PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique

Objective 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. Design Two-round modified Delphi consensus method. Setting Irish and UK general practice. Participants 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. Results 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). Conclusions 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.

[1]  Steven J Durning,et al.  Is There a Consensus on Consensus Methodology? Descriptions and Recommendations for Future Consensus Research , 2016, Academic medicine : journal of the Association of American Medical Colleges.

[2]  D. Wouters,et al.  Detection of potentially inappropriate prescribing in the very old: cross-sectional analysis of the data from the BELFRAIL observational cohort study , 2015, BMC Geriatrics.

[3]  T. Fahey,et al.  Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study) , 2015, The Annals of Family Medicine.

[4]  D. Mant,et al.  Primary care quality indicators for children: measuring quality in UK general practice , 2014, The British journal of general practice : the journal of the Royal College of General Practitioners.

[5]  T. Fahey,et al.  The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria , 2014, BMC Health Services Research.

[6]  R. Boulkedid,et al.  POPI (Pediatrics: Omission of Prescriptions and Inappropriate Prescriptions): Development of a Tool to Identify Inappropriate Prescribing , 2014, PloS one.

[7]  S. Straus,et al.  Quality Indicators for High Acuity Pediatric Conditions , 2013, Pediatrics.

[8]  M. Goldacre,et al.  Increase in emergency admissions to hospital for children aged under 15 in England, 1999–2010: national database analysis , 2013, Archives of Disease in Childhood.

[9]  Jennifer Marriott,et al.  A critical analysis of the methods used to develop explicit clinical criteria for use in older people. , 2012, Age and ageing.

[10]  E. Simonoff,et al.  Quality standards for child and adolescent mental health in primary care , 2012, BMC Family Practice.

[11]  C. Mulvaney,et al.  Development of prescribing-safety indicators for GPs using the RAND Appropriateness Method. , 2011, The British journal of general practice : the journal of the Royal College of General Practitioners.

[12]  K. Verhamme,et al.  Drug use in children: cohort study in three European countries , 2008, BMJ : British Medical Journal.

[13]  G. Guyatt,et al.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations , 2008, BMJ : British Medical Journal.

[14]  P. Gallagher,et al.  STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. , 2008, International journal of clinical pharmacology and therapeutics.

[15]  G. Watt,et al.  The Inverse Care Law: Clinical Primary Care Encounters in Deprived and Affluent Areas of Scotland , 2007, The Annals of Family Medicine.

[16]  Elizabeth A McGlynn,et al.  The quality of ambulatory care delivered to children in the United States. , 2007, The New England journal of medicine.

[17]  R. Grol,et al.  Out-of-hours primary care: development of indicators for prescribing and referring. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[18]  Nick Barber,et al.  Appropriate prescribing in elderly people: how well can it be measured and optimised? , 2007, The Lancet.

[19]  Morten Andersen,et al.  Is it possible to measure prescribing quality using only prescription data? , 2006, Basic & clinical pharmacology & toxicology.

[20]  M. D. de Villiers,et al.  The Delphi technique in health sciences education research , 2005, Medical teacher.

[21]  S. Jamieson.  Likert scales: how to (ab)use them , 2004, Medical education.

[22]  S. Nordly,et al.  Quality of diabetes management in children and adolescents in Denmark 1 , 2003, Diabetic medicine : a journal of the British Diabetic Association.

[23]  F. Haaijer-Ruskamp,et al.  Comparison of indicators assessing the quality of drug prescribing for asthma. , 2001, Health services research.

[24]  S. Campbell,et al.  Consensus methods in prescribing research. , 2001, Journal of clinical pharmacy and therapeutics.

[25]  M. Beers,et al.  Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. , 1997, Archives of internal medicine.

[26]  J. Catford.  Quality of prescribing for children in general practice. , 1980, British medical journal.

[27]  K. Hersberger,et al.  Inappropriate prescribing: a systematic overview of published assessment tools , 2013, European Journal of Clinical Pharmacology.

[28]  Penny S. Shelton,et al.  Assessing Medication Appropriateness in the Elderly , 2000, Drugs & aging.