Drugs: an individual and collective asset 

The technological development of medicine in recent decades has created expectations among patients and the population at large about new diagnostic and therapeutical interventions. In health technologies, drugs are the ones with a more favourable cost-effectiveness profile, accounting for about ¼ of total health spending in developed countries.

The growing use of new drugs, increasingly more effective but also more expensive, by populations of patients who are progressively older, suffering from multiple pathologies and on several types of medication, raises complex issues which have implications on safety, accessibility and sustainability of health systems.

Therefore, drugs are important determinants of health or illness of populations, with an indubitable impact on Public Health.

Health professionals play a key role in the therapeutic process, ensuring that patients have access to the necessary medication, at the best conditions of use and at the appropriate time [1].

Therapeutical decision should be based on timely and reliable information, resulting from clinical trials necessary to demonstrate efficacy, but also from epidemiological studies designed and performed in order to confirm the effectiveness of the drugs.

Contributions of Pharmacoepidemiology  

Pharmacoepidemiology is the study of the use and effect of drugs in human populations and involves knowledge derived mainly from epidemiology and clinical pharmacology.

The use of valid and adequate pharmacoepidemiological methods is critical to assessing the safety and effectiveness of drugs and characterization of their use.

Concepts such as: risk-benefit, risk management, individualized therapy, comparative effectiveness, cost-effectiveness, and health gains have gained considerable importance in recent years [2-4]. In addition to the paradigm shift in the requisites regarding research and development of new drugs [5], we are currently witnessing considerable pressure from patients and society in general in their demands for increased security without compromising accessibility.

The recent knowledge advances in the field of pharmacoepidemiology, through the development of new methodologies that are important to assess the safety and effectiveness of drugs, the production of information supporting quality prescriptions and also the support given to decision-making by policy makers and regulators, justify the ongoing updating of knowledge and the development of research in this field [6,7].

Building skills and producing knowledge  

Aware of the importance of this academic discipline in the Faculty of Medicine of the University of Lisbon, the Institute of Preventive Medicine has carried out several initiatives over the past years to foster scientific knowledge and contribute to the training of health professionals.

With regard to training, and in addition to other initiatives at undergraduate level, there were three editions of the postgraduate course in pharmacoepidemiology, in 2001, 2004 and 2008, respectively, and we are currently preparing a new edition for 2012. This is an IMP initiative in collaboration with the Autonomous University of Barcelona and the National Authority for Drugs and Health Products (INFARMED – I.P.).

In the field of research, some projects related to Compliance with Anti-retroviral Therapy in HIV positive individuals are currently underway, which are part of a master degree project of a student with a first degree in Pharmaceutical Sciences and which also involves some FML students.

In the same fashion, the PhD project of a student with a degree in Pharmaceutical Sciences is also in its early stages. It is called Safety of Tumor Necrosis Factor alpha inhibitors: Infectious diseases and oncogenesis. The work related to this project has already resulted in a scientific article [8].

Two projects in the field of drug prescription and use have also been submitted for funding: Development and Validation of Prescription Quality Indicators in Portugal and Medication Change in the Interface between Primary Health Care and Hospital Care: frequency, determinants and implications for safety and observance of cardiovascular chronic therapy. These are collaborative studies that will involve primary health care units and hospital care services nationwide.

Through these initiatives, the IMP aims to encourage the development of knowledge derived from pharmacoepidemiology and apply it to training, research and care, thus contributing to a more rational, safer and cost-effective use of drugs.
Vasco A. J. Maria (Prof. Doutor)
Coordinator of the Pharmacoepidemiology Unit
Director of the General and Family Medicine course