Tools for Identifying Potentially Inappropriate Prescriptions for Children and Their Applicability in Clinical Practices: A Systematic Review

Li, Siyu; Huang, Liang; Chen, Zhe; Zeng, Linan; Li, Hailong; Diao, Sha; Jia, Zhijun; Cheng, Guo; Yu, Qin; Zhang, Lingli

doi:10.3389/fphar.2022.787113

Cited by 7 publications

(7 citation statements)

References 36 publications

(41 reference statements)

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“…A manual search of reference lists did not yield any additional relevant publications. Ultimately, 23 records, including 15 systematic reviews 12,[14][15][16][17][18][19][34][35][36][37][38][39][40][41] and eight guidelines, [42][43][44][45][46][47][48][49] were included in this review (Figure 1). The detailed characteristics of these systematic reviews and guidelines can be found in Tables 1 and 2, respectively.…”

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review

Anlay,

Paque,

Van Leeuwen

et al. 2023

Brit J Clinical Pharma

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AIMSThe aim of this umbrella review was to identify tools and guidelines to aid the deprescribing process of potentially inappropriate medications (PIM), evaluate development and validation methods, and describe evidence levels for medication inclusion.METHODSSearches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection, and guideline databases from the date of inception to July 7, 2022 and checked for updated tools on July 17, 2023. We analysed the contents of tools and guidelines.RESULTSFrom 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed, 11 implicit) and 9 guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children <18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high‐quality evidence.CONCLUSIONTools are available for a diversity of populations. There were discrepancies with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low‐quality evidence. Particularly, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is highly needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.

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Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review

Anlay,

Paque,

Van Leeuwen

et al. 2023

Brit J Clinical Pharma

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“…Unfortunately, the development and research of PIP detection tools for children are insufficient and limited. 19 …”

Section: Introductionmentioning

confidence: 99%

“…Prescribing appropriate medication prescription is the basis for optimising children’s medical and health services and reducing ADRs. Unfortunately, the development and research of PIP detection tools for children are insufficient and limited 19…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate prescribing in hospitalised children: a retrospective, cross-sectional study at a tertiary children’s hospital in China

Huang

Zeng

et al. 2023

BMJ Open

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IntroductionFor improving and optimising drug use in children, we previously developed a tool (including a series of criteria for identifying potentially inappropriate prescribing in children) by literature review and the two-round Delphi technique to prevent inappropriate medication prescriptions at the prescribing stage.ObjectiveTo assess the prevalence of potentially inappropriate prescription (PIP) among hospitalised children and explore risk factors associated with PIP.DesignA retrospective cross-sectional study.SettingA tertiary children’s hospital in China.ParticipantsHospitalised children with complete medical records who received drug treatment and discharged from 1 January to 31 December 2021.Outcome measuresWe evaluated the medication prescriptions by using a series of previously developed criteria for detecting the prevalence of PIP in hospitalised children and used logistic regression to explore the risk factors (including sex, age, number of drugs, number of comorbidities, days of hospitalisation and admission departments) for PIP in children.ResultsA total of 87 555 medication prescriptions for 16 995 hospitalised children were analysed, and 19 722 PIPs were detected. The prevalence of PIP was 22.53%, and 36.92% of the children had at least one PIP during hospitalisation. The department with the highest prevalence of PIP was the surgical department (OR 9.413; 95% CI 5.521 to 16.046), followed by the paediatric intensive care unit (PICU; OR 8.206; 95% CI 6.643 to 10.137). ‘Inhaled corticosteroids for children with respiratory infections but without chronic respiratory diseases’ was the most frequent PIP. Logistic regression results showed that PIP was more likely to occur in male patients (OR 1.128, 95% CI 1.059 to 1.202) and younger patients (<2 years old; OR 1.974; 95% CI 1.739 to 2.241), and in those with more comorbidities (≥11 types; OR 4.181; 95% CI 3.671 to 4.761), concomitant drugs (≥11 types; OR 22.250; 95% CI 14.468 to 34.223) or longer hospital stay (≥30 days; OR 8.130; 95% CI 6.727 to 9.827).ConclusionsMedications for long-term hospitalised young children with multiple comorbidities should be minimised and optimised, to avoid PIP, reduce adverse drug reactions and ensure children’s medication safety. The surgery department and PICU had a high prevalence of PIP in the studied hospital and should be the focus of supervision and management in routine prescription review.

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“…In the pediatric population, the incidence of ADRs in inpatients is 9.53% and in outpatients is 1.46%; and the incidence of ADRs leading to hospital admission in children is 2.09% ( Impicciatore et al, 2001 ). Unlike the elderly, the development of explicit PIP criteria for children is in its infancy, and there are only five PIP criteria for children ( Prot-Labarthe et al, 2011 ; Barry et al, 2016 ; Corrick et al, 2019 ; Meyers et al, 2020 ; Sadozai et al, 2020 ; Li et al, 2022 ). Experts in France were the first to develop the PIP criteria for children.…”

Section: Introductionmentioning

confidence: 99%

“…They released the POPI criteria (Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions) in 2011 ( Prot-Labarthe et al, 2011 ), then the United Kingdom ( Barry et al, 2016 ; Corrick et al, 2019 ) and the US ( Meyers et al, 2020 ) successively released their PIP criteria for children. We previously conducted a comprehensive systematic review on existing tools for identifying PIPs in children and their applicability in clinical practices ( Li et al, 2022 ) and regrettably found that China has not yet developed a tool for detecting PIPs in children based on its actual clinical practice.…”

Section: Introductionmentioning

confidence: 99%

A tool for screening potentially inappropriate prescribing in Chinese children

Huang²,

Zeng³

et al. 2022

Front. Pharmacol.

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Background: More than half of adverse drug events in pediatric patients are avoidable and blocking medication errors at the prescribing stage might be one of the most effective preventive measures.Objective: To form a tool (a series of criteria) for detecting potentially inappropriate prescriptions in children, promote clinical rational drug use and reduce risks of medication in children.Methods: Potentially inappropriate prescription propositions for children were collected through a systematic review. Then, the Delphi technique was adopted to form the final criteria. Panelists were asked to use a 5-point Likert scale to rate their agreement with each potentially inappropriate prescription proposition and were encouraged to add new propositions based on their clinical experience and knowledge. After 2 rounds of Delphi survey and propositions were fully revised and improved, the final criteria for identifying potentially inappropriate prescriptions in children were formed.Results: The final criteria for identifying potential inappropriate prescriptions in children has 136 propositions, which were divided into “criteria for children with non-specific diseases/conditions” (71 propositions: 68 for potentially inappropriate medication, 3 for potential prescribing omission) and “criteria for children with specific diseases/conditions” (65 propositions: 55 for potentially inappropriate medication, 10 for potential prescribing omission), according to whether the proposition was about identifying specific risks associated with one drug in children with a specific other diseases/conditions that do not exist in children with other diseases/conditions.Conclusion: A tool for screening potentially inappropriate prescriptions in children is formed to detect potentially inappropriate medication and prescribing omission in pediatrics and is available to all medical professionals liable to prescribe or dispense medicines to children.

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Tools for Identifying Potentially Inappropriate Prescriptions for Children and Their Applicability in Clinical Practices: A Systematic Review

Cited by 7 publications

References 36 publications

Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review

Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review

Potentially inappropriate prescribing in hospitalised children: a retrospective, cross-sectional study at a tertiary children’s hospital in China

A tool for screening potentially inappropriate prescribing in Chinese children

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