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Prescribing patterns of polypharmacy in Korean pediatric patients


Autoři: Soo-Min Jeon aff001;  Susan Park aff001;  Sandy Jeong Rhie aff002;  Jin-Won Kwon aff001
Působiště autorů: College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea aff001;  College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222781

Souhrn

Background

Several studies have examined the risk and health outcomes related to polypharmacy among the elderly. However, information regarding polypharmacy among pediatric patients is lacking.

Objective

The aim of this study was to investigate the prevalence of polypharmacy and its related factors among the pediatric population of South Korea.

Methods

We used national claim data from the Health Insurance Review and Assessment Service—Pediatric Patients Sample (HIRA-PPS) in Korea originating from 2012 through 2016. Polypharmacy was defined as a daily average of two or more drugs used yearly. Complex chronic conditions (CCCs) were examined to evaluate concomitant chronic diseases in pediatric patients. Age-specific contraindications and potential drug-drug interactions were assessed according to criteria established by the Korea Institute of Drug Safety & Risk Management (KIDS). Descriptive statistics and logistic regression were conducted to analyze the status of polypharmacy and its associated risk factors in pediatric patients.

Results

The 5-year prevalence of pediatric polypharmacy in pediatric patients was 3.7%. The prevalence of polypharmacy was much higher in younger pediatric patients: 9.5% for patients between the ages of 1–7 years, 0.9% for ages 6–11 years, and 1.1% for ages 12–19 years. Pediatric patients with CCCs, Medical Aid benefits, or a hospital admission history had a significantly higher prevalence of polypharmacy when compared to their counterparts without those conditions. The most commonly prescribed drugs were respiratory agents (29%) followed by anti-allergic drugs (18.7%), central nervous system agents (15.9%), antibiotics (10.1%), and gastrointestinal drugs (7.7%). There was a positive correlation between the daily average number of inappropriate prescriptions and the degree of polypharmacy, especially in pediatric patients between the ages of 1–7 years. Contraindications and potential drug-drug interactions occurred in 11.0% and 10.1% of patients exposed to polypharmacy, respectively.

Conclusions

One in ten pediatric patients under the age of 7 years was prescribed two or more concurrent drugs on average per day. Furthermore, pediatric patients exposed to polypharmacy showed an increased risk of inappropriate drug use. The implementation of a medication review system that considers pediatric patient polypharmacy exposure would reduce inappropriate drug use and prevent unwanted adverse outcomes.

Klíčová slova:

Antibiotics – Drug metabolism – Drug therapy – Health insurance – Hospitals – Korea – Pediatrics – Drug-drug interactions


Zdroje

1. Burt J, Elmore N, Campbell SM, Rodgers S, Avery AJ, Payne RA. Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study. BMC Med. 2018;16(1):91-. doi: 10.1186/s12916-018-1078-7 29895310.

2. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230-. doi: 10.1186/s12877-017-0621-2 29017448.

3. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57–65. Epub 2013/09/27. doi: 10.1517/14740338.2013.827660 24073682.

4. Frazier SC. Health outcomes and polypharmacy in elderly individuals: an integrated literature review. Journal of gerontological nursing. 2005;31(9):4–11. Epub 2005/09/30. doi: 10.3928/0098-9134-20050901-04 16190007.

5. Fried TR, O'Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc. 2014;62(12):2261–72. doi: 10.1111/jgs.13153 25516023.

6. Morden NE, Goodman D. Pediatric polypharmacy: time to lock the medicine cabinet? Arch Pediatr Adolesc Med. 2012;166(1):91–2. Epub 2011/09/05. doi: 10.1001/archpediatrics.2011.162 21893639.

7. Burns KH, Casey PH, Lyle RE, Bird TM, Fussell JJ, Robbins JM. Increasing prevalence of medically complex children in US hospitals. Pediatrics. 2010;126(4):638–46. Epub 2010/09/22. doi: 10.1542/peds.2009-1658 20855383.

8. Cox ER, Halloran DR, Homan SM, Welliver S, Mager DE. Trends in the prevalence of chronic medication use in children: 2002–2005. Pediatrics. 2008;122(5):e1053–61. Epub 2008/11/04. doi: 10.1542/peds.2008-0214 18977954.

9. Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007–2008. NCHS data brief. 2010;(42):1–8. Epub 2010/09/22. 20854747.

10. Díaz-Caneja CM, Espliego A, Parellada M, Arango C, Moreno C. Polypharmacy with antidepressants in children and adolescents. International Journal of Neuropsychopharmacology. 2014;17(7):1063–82. doi: 10.1017/S1461145712001265 23190624

11. Toteja N, Gallego JA, Saito E, Gerhard T, Winterstein A, Olfson M, et al. Prevalence and correlates of antipsychotic polypharmacy in children and adolescents receiving antipsychotic treatment. The international journal of neuropsychopharmacology. 2014;17(7):1095–105. Epub 2013/05/16. doi: 10.1017/S1461145712001320 23673334.

12. Feudtner C, Dai D, Hexem KR, Luan X, Metjian TA. Prevalence of polypharmacy exposure among hospitalized children in the United States. Arch Pediatr Adolesc Med. 2012;166(1):9–16. Epub 2011/09/07. doi: 10.1001/archpediatrics.2011.161 21893637.

13. Feinstein JA, Feudtner C, Valuck RJ, Kempe A. The depth, duration, and degree of outpatient pediatric polypharmacy in Colorado fee-for-service Medicaid patients. Pharmacoepidemiology and drug safety. 2015;24(10):1049–57. doi: 10.1002/pds.3843 26248529

14. Bakaki PM, Horace A, Dawson N, Winterstein A, Waldron J, Staley J, et al. Defining pediatric polypharmacy: A scoping review. PLOS ONE. 2018;13(11):e0208047. doi: 10.1371/journal.pone.0208047 30496322

15. Lai SW, Lin CH, Liao KF, Su LT, Sung FC, Lin CC. Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatrics & gerontology international. 2012;12(3):491–8. Epub 2012/01/12. doi: 10.1111/j.1447-0594.2011.00800.x 22233227.

16. Park HY, Park JW, Sohn HS, Kwon JW. Association of Parkinsonism or Parkinson Disease with Polypharmacy in the Year Preceding Diagnosis: A Nested Case-Control Study in South Korea. Drug safety. 2017;40(11):1109–18. Epub 2017/06/22. doi: 10.1007/s40264-017-0559-5 28634824.

17. Park HY, Ryu HN, Shim MK, Sohn HS, Kwon JW. Prescribed drugs and polypharmacy in healthcare service users in South Korea: an analysis based on National Health Insurance Claims data. Int J Clin Pharmacol Ther. 2016;54(5):369–77. Epub 2016/03/24. doi: 10.5414/CP202484 27007996.

18. Kim L, Kim J-A, Kim S. A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples. Epidemiology and health. 2014;36:e2014008–e. doi: 10.4178/epih/e2014008 25078381.

19. MFDS. Regulation on Codes for Classification of Drugs and Other Products (MFDS Internal Rule No. 68) 2015. https://www.mfds.go.kr/eng/brd/m_18/view.do?seq=70098&srchFr=&srchTo=&srchWord=&srchTp=&itm_seq_1=0&itm_seq_2=0&multi_itm_seq=0&company_cd=&company_nm=&page=3.

20. Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC pediatrics. 2014;14:199-. doi: 10.1186/1471-2431-14-199 25102958.

21. KIDS. The list of age-related contradictions 2016. https://www.drugsafe.or.kr/iwt/ds/ko/useinfo/EgovDurInfoSerAge.do.

22. KIDS. The list of contraindication of comedication 2016. https://www.drugsafe.or.kr/iwt/ds/ko/useinfo/EgovDurInfoSerJoin.do.

23. KIDS. Introduction of DUR 2016. https://www.drugsafe.or.kr/iwt/ds/en/useinfo/EgovIntroductionDur.do.

24. Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Polypharmacy: Misleading, but manageable. Clinical Interventions in Aging. 2008;3(2):383–9. 18686760

25. Sharma S, Bowman C, Alladin-Karan B, Singh N. Antibiotic prescribing patterns in the pediatric emergency department at Georgetown Public Hospital Corporation: a retrospective chart review. BMC infectious diseases. 2016;16(1):170. doi: 10.1186/s12879-016-1512-4 27094391

26. OECD. Health at a Glance 2017: OECD indicators. OECD, 2017.

27. Tchoe B, Nam S-H. Aging risk and health care expenditure in Korea. Int J Environ Res Public Health. 2010;7(8):3235–54. Epub 2010/08/20. doi: 10.3390/ijerph7083235 20948958.

28. Rui P, Okeyode T. National ambulatory medical care survey: 2016 National Summary Tables. 2016.

29. Hilt RJ, Chaudhari M, Bell JF, Wolf C, Koprowicz K, King BH. Side effects from use of one or more psychiatric medications in a population-based sample of children and adolescents. J Child Adolesc Psychopharmacol. 2014;24(2):83–9. Epub 2014/02/11. doi: 10.1089/cap.2013.0036 24506790.

30. Kearns Gregory L. A-R SM, Alander Sarah W. B DL, Leeder J. Steven K RE. Developmental Pharmacology-Drug Diposition, Action, and Therapy in Infants and Children. The new england journal of medicine. 2003;349:1157–67. doi: 10.1056/NEJMra035092 13679531

31. Bourgeois FT, Shannon MW, Valim C, Mandl KD. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiology and drug safety. 2010;19(9):901–10. Epub 2010/07/14. doi: 10.1002/pds.1984 20623513.

32. Guarino A A F, Ashkenazi S, Gendrel D, Hoekstra JH, Shamir R, Szajewska H ESPGHAN/ESPID Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe Expert Working Group. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: executive summary. Journal of Pediatric Gastroenterology and Nutrition. 2008;46(5):619–21. 18493225

33. Nazarian L.F., Berman J.H., Brown G., Margolis P. Practice parameter: The management of acute gastroenteritis in young children American Academy of Pediatrics. 1996;97:424–35. 8604285

34. Principi N, Esposito S. Antimicrobial stewardship in paediatrics. BMC infectious diseases. 2016;16(1):424. Epub 2016/08/20. doi: 10.1186/s12879-016-1772-z 27538503.

35. Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of Adverse Events With Antibiotic Use in Hospitalized PatientsAdverse Events and Antibiotic Use in Hospitalized PatientsAdverse Events and Antibiotic Use in Hospitalized Patients. JAMA Internal Medicine. 2017;177(9):1308–15. doi: 10.1001/jamainternmed.2017.1938 28604925

36. Comer Jonathan S., Olfson Mark, Mojtabai R. National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996–2007. Journal of the American Academy of Child & Adolscent Psychiatry 2010;49. Epub 2010. Sep. 1. doi: 10.1016/j.jaac.2010.07.007 20855045

37. Comer Jonathan S. O M, Mojtabai Ramin. National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996–2007. Journal of the American Academy of Child and Adolescent Psychiatry. 2010;49(10):1001–10. doi: 10.1016/j.jaac.2010.07.007 20855045

38. Diaz-Caneja CM, Espliego A, Parellada M, Arango C, Moreno C. Polypharmacy with antidepressants in children and adolescents. The international journal of neuropsychopharmacology. 2014;17(7):1063–82. Epub 2012/11/30. doi: 10.1017/S1461145712001265 23190624.

39. Juurlink David N., Mamdani Muhammad, Kopp Alexander, Laupacis Andreas, Redelmeier Donald A. Drug-Drug Interactions Among Elderly Patients Hospitalized for Drug Toxicity. Jama. 2003;289:1652–8. doi: 10.1001/jama.289.13.1652 12672733

40. Doan J, Zakrzewski-Jakubiak H, Roy J, Turgeon J, Tannenbaum C. Prevalence and risk of potential cytochrome P450-mediated drug-drug interactions in older hospitalized patients with polypharmacy. Ann Pharmacother. 2013;47(3):324–32. Epub 2013/03/14. doi: 10.1345/aph.1R621 23482734.


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