IntroductionThe aim of this study was to evaluate the effectiveness of interventions used for improving ADR reporting by patients and healthcare professionals. Areas coveredA systematic review of literature was conducted by searching Medline, Embase and Cochrane Central Register of Controlled of Trials. Meta-analysis of randomised controlled trials (RCTs; n=5) was conducted to estimate the pooled risk ratio for the effectiveness of interventions on ADR reporting rates. Data from observational studies were synthesised using narrative synthesis approach. Expert OpinionA total of 28 studies were included. All except one study targeted healthcare professionals using educational, technological, policy, financial and/or mixed interventions. The results showed that financial and face-to-face educational interventions improved quality and quantity of ADR reporting when compared with interventions not involving face-to-face interactions. However, the quality of studies was generally low. Meta-analysis showed a statistically significant 3.5-fold overall increase in reporting of ADRs [RR 3.53; 95% CI (1.77,7.06)] in the intervention group compared to the control. There was a lack of consideration of theory and sustainability in the design of the interventions. There is a need to develop and test theory-based interventions and target patient reporting. More research needs to be conducted in the low-and-middle-income countries.

Background Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. Methods Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385

Objectives: This study aimed to assess the impact of the COVID-19 pandemic on the mental health status of healthcare professionals (HCPs) and undergraduate students in the health sciences center (HSCUs). In addition, it explored the factors associated with the increased levels of mental health burden among the study population. Methods: A cross-sectional study was performed using two online-administered questionnaires: the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7), which were distributed in parallel to HCPs and HSCUs in Kuwait. These instruments are validated assessment scales to assess mental health status: depression (PHQ-9) and anxiety (GAD-7). Statistical analyses were carried out using SPSS- version 25. Results: A total of 857 individuals (559 HCPs and 298 HSCUs) participated in this study. The prevalence of moderately severe depression or severe depression (PHQ-9 total score of ≥15) among respondents was 66.6%. The median (interquartile range, IQR) PHQ-9 score was significantly higher among HSCUs (20 {11.5}) compared to HCPs (17 {8}). The prevalence of severe anxiety (GAD-7 total score of ≥15) among respondents was 36.7%. There were no significant differences between the median (IQR) GAD-7 scores among the HCPs (14 {7}) and HSCUs (13 {8}). Binary logistic regression analysis revealed that three variables were significantly and independently associated with severe depression among HCPs. The prevalence of severe depression was found to be greater among females compared to males. In addition, it was significantly lower among those who were aged ≥50 years, and those who reported that they were not in direct contact with COVID-19 patients. Among HSCUs, females showed greater depression than males. In contrast, those aged >29 years and who had no history of chronic disease showed lower depression compared to their counterparts in the 18–29 years age group and who had a chronic disease history. Conclusions: The COVID-19 pandemic had a significant negative impact on the mental health of HCPs and HSCUs in Kuwait. This highlights the need for proactive efforts to support their mental health and well-being through educational campaigns and psychological support programs.

Aims:To conduct a systematic review and meta-analysis of the effectiveness of general practice-based pharmacist interventions in reducing the medical risk factors for the primary prevention of cardiovascular events. Methods:A systemic search was undertaken in 8 databases: PubMed, MEDLINE, EMBAS, PsycINFO, Cochrane Library, CINAHL Plus, SCOPUS and Science Citation Index, with no start date up to 27 March 2019. Randomised controlled trials assessing the effectiveness of pharmacist-led interventions delivered in the general practice in reducing the medical risk factors of cardiovascular events were included in the review. The risk of bias in the studies was assessed using the Cochrane risk of bias tool. Results: A total of 1604 studies were identified, with 21 randomised controlled trials (8933 patients) meeting the inclusion criteria. Fourteen studies were conducted in patients with diabetes, 7 in hypertension, 2 involving dyslipidaemia, and 2 with hypertension and diabetes together. The most frequently used interventions were medication review and medication management. The quality of the included studies was variable. Patients receiving pharmacist-led interventions were associated with a statistically significant reduction in their systolic blood pressure (−9.33 mmHg [95% Confidence Interval (CI) −13.36 to −5.30]), haemoglobin A1C (−0.76% [95% CI −1.15 to −0.37]) and low-density lipoprotein-cholesterol (−15.19 mg/dL [95% CI −24.05 to −6.33]). Moreover, practice-based pharmacists' interventions were also reported to have a positive impact on patient adherence to medications. Conclusion:The findings of this review suggest that pharmacist-led interventions in general practice can significantly reduce the medical risk factors of cardiovascular disease events. These findings support the involvement of pharmacists as healthcare providers in managing patients with hypertension, diabetes and dyslipidaemia. K E Y W O R D Scardiovascular disease, general practice, pharmacist PI statement: The authors confirm that the Principal Investigator for this paper is Abdullah A. Alshehri and that he had direct clinical responsibility for patients.

Objective: This study aimed to assess the prevalence and predictors of non-adherence to antihypertensive medication among patients with hypertension attending various healthcare settings in Islamabad, Pakistan. Methods: A questionnaire-based cross-sectional study was conducted in selected healthcare facilities between September 2017 and December 2018. The study was conducted in primary, secondary and tertiary healthcare settings in Islamabad, Pakistan. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Sociodemographic and clinical data of recruited patients were collected through a structured questionnaire. Binary logistic regression analysis was performed to determine covariates significantly associated with medication adherence and blood pressure control. Results: A total of 776 hypertensive patients were invited and 741 (95%) completed the questionnaire. The mean ± SD age of participants was 53.6±12.6 years; 284 patients (38.3%) had high adherence, 178 (24%) had moderate adherence and 279 (37.7%) were non-adherent to the prescribed antihypertensive therapy. Binary regression analysis revealed that old age (OR 1.783 [95% CI: 1.172-2.712]; P=0.013), being educated (OR 2.018 [95% CI: 1.240-3.284]; P=0.036), entitlement to free medical care (OR 1.369 [95% CI: 1.009-1.859]; P=0.044), treatment duration (OR 2.868 [95% CI: 1.913-4.299]; P=0.001), number of medications (OR 1.973 [95% CI: 1.560-2.495]; P=0.001), presence of any comorbidity (OR 2.658 [95% CI: 1.836-3.848]; P=0.001) and blood pressure control (OR 3.103 [95% CI: 2.268-4.247]; P=0.001) were significantly associated with good adherence. Similarly, age (OR 1.998 [95% CI: 1.313-3.040]; P=0.004), entitlement to free medical care (OR 1.498 [95% CI: 1.116-2.010]; P=0.007), treatment duration (OR 1.886 [95% CI: 1.143-3.113]; P=0.013), presence of any comorbidity (OR 1.552 [95% CI: 1.123-2.147]; P=0.008) and adherence level ; P=0.001) had significant association with controlled blood pressure. The following were the main reasons for non-adherence to prescribed antihypertensive medication: "don't feel need for regular use" (24.7%), "Carelessness" (13.4%) and "adverse effects" (11.2%). Conclusion: The prevalence of non-adherence to antihypertensive medications was high in the study population and poor medication adherence could potentially explain poor blood pressure control. Evidence-based targeted interventions on both medication adherence and blood pressure control should be introduced and implemented for better treatment outcomes.