The PIPc study: Development and validation of indicators of potentially inappropriate prescribing in children (PIPc) in primary care
Background: There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle aged adults but few are relevant to children. This thesis outlines the development of a set of prescribing indicators to be applied to be applied to the Primary Care Reimbursement Database (PCRS) to determine the prevalence of potentially inappropriate prescribing (PIP) in children in primary care settings.
Methods: Two round Delphi consensus method: A literature search was conducted to identify published indicators for children (< 16 years). A Project Steering Group reviewed the suitability of the indicators. These criteria underwent a two round Delphi process using an expert panel consisting of general practitioners, pharmacists, paediatricians and clinical pharmacologists from the Republic of Ireland and the United Kingdom. Using a web based questionnaire, 15 panellists were asked to indicate their level of agreement with each indicator via a five point Likert scale to assess applicability to children in the absence of clinical information. Criteria were accepted or rejected or revised based on the panel’s level of agreement using the median response/interquartile range and additional comments. The final set of indicators was applied to the PCRS database for 2014 to determine the prevalence of PIP in children. The association of PIPc and gender were examined. Costs of PIP were calculated Results: The final list consisted of 12 indicators categorized by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2). The most common commission of PIPc was the prescribing of carbocisteine to children (32.7/1000 GMS children). The most common omission of appropriate prescribing was the failure to prescribe a spacer device at least annually for children < 12 years who used a pressurised metered dose inhaler (70% of eligible children).The relative risk of PIPc in males compared to females was statistically significant by indicators of omission (RR 1.3; 95% CI 1.02-1.66) but not by indicators of commission (RR 1.03; 95% CI 0.65-1.62).The costs not incurred or saved due to omissions of appropriate prescribing (€678,816.30) far exceeded the costs incurred by commissions of PIPc in 2014. (€129,255.04) 15
Conclusions: The PIPc indicators are the first set of prescribing criteria developed for use in children in primary care. The prevalence of PIP in GMS eligible children was found to be low.