Aim: To conduct an overview of systematic reviews examining interventions to stimulate spontaneous reporting of suspected adverse drug reactions (ADRs) by healthcare professionals (HCPs) and/or patients/carers.
Methods: Systematic reviews published since 1 January 2000 were identified and the included publications categorized in relation to the 4Es (education, engineering, economics and enforcement).
Results: Almost all studies were aimed at HCPs. Educational initiatives were most often used and, in most studies, were associated with improvements in quantity and/or quality of reports, at least in the short term. Lectures/presentations and regular reminders (eg, verbal or by e-mail) were the educational methods most often identified by systematic reviews. Engineering initiatives were also generally effective, including improving the availability of reporting forms, electronic ADR reporting, modification of reporting procedures/policies or the reporting form and assistance to complete the form. Evidence for the benefit of economic incentives (eg, monetary rewards, lottery tickets, days off work, "giveaways" and educational credits) was often clouded by the potential effects of other concomitant initiatives, and any possible associated improvements often disappeared rapidly after incentives were discontinued.
Conclusion: Educational and engineering strategies appear to be the interventions most often associated with improvements in reporting rates by HCPs, at least in the short to medium term. However, the evidence for sustained impact is weak. The available data were insufficient to clearly identify the separate impact of economic strategies. Further work is also needed to examine the effects of these strategies on reporting by patients, carers and the public.
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