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Association between polypharmacy and clinical outcomes in children with medical complexity: a retrospective cohort

Shuangzhu Shao1, Kafen Hu2, Jinlong Zhou3

  • 1Department of Pediatrics, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang City, Zhenjiang City, Jiangsu Province, China.

Frontiers in Pediatrics
|July 24, 2026
PubMed

Insights

Polypharmacy in children with medical complexity (CMC) is common and linked to more adverse drug events (ADEs) and healthcare use. Optimizing medication regimens for CMC is crucial to improve outcomes.

Area of Science:

  • Pediatric Pharmacology
  • Clinical Pharmacy
  • Health Services Research

Background:

  • Children with medical complexity (CMC) often require multiple medications, leading to polypharmacy.
  • The clinical impact of polypharmacy on CMC outcomes is not well understood.

Purpose of the Study:

  • To investigate the association between polypharmacy and adverse drug events (ADEs).
  • To examine the relationship between polypharmacy and medication appropriateness, adherence, and healthcare utilization in CMC.

Main Methods:

  • Retrospective cohort study of 1,486 CMC (aged 0-18 years) from January 2019 to June 2021.
  • Polypharmacy defined as ≥5 chronic medications for ≥90 consecutive days; PRN medications excluded.
  • Outcomes included ADEs, potentially inappropriate medication (PIM) use, adherence (PDC), and healthcare utilization (ED visits, admissions, ICU admissions, hospital days, readmissions).

Main Results:

  • 42.3% of CMC experienced polypharmacy.
  • Polypharmacy was associated with higher ADE rates (2.70 ARR), increased PIM use (53.8%), lower adherence (mean PDC 63.5%), and greater healthcare utilization (ED visits, admissions, ICU admissions).
  • A dose-response relationship was observed between medication number and adverse outcomes (P < 0.001).

Conclusions:

  • Polypharmacy in CMC is strongly linked to increased ADEs, PIM use, reduced adherence, and higher healthcare utilization.
  • Findings highlight the need for medication optimization strategies in CMC.
  • Prospective studies are warranted to further investigate and address these issues.
Abstract

Keywords:
adverse drug eventschildren with medical complexityhealthcare utilizationmedication safetypolypharmacy

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