Among the actioners group, a limitation is that actioners only received feedback after their first notification. Only 48.3% of the intervention group and 53.8% of the GDC-0449 purchase control group received feedback somewhere between November 28th 2007 and May 25th 2008. The actioners group is relatively small (238) and despite randomisation, actioners assigned to the control group reported significantly more ODs in the 180 days before November 27th 2007 than actioners assigned selleck inhibitor to the intervention group. The reporting behaviour in the control group stayed about the same in the follow-up period. Among the OPs receiving personalized feedback, including a scientific article closely related to the

OD that was reported, the total and the mean number of notifications increased, although the differences between intervention and control group were not significant. This may be due to the relatively small group of actioners that ultimately could be analysed after receiving feedback. But the increase of reporting in the intervention group may also be a statistical regression to the mean. Underreporting

in mandatory surveillance schemes is widely recognized, and the causes are relatively well explored. But there is only limited evidence from controlled studies on what interventions could improve reporting. Education may have a positive effect. LGX818 chemical structure Smits et al. (2008) found that an active, multifaceted workshop on occupational diseases is moderately effective in increasing the number of physicians reporting occupational diseases. Although both knowledge and self-efficacy increased significantly, only self-efficacy turned out to be a predictive factor for such reporting. Other studies found a positive effect of a distance-learning program with educational credits (Bracchi et al. 2005) and a targeted one-hour educational outreach visit (Figueiras et al. 2006) on reporting adverse drug reactions. There is also some

evidence that sending information and reminders can cAMP improve reporting. Brissette et al. (2006) evaluated the effects of different messages to promote complete and timely reporting of occupational lung diseases to the New York State Occupational Lung Disease Registry. They found that physicians receiving correspondence describing the legal obligation to report were more likely to report occupational lung diseases than those receiving a message describing only the public health benefits. On the other hand, stressing the public health benefits of reporting led to submittance of more complete reports. Studies in pharmacovigilance looking at the effects of sending regular reminders or newsletters showed similar results (McGettigan et al. 1997; Castel et al. 2003), but stressed that they may have only a temporal effect; when the information is withdrawn, reporting declines.