Correlates of spontaneous reporting of adverse drug reactions within primary care: the paradox of low prescribers who are high reporters

AIM(S) To examine Primary Care Trust (PCT) demographics influencing general practitioner (GP) involvement in pharmacovigilance. METHODS PCT adverse drug reaction (ADR) reports to the Yellow Card scheme between April 2004 and March 2006 were obtained for the UK West Midlands region. Reports were analysed by all drugs, and most commonly reported drugs (‘top drugs’). PCT data, adjusted for population size, were aggregated. Prescribing statistics and other characteristics were obtained for each PCT, and associations between these characteristics and ADR reporting rates were examined. RESULTS During 2004–06, 1175 reports were received from PCTs. Two hundred and eighty (24%) of these reports were for 14 ‘top drugs’. The mean rate of reporting for PCTs was 213 reports per million population. A total of 153 million items were prescribed during 2004–06, of which 33% were ‘top drugs’. Reports for all drugs and ‘top drugs’ were inversely correlated with the number of prescriptions issued per thousand population (rs = -0.413, 95% CI -0.673, -0.062, P < 0.05, and r = -0.420, 95% CI -0.678, -0.071, P < 0.05, respectively). Reporting was significantly negatively correlated with the percentages of male GPs within a PCT, GPs over 55 years of age, single-handed GPs within a PCT, the average list size of a GP within a PCT, the overall deprivation scores and average QOF total points. ADR reports did not correlate significantly with the proportion of the population over 65 years old. CONCLUSIONS Some PCT characteristics appear to be associated with low levels of ADR reporting. The association of low prescribing areas with high ADR reporting rates replicates previous findings.

Expatriate managers adjustment and its impact on subordinates reactions: a cross cultural leadership study of Kenya and Ethiopia

Research on culture, leadership and adjustment shows that societal culture influences leadership in such a way that it can impact on expatriate managers' effectiveness and adjustment in a new culture. In previous research, cultural background, personality, motives or behaviour of expatriate managers and their followers' reactions to them have been investigated in Europe, America and Asia. However, little attention has been paid on research on expatriate managers in African cultures especially in Eastern Africa. The present study represents an attempt to address the gap by examining how societal culture, leadership and adjustment success are interrelated for expatriate managers in Kenya and Ethiopia. Questionnaire data were obtained from a) local middle managers (N=160) for studying societal culture and leadership in Kenya and Ethiopia, b) expatriate managers in non-governmental organizations - NGOs (N=28) for studying expatriate managers' personality, motives and adjustment success and c) their immediate subordinates (N=125) for studying the expatriate managers' behaviours and their subordinates' reactions to them. Additionally, expatriate managers were interviewed and responses were coded for implicit motives, experiences and adjustment. SPSS was used to analyse data from questionnaires to obtain cultural and leadership dimensions, leader behaviour and subordinate reactions. The NVIVO computer based disclosure analysis package was used to analyse interview data. Findings indicate that societal culture influences leadership behaviours and leadership perceptions while the expatriate managers' motives, behaviours, personality and the cross cultural training they received prior to their assignment impact on the expatriates' adjustment success and on subordinates' reactions to them. The cultural fit between expatriate managers' home country (19 countries) and the target country (Kenya or Ethiopia) had no significant association with adjustment success but was positively related to expatriate behaviour and negatively associated with subordinates reactions. However, some particular societal practices - obviously adopted by expatriates and transferred to their target country - did predict subordinates' commitment, motivation and job satisfaction. Furthermore, expatriates' responsibility motivation was positively related to their adjustment success. Regarding leadership behaviours and effectiveness, expatriate' supportive behaviours predicted subordinates' job satisfaction most strongly. Expatriate managers expressing their management philosophies and experience shed light on the various aspects of adjustment and management of NGOs. In addition, review of Kenyan and Ethiopian cultures and the NGO context in these countries offers valuable information for expatriate managers. This study's general imphcation for Cross Cultural Management and lnternational Human Resources Management is that the combination of culture general and culture specific knowledge and reflections on Eastern Africa countries can inform senior management and international HR staff about the critical issue of what to include in training, coaching, and actual experience in a particular host country in order to ensure effective leadership. Furthennore, this knowledge is expected to influence expatriate managers' behaviour modification to enhance positive subordinate reactions. Questions about how to prepare expatriate managers and subordinates to work more competently and sensitively across cultures are addressed. Further theoretical implications, limitations of the study and directions for future research are also addressed.