Barry Emma, O'Brien Kirsty, Moriarty Frank, Cooper Janine, Redmond Patrick, Hughes Carmel M, Bennett Kathleen, Fahey Tom, Smith Susan M
Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.
BMJ Open. 2016 Sep 6;6(9):e012079. doi: 10.1136/bmjopen-2016-012079.
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. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings.
Two-round modified Delphi consensus method.
Irish and UK general practice.
A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel.
47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2).
The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases.
关于初级保健中儿童处方质量的证据有限。已制定了若干处方标准（指标）来评估老年人和中年人处方的适宜性，但很少有与儿童相关的。本研究的目的是制定一套可应用于处方或配药数据集的处方指标，以确定初级保健环境中儿童潜在不适当处方（PIPc）的发生率。
两轮改良德尔菲共识法。
爱尔兰和英国的全科医疗。
成立了一个由学术和临床全科医生（GP）以及药剂师组成的项目指导小组，以根据文献综述和临床专业知识制定指标清单。来自爱尔兰共和国和英国的15名专家（包括全科医生、药剂师和儿科医生）组成了德尔菲小组。
项目指导小组审查了47项指标，并向德尔菲小组提交了16项。在该活动的第一轮中，就其中9项指标达成了共识。在其余7项指标中，根据专家小组的意见审查和项目指导小组的讨论，删除了2项。德尔菲过程的第二轮集中在其余5项指标上，这些指标根据第一轮反馈进行了修改。第二轮德尔菲过程后接受了3项指标，其余2项指标被删除。最终清单由12项指标组成，按呼吸系统（n = 6）、胃肠道系统（n = 2）、神经系统（n = 2）和皮肤系统（n = 2）分类。
PIPc指标是在缺乏临床信息的情况下为初级保健中的儿童制定的一套处方标准。这些标准的实用性将在使用处方数据库的进一步研究中进行测试。
