Abstract
BackgroundSeveral studies have examined the risk and health outcomes related to polypharmacy among the elderly. However, information regarding polypharmacy among pediatric patients is lacking.ObjectiveThe aim of this study was to investigate the prevalence of polypharmacy and its related factors among the pediatric population of South Korea.MethodsWe 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.ResultsThe 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.ConclusionsOne 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.
Highlights
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 chronic conditions (CCCs), Medical Aid benefits, or a hospital admission history had a significantly higher prevalence of polypharmacy when compared to their counterparts without those conditions
Pediatric patients exposed to polypharmacy showed an increased risk of inappropriate drug use
Summary
Polypharmacy is a common global phenomenon caused by increasing comorbidities [1, 2], and it increases the risk of inappropriate medicine use, drug-drug interactions, and adverse health outcomes [3,4,5]. One study examining pediatric patients from 463 hospitals in the United States (U.S.) found that 10% of children less than one year of age received 11 medications on the first day of admission into a healthcare facility and were cumulatively exposed to 29 medications during 7 days of admission [12]. Another U.S study by Feinstein et al examining polypharmacy among outpatients reported that 35% of pediatric patients (N = 232,240) were exposed to more than two concurrent drugs for at least one day during the one-year observation period [13].
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