on computer desktops. The median of spontaneous ADR reports (total and online) per month and the respective ranges were presented before and after the intervention in all hospitals in this study. The comparisons were performed using the Mann-Whitney U-test.
  
  
  RESULTS
  Sixteen hospital centres were involved in the study (27 hospitals). Eleven centres (18 hospitals) included the hyperlinks. Considering the hospitals with hyperlink access to the EPRs, the median ADR reports per month significantly increased, from two (range 0-12) to five reports (range 1-17). The median of ADR reports per month using the online form also increased significantly, from one (range 0-5) before the intervention to four (range 1-17) after it. Moreover, serious ADRs increased 3-fold, and non-previously described ADRs increased 4.5-fold. None of these significant increases were observed in the hospitals where the hyperlink was not installed. We also found a significant increase in daily UFN website visits, from ten before the intervention to 27 after it (p < 0.001).
  
  
  CONCLUSIONS
  The increase in ADR reporting shows that the inclusion of hyperlinks to online ADR reporting forms is an easy and cost-effective way to change health professional behaviours with regard to spontaneous ADR reports.
authors.affiliation: Northern Pharmacovigilance Centre, Faculty of Medicine, University of Porto, Porto, Portugal. inesvaz@med.up.pt
authors.forename: Inês
authors.initials: I
authors.lastname: Ribeiro-Vaz
authors.forename: Cristina
authors.initials: C
authors.lastname: Santos
authors.forename: Altamiro
authors.initials: A
authors.lastname: da Costa-Pereira
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cruz-Correia
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000458:organization & administration*; D016903:Drug Monitoring / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions; D057286:Electronic Health Records / Q000458:organization & administration*; D006293:Health Promotion; D055991:Health Records, Personal; D006801:Humans; D020407:Internet; D008498:Medical Record Linkage / Q000379:methods*; D060735:Pharmacovigilance; D011174:Portugal; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care