OBJECTIVES: Adverse drug reaction (ADR) under-reporting is a limitation of pharmacovigilance systems and is predominantly observed in developing countries. Our goal was to find the differences in knowledge, attitude, and perceived barriers of ADR reporting by hospital pharmacists in Pakistan vs USA.

METHODS: A structured validated online questionnaire was administered via Qualtrics to hospital pharmacist in Pakistan and from the world’s largest medical center in Texas USA during November-December 2021. Participants’ demographics, practice setting, working-hours and experience information was obtained. Knowledge was assessed by means of 17-item yes/no scale while attitude (14-items) and perceived barriers (19-items) were measured on 5-point Likert-scale. Participants were then categorized based on their overall knowledge (poor vs good) and attitude (positive vs negative). Descriptive statistics, Chi-square and Mann-Whitney-U test were carried out to compare two groups.

RESULTS: In this sample we had 68 (64.7%) hospital pharmacists form Pakistan and 37 (35.2%) from USA, respectively. Most respondents were females (67.6%) and less than 40-years old (83.8%). Majority of pharmacist from Pakistan (57.4%) and USA (70.3%) had good knowledge scores. About 63.2% of pharmacists from Pakistan and 54.9% of US pharmacist indicated positive attitude towards ADR reporting. Mann-Whitney-U test indicated that hospital pharmacist in Pakistan perceived the following barriers in ADR reporting significantly higher than those in USA, namely, insufficient knowledge to detect ADR (p<0.001), lack of professional setup for ADR discussion (p<0.001), lack of ADR reporting culture (p<0.001), fear of retaliation from physician (p<0.001), and no encouragement from relevant authorities (p<0.008).

CONCLUSIONS: Certain institutional barriers exist for hospital pharmacists in Pakistan as compared to USA when reporting ADRs. Although not much differences exist in their knowledge and attitude towards ADR reporting, these barriers could affect future improvement in the process of ADR reporting. Policies encouraging ADR reporting including monetary benefits may facilitate better ADR reporting processes.