Transcript Prevalence of Polypharmacy Exposure Among

Prevalence of Polypharmacy Exposure Among
Hospitalized Children in the United States
Feudtner C, Dai D, Hexem KR, Luan X, Metjian TA. Prevalence of
polypharmacy exposure among hospitalized children in the United
States. Arch Pediatr Adolesc Med. Published online September 5,
2011. doi:10.1001/archpediatrics.2011.161.
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Introduction
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Background
– In the hospital setting, efficacy and safety of many pediatric medications
have not been well established.
– Recent federal legislation has called for greater attention to safety and
effectiveness of on- and off-label drug treatments for children.
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Study Goal
– To characterize overall patterns of pediatric inpatient drug and
therapeutic agent use in order to enhance efforts to prioritize and design
future research studies regarding effectiveness and safety of pediatric
inpatient medications.
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Methods
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Study Design
– Secondary analyses of pediatric inpatient data (from patients aged <18
years) from 2 data sources (Pediatric Health Information System and
Perspective Data Warehouse) that together include approximately 20%
of pediatric inpatient hospitalizations in 2006.
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Sample
– 365 868 unique pediatric inpatients, responsible for 491 451
hospitalizations in 52 children’s hospitals.
– 221 559 unique pediatric inpatients, responsible for 260 740
hospitalizations in 411 general hospitals.
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Outcome/Analyses
– Differences in exposures to pharmaceutical agents by hospital type,
adjusted for patient covariates (age, sex, length of stay, surgery).
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Methods
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Limitations
– Prescribed medications do not ensure that the medications were
administered.
– Although pro re nata (PRN) medications ordered should not be billed if
not used, it is possible that some PRN medications are included but
were not administered.
– Drug doses were not available from the data.
– Intentions and clinical purposes for which drugs were prescribed are not
known with certainty.
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Results
Percentage of patients exposed
to major drug and therapeutic
agent classes by age group and
hospital type. (Only the upper
portion of the figure is shown; for
data regarding other agents,
please see the article.)
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Results
Top Generic Drug Entity Exposures by Hospital Typea
aPercentage
of patients exposed to the named drug at any point during the hospitalization; rank ordering
omits intravenous fluids, sterile water, dextrose water, heparin intravenous flushes, hyperalimentation,
multivitamins, and glycerin suppository. (Only the upper portion of the table is shown; for data regarding
older age groups, please see the article.)
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Results
Cumulative number of
distinct drug and
therapeutic agent
exposures per
hospitalization by length
of stay, hospital type, and
patient age. IQR indicates
interquartile range.
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Results
Multivariable Adjusted Rate
Ratios of Cumulative Total
Number of Exposures to
Distinct Drugs and Therapeutic
Agents for Hospitalized
Pediatric Patients
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Comment
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A large proportion of children are exposed to 5 or more drugs or therapeutic
agents during each day of hospitalization.
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Differences in exposure by hospital type are largely nullified when
differences in patients are taken into account.
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Variation among children’s hospitals and among general hospitals in drug
and therapeutic agent use was substantial (see the article for details).
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Comment
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Implications for Future Research in This Area
– Opportunity to apply use data in prioritization of research on safety and
efficacy, especially for off-label use.
– Development of new mechanisms to detect adverse events in pediatric
settings.
– Further research regarding possible drug-drug interactions that may
place children at risk in the setting of polypharmacy.
– Opportunities for comparative effectiveness research given the broad
variation across institutions in the management of common clinical
problems.
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Contact Information
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If you have questions, please contact the corresponding author:
– Chris Feudtner, MD, PhD, MPH, CHOP North–Room 1523, The
Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard,
Philadelphia, PA 10104 ([email protected]).
Funding/Support
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This study was supported by Center for Education and Research on
Therapeutics grant U18 HS017991 from the Agency for Healthcare
Research and Quality.
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