Defining pediatric polypharmacy: A scoping review

Bakaki, Paul M.; Horace, Alexis; Dawson, Neal V.; Winterstein, Almut G.; Waldron, Jennifer J.; Staley, Jennifer; Pestana-Knight, Elia M.; Meropol, Sharon B.; Liu, Rujia; Johnson, Hannah; Golchin, Negar; Feinstein, James A.; Bolen, Shari; Kleinman, Lawrence C.

doi:10.1371/journal.pone.0208047

Cited by 48 publications

(70 citation statements)

References 101 publications

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“…Two others defined polypharmacy in the general population 3,8 and 1 review, the most recent, focused on paediatric polypharmacy. 9 The studies included in these included reviews were published between 1985 and July 2017.…”

Section: Description Of Included Reviewsmentioning

confidence: 99%

“…15 The last selected review is a scoping review published by an American team in November 2018, including 363 articles. 9 It describes definitions and terminology of paediatric polypharmacy and provides an overview of the wide range of definitions associated to the term "polypharmacy" in paediatric studies. This review's results are similar to those found in other reviews concerning the general population: the vast majority of definitions are quantitative; the difference is the number of medications.…”

Section: Dovepressmentioning

confidence: 99%

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<p>Failure to Reach a Consensus in Polypharmacy Definition: An Obstacle to Measuring Risks and Impacts—Results of a Literature Review</p>

Taghy¹,

Cambon²,

Cohen³

et al. 2020

TCRM

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Introduction: The risk of polypharmacy is on the rise in most industrialized countries, threatening to burden their health systems. Although many definitions exist and numerous concepts are found in literature as synonyms, the phenomenon of polypharmacy remains poorly defined. The aim of this literature review is to provide an overview of available definitions of polypharmacy, to analyse their convergences and divergences and to discuss the consequences on the assessment of the problem. Methods: A literature review was conducted to identify all published systematic reviews on definitions of polypharmacy available via Scopus and Pubmed databases. The Assessment of Multiple Systematic Reviews (AMSTAR) tool was used to appraise the methodological quality of the selected reviews. Available definitions and other characteristics were extracted; summarised in a table and analysed. Results: Six systematic reviews were identified. They were published between 2000 and 2018. Three focussed on definitions of polypharmacy in the elderly; two in the general population and one in children. The strategy adopted in reviews is more rigorous in the most recent ones. However, they remain, at best, partially exhaustive. The definitions found in the literature used two main approaches, either (i) quantitative, applying varying thresholds and types of polypharmacy based on the number of medications being taken by the patient (ii) qualitative, based on the clinical indications and effects of a given drug regimen, with a growing number of characteristics to describe polypharmacy. The term "inappropriate" is increasingly associated with polypharmacy especially in studies that aimed to use this definition to identify possible solutions for healthcare providers in the field related to aging. Conclusion: This review confirms a high variability and an evolution in the approaches defining "polypharmacy" in the absence of a consensus following standardized criteria. That makes it very difficult to estimate and measure the outcomes associated with this phenomenon.

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Section: Description Of Included Reviewsmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

<p>Failure to Reach a Consensus in Polypharmacy Definition: An Obstacle to Measuring Risks and Impacts—Results of a Literature Review</p>

Taghy¹,

Cambon²,

Cohen³

et al. 2020

TCRM

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“…31,32 This type of assessment is critical to conduct ahead of implementing prescribing policies (eg, restricted formularies or limitations on the number of refills) that could interfere with children's access to essential medications and adversely affect the health of children. 34 This limited our ability to (1) determine if medication switching (eg, cetirizine changed to loratadine) versus add-on therapy contributed to increased CM counts and (2) perform analyses of potential drugdrug interactions. Fourth, chronic conditions and CCCs were identified from claims-based diagnosis codes without validation of actual disease, and these classification systems may have a wide range of sensitivity and specificity across different data sources.…”

Section: Clinical Characteristics By Number Of Cmsmentioning

confidence: 99%

Chronic Medication Use in Children Insured by Medicaid: A Multistate Retrospective Cohort Study

et al. 2019

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BACKGROUND AND OBJECTIVES: Little is known about the use of chronic medications (CMs) in children. We assessed the prevalence of CM use in children and the association of clinical characteristics and health care resource use with the number of CMs used. METHODS: This is a retrospective study of children ages 1 to 18 years using Medicaid from 10 states in 2014 grouped by the annual number of CMs (0, 1, 2-4, 5-9, and $10 medications), which are defined as a dispensed $30-day prescription with $2 dispensed refills. Trends in clinical characteristics and health care use by number of CMs were evaluated with the Cochran-Armitage trend test. RESULTS: Of 4 594 061 subjects, 18.8% used CMs. CM use was 44.4% in children with a complex chronic condition. Across all children, the most common CM therapeutic class was neurologic (28.9%). Among CM users, 48.8% used multiple CMs (40.3% used 2-4, 7.0% used 5-9, and 0.5% used $10). The diversity of medications increased with increasing number of CMs: for 1 CM, amphetamine stimulants were most common (29.0%), and for $10 CMs, antiepileptics were most common (7.1%). Of $2.3 billion total pharmacy spending, 59.3% was attributable to children dispensed multiple CMs. Increased CM use (0 to $10 medications) was associated with increased emergency department use (32.1% to 56.2%) and hospitalization (2.3% to 36.7%). CONCLUSIONS: Nearly 1 in 5 children with Medicaid used CMs. Use of multiple CMs was common and correlated with increased health care use. Understanding CM use in children should be fundamentally important to health care systems when strategizing how to provide safe, evidence-based, and cost-effective pharmaceutical care to children. WHAT'S KNOWN ON THIS SUBJECT: Children insured by Medicaid frequently use medications, but little is known specifically about chronic medication (CM) use. Without understanding which children use CMs, it is challenging to plan investigations to determine the appropriateness of current prescription practices. WHAT THIS STUDY ADDS: One in 5 children insured by Medicaid use a CM annually; nearly 1 in 10 used multiple CMs. Central nervous system agents accounted for nearly 30% of all CMs. CMs were positively correlated with health care resource use and spending.

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“…5 Yet, there is a paucity of research in this area, with most of the pediatric literature focusing on the outpatient setting and specific populations, including epilepsy and mental health. [6][7][8] How providers, patients, and families translate medication lists to counts of medications-and hence the burden of polypharmacy-is not clearly or consistently described. Often in studies of polypharmacy, researchers utilize medication claims data to count the number of medications a patient has filled from the pharmacy.…”

mentioning

confidence: 99%

“…9 A recent review of the pediatric polypharmacy literature suggested a lower threshold, with any two concurrent medications for at least a day. 7 Yet, the best approach to "count" medications at hospital discharge is unclear. The simplest method is to tally the number of medications listed in the discharge summary.…”

mentioning

confidence: 99%

Counting the Ways to Count Medications: The Challenges of Defining Pediatric Polypharmacy

Auger

Shah

Davis

et al. 2019

Journal of Hospital Medicine

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Defining pediatric polypharmacy: A scoping review

Cited by 48 publications

References 101 publications

<p>Failure to Reach a Consensus in Polypharmacy Definition: An Obstacle to Measuring Risks and Impacts—Results of a Literature Review</p>

<p>Failure to Reach a Consensus in Polypharmacy Definition: An Obstacle to Measuring Risks and Impacts—Results of a Literature Review</p>

Chronic Medication Use in Children Insured by Medicaid: A Multistate Retrospective Cohort Study

Counting the Ways to Count Medications: The Challenges of Defining Pediatric Polypharmacy

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