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Polypharmacy in Children with Medical Complexity: A Cross-Sectional Study in a Pediatric Palliative Care Center
Anna Zanin1, Fernando Baratiri2, Barbara Roverato1
1Palliative Care and Pain Service, Department of Women's and Children's Health, University of Padua, 35128 Padua, Italy.
Insights
Polypharmacy and medication burden are common in children with medical complexity (CMC), affecting over half of patients. These issues vary by primary diagnosis, highlighting the need for tailored care strategies.
Area of Science:
- Pediatric pharmacology
- Healthcare outcomes research
Background:
- Children with medical complexity (CMC) frequently use multiple medications, leading to polypharmacy.
- Polypharmacy is associated with adverse effects, medication errors, and increased caregiver burden.
- Understanding medication patterns in CMC is crucial for improving patient care and reducing healthcare costs.
Purpose of the Study:
- To determine the prevalence of polypharmacy and medication burden in pediatric patients with medical complexity.
- To investigate the extent of off-label drug use and associated medication costs.
- To analyze variations in these medication parameters based on primary diagnosis.
Main Methods:
- A cross-sectional observational study was conducted at a Pediatric Palliative Care Center.
- Data were collected from 169 patients (age 0.3-23 years) via medical records and caregiver interviews.
- Statistical analysis, including Chi-square and ANOVA tests, was used to compare medication data.
Main Results:
- Polypharmacy affected 52.7% of patients, and medication burden was present in 44.4%.
- Both polypharmacy and medication burden showed significant variation based on primary diagnosis (p < 0.001).
- The median daily drug cost per patient was EUR 2.2, with significant subgroup differences; 34.6% of prescriptions were off-label.
Conclusions:
- Polypharmacy and medication burden are prevalent in the studied pediatric population with medical complexity.
- Significant differences in medication patterns exist according to primary diagnosis.
- These findings underscore the need for careful medication management in CMC to optimize outcomes and reduce burden.
Background:
Children with medical complexity (CMC) often require multiple medications, leading to polypharmacy, which seems to be linked to adverse effects, administration errors, and increased caregiver burden. This study aimed to describe the prevalence of polypharmacy, medication burden, off-label drug use, and associated costs.
Methods:
Conducted at the Pediatric Palliative Care Center of Padua, Italy, from August to October 2021, this cross-sectional observational study included patients up to 23 years old with at least one prescribed drug. Data were collected from medical records and caregiver interviews. Drug costs were collected from the Italian Medicine Agency. Descriptive statistical analysis was performed. For comparisons among categorical variables, the Chi-square test was used, and for those among continuous variables, the ANOVA test was used.
Results:
This study analyzed treatment regimens of 169 patients with a median age of 12.5 years (0.3-23). Polypharmacy was present in 52.7% of patients, and medication burden was observed in 44.4%, both varying significantly by primary diagnosis (p < 0.001). The median daily cost per patient was EUR 2.2 (IQR 0.9-7.1), with significant variation among subgroups. Only 34.6% of prescriptions were off-label.
Conclusions:
polypharmacy and medication burden are frequent among our CMC population, with some differences according to primary diagnosis.
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