Misuse of Pediatric Medications and Parent-Physician Communication: An Interactive Voice Response Intervention

Abstract

Background Children take 1 medication each week on average at home. Better communication between parents and providers could support safer home medication use and prevent misuse of pediatric medications, such as intentional underdosing or overdosing. Our primary objective was to assess the impact of an interactive voice response system on parent-provider communication about medications. Methods Parents of children 4 months to 11 years of age with upcoming well child visits were invited to call our interactive voice response system, called Personal Health Partner (PHP), which asked questions about the child’s health and medication use. Responding parents were randomized to either PHP (interview and counseling) or control (injury prevention survey). Parents’ responses were embedded in the electronic health record. After the physical visit, research assistants performed a phone follow-up survey. Results Of 475 parents, including 293 PHPs and 182 controls, 93% were women. We found a high prevalence of misuse of medications: 14% reported underdosing (n = 63) fever-reducer medications and 3% reported overdosing (n = 13). Twenty percent (n = 37) of the 190 children younger than 3 years had received cold medication. Thirty-three percent (n = 19) of 62 PHP parents of children on prescription medications reported nonadherence. Among children on prescription medications, PHP significantly increased discussion of medications at the physical, but not the number who brought medications to the visit; it had no impact on those not on prescription medications. Conclusions Pediatric medication misuse was common in this study. Use of a previsit interactive voice response system increased medication-related communication during visits and supports the need for systems that better prepare patients for visits and improve medication-related patient-physician communication.

Medication Order Errors at Hospital Admission Among Children With Medical Complexity

“…The most common medication errors that emerged in the current study are similar to, and in some respects diverge from, existing studies. Although MOEs related to dosing and omissions were common in our study and consistent with prior literature on pediatric medication errors, 1,7,35–38 much of the established research presents errors related to short-term medications administered for the treatment of acute illnesses in patients not requiring significant polypharmacy 6,22,39–41 . In contrast, results presented herein illuminate the additional risk to chronically ill children posed by the ongoing use of many, concurrent home medications required to be administered throughout their hospitalization.…”

“…Although MOEs related to dosing and omissions were common in our study and consistent with prior literature on pediatric medication errors, 1,7,[35][36][37][38] much of the established research presents errors related to short-term medications administered for the treatment of acute illnesses in patients not requiring significant polypharmacy. 6,22,[39][40][41] In contrast, results presented herein illuminate the additional risk to chronically ill children posed by the ongoing use of many, concurrent home medications required to be administered throughout their hospitalization. Failure to proactively identify and correct MOEs stemming from these home medications can potentially lead to exacerbations of CMC's underlying chronic conditions.…”

“…Reviewing routine home medications and paying particular attention to identifying omitted medications should be a focus of medication reconciliation for CMC. 40,45 In our clinical practice, we have observed admitting physicians omit certain home medications, such as baclofen, without discussion or clinical context because of incorrect perceptions that they are peripheral and nonessential for continued administration during hospitalization. This study did not evaluate clinician perceptions of medication importance, but issues like these have been shown to contribute to medication errors in hospitalized individuals with polypharmacy 27,[46][47][48] and warrant further investigation about how they influence MOEs for CMC.…”

“…Reviewing routine home medications and paying particular attention to identifying omitted medications should be a focus of medication reconciliation for CMC 40,45 . In our clinical practice, we have observed admitting physicians omit certain home medications, such as baclofen, without discussion or clinical context because of incorrect perceptions that they are peripheral and nonessential for continued administration during hospitalization.…”

Family role in paediatric safety incidents: a retrospective study protocol

“…Families have the potential to play key roles in the nature of unsafe care. For example, studies from the USA and UK highlight that medication errors in the community setting, such as accidentally administering the wrong dose of a drug, often involve parents 6 8–10. Conversely, parents are well placed to detect errors due to their continuous presence, overview of any care received, and extensive knowledge of the child’s diagnoses and management plans 6–8 11.…”