Department of Health Sciences (L.K.F., D.G-S., S.J. A.P., J.T.), University of York, York, UK; Martin House Research Centre (L.K.F., D.G-S., S.J., A.P., J.T.), University of York, York, UK.
Department of Health Sciences (L.K.F., D.G-S., S.J. A.P., J.T.), University of York, York, UK; Martin House Research Centre (L.K.F., D.G-S., S.J., A.P., J.T.), University of York, York, UK.
J Pain Symptom Manage. 2022 Sep;64(3):213-221.e1. doi: 10.1016/j.jpainsymman.2022.05.020. Epub 2022 Jun 5.
Polypharmacy is often appropriate for children with life-limiting conditions but is associated with an increase in hospitalizations and inappropriate prescribing, and can affect the quality of life of children and their families as they manage complex medication schedules. Despite this, little is known about polypharmacy in this population.
To describe the prevalence and patterns of polypharmacy in children with a life-limiting condition in a nationally representative cohort in England.
Observational study of children (age 0-19 years) with a life-limiting condition in a national database from 2000 to 2015. Common definitions of polypharmacy were used to determine polypharmacy prevalence in each year based on unique medications and regular medications. Hierarchical regression analyses were used to explore factors associated with polypharmacy.
Data on 15,829 individuals were included. Each year 27%-39% of children were prescribed ≥5 unique medications and 8%-12% were prescribed ≥10. Children with a respiratory (OR 7.6, 95%CI 6.4-9.0), neurological (OR 2.8, 95%CI 2.4-3.2), or metabolic (OR 2.2, 95%CI 1.7-2.8) condition were more likely than those with a congenital condition to experience polypharmacy. Increasing age, being diagnosed with a LLC under one year of age, having >1 life-limiting or chronic condition or living in areas of higher deprivation were also associated with higher prevalence of polypharmacy.
Children with life-limiting conditions have a high prevalence of polypharmacy and some children are at greater risk than others. More research is needed to understand and address the factors that lead to problematic polypharmacy in this population.
对于患有生命有限状况的儿童，多药治疗通常是合适的，但会增加住院率和不适当的处方，并且会影响儿童及其家庭管理复杂的药物治疗计划的生活质量。尽管如此，对于这一人群的多药治疗情况却知之甚少。
描述英格兰全国代表性队列中患有生命有限状况的儿童多药治疗的流行率和模式。
对 2000 年至 2015 年全国数据库中患有生命有限状况的儿童（年龄 0-19 岁）进行观察性研究。使用常见的多药治疗定义，根据独特药物和常规药物来确定每年的多药治疗流行率。采用分层回归分析来探讨与多药治疗相关的因素。
共纳入 15829 名儿童的数据。每年有 27%-39%的儿童被开处≥5 种独特药物，8%-12%的儿童被开处≥10 种药物。患有呼吸系统（OR 7.6，95%CI 6.4-9.0）、神经系统（OR 2.8，95%CI 2.4-3.2）或代谢性（OR 2.2，95%CI 1.7-2.8）疾病的儿童比患有先天性疾病的儿童更有可能经历多药治疗。年龄增长、一岁以下被诊断为 LLC、患有>1 种生命有限或慢性疾病或生活在贫困程度较高的地区也与多药治疗的高流行率相关。
患有生命有限状况的儿童多药治疗的流行率较高，有些儿童比其他儿童面临更大的风险。需要进一步研究以了解和解决导致该人群多药治疗出现问题的因素。
