An Informatics Approach to Assess Pediatric Pharmacotherapy: Design and Implementation of a Hospital Drug Utilization System

Zuppa, Athena F.; Vijayakumar, Sundararajan; Jayaraman, Bhuvana; Patel, Dhaval; Narayan, Mahesh; Vijayakumar, Kalpana; Mondick, John T.; Barrett, Jeffrey S.

doi:10.1177/0091270007304105

Cited by 8 publications

(7 citation statements)

References 17 publications

(14 reference statements)

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“…We have previously studied drug utilization patterns in the pediatric ICU[12], developed visualization tools to mine and query utilization patterns in the hospital in-patient setting[13], developed a key performance index (KPI) scoring system to rank and prioritize agents on formulary for future study[14], and described how predictive models can inform decision support system that interface with the hospital's electronic medical records (EMRs)[15]. Our objective for this investigation was to assess pediatric caregiver prescribing habits, including attitudes with respect to their valuation of available resources to guide pediatric pharmacotherapy.…”

Section: Introductionmentioning

confidence: 99%

Prescribing habits and caregiver satisfaction with resources for dosing children: Rationale for more informative dosing guidance

et al. 2011

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BackgroundPhysicians, nurses and hospital pharmacists were surveyed to assess attitudes of hospital-based pediatric caregivers regarding the dosing of medicine to children. Our objectives were to gauge how current resources are utilized to guide the management of pediatric pharmacotherapy, assess drugs and drug classes where guidance is most critical and examine the prevalence and practice of dose adjustment in pediatric patients.MethodsQuestionnaire categories included demographics, pharmacotherapy resources, dosing adjustment and modification, and valuation of additional tools to provide improved pharmacotherapy guidance. The questionnaire was developed in collaboration with representative nurse, pharmacist and physician team members using the SurveyMonkey.com site and survey tool. The survey link was distributed to caregivers via email. The questionnaire results of 303 respondents were collected into MS Excel and imported into SAS for data summarization.ResultsA total of 313 responses were obtained. Physician and nurse practitioner groups comprised the majority of the responses. Approximately 80% of the responders considered dosing adjustment important in pediatric pharmacotherapy. While there was general satisfaction with available resources, nearly 75% responded in support of access to predictive tools that facilitate individualized patient pharmacotherapy. The majority of respondents (> 65%) indicated that dosing outside standard practice occurs in 1-20% of their patients, while still a substantial number of respondents (a range of 8 to 20% reflecting the resident and fellow categories) estimated between 20 and 50% of their patients required adjustments outside the standard practice.ConclusionsDifferences in prescribing habits based on caregiver role, specialty and location were small and likely require further exploration. Existing resources are generally viewed as helpful but inadequate to guide recommendations for individual patients. Decision support systems connected to hospital-based electronic medical records offer the promise of informative and individualized pharmacotherapy guidance.

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Section: Introductionmentioning

confidence: 99%

Prescribing habits and caregiver satisfaction with resources for dosing children: Rationale for more informative dosing guidance

et al. 2011

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“…In a recent publication by Zuppa et al1 it had been registered 61,916 encounters in one Philadelphia’s children’s hospital. Sodium chloride (9%), sodium heparin (7%), acetaminophen (5%) and albuterol (4%) were the four most prescribed medications.…”

Section: Discussionmentioning

confidence: 99%

General medications utilization and cost patterns in hospitalized children

Okasha

Kassis

Haddad

et al. 2009

Pharmacy Practice (Internet)

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Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults.ObjectivesThe aim of this descriptive study was to analyze general medication utilization patterns and costs excluding antimicrobials prescriptions and to compare two pediatric admission units in a tertiary care university hospital.MethodsThe total number of admitted children was 1,521 and 1,467 for the A and B admission units, respectively. The electronic data from 252 and 253 hospitalized children in the A and B admission unit were prospectively screened for general medication prescriptions, children on antimicrobials were excluded from the analysis. Their electronic charts were viewed once weekly from October 15, 2007 up to April 7, 2008 using the prescription-point prevalence method. One medication was considered to be one prescription.ResultsThe general medications prescription number was 790 for 94 children (8.4 prescription/patient) in A and 959 for 88 children (10.9 prescription/patient) in B (p=0.02). The general medications defined daily dose (DDD) and drug utilization 90% (DU90%) index were 2,509.63, 2,259 for A; and 6,110.35, 5,499 for B, respectively. The DU90% index placed salbutamol inhalation with 835 DDD and sodium heparin with 2,102 DDD in the first place for the A and B admission units, respectively. A net increment in medication cost was registered according to the calculated cost from the depicted DU90% when the A (20,263 NIS) and B (6,269 NIS) admission units were compared (p=0.04).ConclusionsA significant difference in the prescription utilization of general medications was shown between the A and B admission units. The A admission unit had lower prescriptions measured by the DU90% index with higher medication cost. Potential drug-drug interactions were depicted in 18 (19%) and 17 (19%) subjects in the A and B admission unit, respectively.

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“…While computer simulation cannot completely replace clinical trials, informed, well-designed trials supported by well-qualified modeling and simulation results can together provide information that is supportive for pediatric labeling. At the very least, it provides an integrated manner to combine existing clinical knowledge and data to alter dosing in patients being treated with an agent [54–56]. …”

Section: Methods For Improvementmentioning

confidence: 99%

Challenges in conducting clinical trials in children: approaches for improving performance

Kern¹

2009

Expert Review of Clinical Pharmacology

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Recent legislative changes in both Europe and the USA have increased the responsibility of drug developers to purposefully study the agents they market in children so that specific dosing recommendations can be made to assist clinicians in their use. Typically, clinicians use empiricalor experiential-based rationales for selecting the dose to use in children, generally in a manner that attempts to achieve the same dose-exposure or pharmacokinetic profile in children as in adults. However, whether this approach achieves the necessary dose exposure or exposure effect needed may not be systematically explored during off-label use. This creates the opportunity for under-or over-exposure in children, particularly in very young children (i.e., less than 2 years old) where a combination of factors during development can effect both pharmacokinetics and pharmacodynamics. The ethical, physiological and statistical differences of studying new therapeutic agents in children present economic challenges that may create unintended incentives -both positive and negative -for any individual developer who tries to meet the requirements of new legislation to study pharmaceutical agents in children. There should be a continued emphasis in academic clinical pharmacology programs towards creative methods and approaches to better understand these differences in children compared with adults. The ability to use information from knowledge obtained from adult studies, from preclinical studies, from studies of compounds with similar chemistry or pharmacology, or from known physiological differences between children and adults is essential to choosing a suitable dose for children and achieving these regulatory aims.

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An Informatics Approach to Assess Pediatric Pharmacotherapy: Design and Implementation of a Hospital Drug Utilization System

Cited by 8 publications

References 17 publications

Prescribing habits and caregiver satisfaction with resources for dosing children: Rationale for more informative dosing guidance

Prescribing habits and caregiver satisfaction with resources for dosing children: Rationale for more informative dosing guidance

General medications utilization and cost patterns in hospitalized children

Challenges in conducting clinical trials in children: approaches for improving performance

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