Rationality of Commercial Oral Multiple-Active Ingredients Medications and Outpatient Prescription Patterns for Children in Taiwan
Date Issued
2010
Date
2010
Author(s)
Chen, Yen-Ju
Abstract
Background
Improving pediatric drug safety and increasing the number of pediatric formulations are important issues all over the world. In Taiwan, there are many multiple- active ingredients medications for children. The appropriate and the utilization of these multiple-active ingredients medications in children are unknown.
Objective
To understand the availability and appropriateness of multiple-active ingredients medications for children as well as their prescribing pattern for pediatric outpatients in Taiwan.
Materials and Methods
The drug database we used was the drug formulary issued by the Bureau of National Health Insurance (NHI) in July, 2009. The outpatient prescriptions were obtained from the longitudinal database and registration datasets from the National Health Insurance Research Database between 2005 and 2008.
The criteria to evaluate the appropriateness of multiple- active ingredients medications for children younger than 12 years include: indications, dosing information of active ingredients for children, unit contents, dosage form, and therapeutic duplications of the active ingredients and dosing ratio. The appropriate for children were divided into those for children younger than 6 y/o and those for children 6-12 y/o. We analyzed the outpatient prescriptions for children younger than 12 y/o which contain at least one multiple- active ingredients medications. The utilization of multiple- active ingredients medications in different clinical setting, medical divisions and diagnosis were analyzed. We used SAS (version 9.1.3 SAS Institute Inc., Cary, NC, U.S.A.) to do multiple regression to explore the influence factors.
Results
Of the NHI formulary, there are 1348 oral multiple- active ingredients medications were included in the study. These included 219 major active ingredients and 23 dosage forms. The percentage of multiple- active ingredients medications appropriateness for children younger than 12 y/o is 23.5% (317), including 21 (1.6%) considered suitable for children without pediatric dosage information. Among them, there were 205 (15.2%) were suitable for children younger than 6 y/o. Only 130 (9.6%) of all the multiple- active ingredients medications met all the criteria of an ideal pediatric. The most common proportion suitable for children were agents for alimentary tract and metabolism (35.5%), antiinfectives (28.0%) and respiratory system (20.6%). Systemic hormonal preparations, excl. Sex hormones and insulins, antineoplastic and immunomodulating agent, and sensory organs had no suitable multiple- active ingredients medications for children.
About 90% of the prescriptions for children younger than 12 y/o were prescribed in primary care clinics, and there were 55%~60% prescriptions contained at least one multiple- active ingredients medications. The major diagnoses for children were diseases of respiratory system. The most often prescribed medications were those used for respiratory system (70%). The utilization of appropriate multiple- active ingredients medications were 11.2% in children younger than 6 y/o, and 10.3% in children between 6 and 12 y/o. Of the multiple- active ingredients prescriptions, 87.4%of drugs for alimentary tract and metabolism were preparations appropriate for children, while only 0.3% prescription of drugs for respiratory system were appropriate.
Conclusions
About 23.5% of multiple- active ingredients medications can be used in children younger than 12 y/o, only 9.6% are ideal pediatric dosage forms. Only 10.3%~11.2% of the multiple- active ingredients medications were preparation suitable for children. In primary care clinics, only 2.2% of the multiple- active ingredients medications prescription ideal pediatric dosage forms. Most children received multiple- active ingredients medications with inappropriate components, doses, or dosage forms, especially drugs for respiratory diseases.
Subjects
Child
National Health Insurance
Outpatients
Prescriptions
Taiwan
Type
thesis
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