Ewig Celeste L Y, Wong Kai Sang, Chan Pak Hei, Leung Ting Fan, Cheung Yin Ting
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida (CE).
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong (KSW, PHC, YTC).
J Pediatr Pharmacol Ther. 2022;27(6):537-544. doi: 10.5863/1551-6776-27.6.537. Epub 2022 Aug 19.
This study aimed to determine the prevalence and predictors of chronic polypharmacy among pediatric patients in an outpatient setting.
We conducted a review of medications dispensed to patients from an outpatient pediatric facility during a 12-month period. Patients who received chronic medications (≥30 days' supply), which contained at least 1 active pharmaceutical ingredient were included in the study. Descriptive analysis was used to determine prevalence of polypharmacy while predictive factors for polypharmacy were evaluated using logistic regression.
Our study included 3920 patients (median age, 9.9 years; IQR, 9.4) and 16,401 medications. The median number of chronic medications used among our study cohort was 2.0 (IQR, 1) with polypharmacy identified in 309 (7.9%) patients. Predictors for polypharmacy were age and the use of certain therapeutic class of medications. Patients 12 to <19 years old (OR, 6.95; 95% CI, 4.1-10.1) were more likely to require ≥5 concurrent medications compared with patients younger than 2 years of age. Use of calcium supplements (OR, 21.2; 95% CI, 11.3-39.6), Vitamin D analogues (OR, 14.3; 95% CI, 8.0-25.8), and systemic glucocorticoids (OR, 18.8; 95% CI, 10.7-33.2) were also highly associated with polypharmacy.
Adolescents and children with chronic medical conditions who require prolonged systemic glucocorticoids, calcium, and Vitamin D supplements are at higher risk of incurring long-term polypharmacy. This subgroup of pediatric patients may be more vulnerable to the occurrence of negative outcomes resulting from the use of multiple chronic medications.
本研究旨在确定门诊儿科患者中慢性多重用药的患病率及预测因素。
我们对一家门诊儿科机构在12个月期间发放给患者的药物进行了回顾。接受慢性药物治疗（供应≥30天）且包含至少1种活性药物成分的患者纳入本研究。采用描述性分析确定多重用药的患病率，同时使用逻辑回归评估多重用药的预测因素。
我们的研究纳入了3920名患者（中位年龄9.9岁；四分位距9.4）和16401种药物。我们研究队列中使用的慢性药物中位数为2.0（四分位距1），309名（7.9%）患者被确定为多重用药。多重用药的预测因素为年龄和某些治疗类别的药物使用情况。与2岁以下患者相比，12至<19岁的患者（比值比，6.95；95%置信区间，4.1 - 10.1）更有可能需要同时使用≥5种药物。使用钙补充剂（比值比，21.2；95%置信区间，11.3 - 39.6）、维生素D类似物（比值比，14.3；95%置信区间，8.0 - 25.8）和全身糖皮质激素（比值比，18.8；95%置信区间，10.7 - 33.2）也与多重用药高度相关。
需要长期使用全身糖皮质激素、钙和维生素D补充剂的患有慢性疾病的青少年和儿童发生长期多重用药的风险更高。这一亚组儿科患者可能更容易受到使用多种慢性药物导致的负面结果的影响。
