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  • The PIPc Study—application of indicators of potentially inappropriate prescribing in children (PIPc) to a national prescribing database in Ireland: a cross-sectional prevalence study

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General practice / Family practice
Research
The PIPc Study—application of indicators of potentially inappropriate prescribing in children (PIPc) to a national prescribing database in Ireland: a cross-sectional prevalence study
  1. Emma Barry1,
  2. Frank Moriarty1,
  3. Fiona Boland1,
  4. Kathleen Bennett2,
  5. Susan M Smith1
  1. 1 HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2 Division of Population Health Sciences (PHS), Royal College of Surgeons, Dublin, Ireland
  1. Correspondence to Professor Susan M Smith; susansmith{at}rcsi.ie

Abstract

Objectives Evidence is limited regarding the quality of prescribing to children. The objective of this study was to apply a set of explicit prescribing indicators to a national pharmacy claims database (Primary Care Reimbursement Service) to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care.

Primary and secondary outcomes measures To determine the overall prevalence of potentially inappropriate prescribing (PIP) in children in primary care. To examine the prevalence of PIPc by gender.

Design and setting Cross-sectional study. Application of indicators of commission of PIP and omission of appropriate prescribing to a national prescribing database in Ireland.

Participants Eligible children <16 years of age who were prescribed medication in 2014.

Results Overall prevalence of PIPc by commission was 3.5% (95% CI 3.5% to 3.6%) of eligible children <16 years of age who were prescribed medication in 2014. Overall prevalence of PIPc by omission was 2.5% (95% CI 2.5% to 2.6%) which rose to 11.5% (95% CI 11.4% to 11.7%) when prescribing of spacer devices for children with asthma was included. The most common individual PIPc by commission was the prescribing of carbocisteine to children (3.3% of eligible children). The most common PIPc by omission (after excluding spacer devices) was failure to prescribe an emollient to children prescribed greater than one topical corticosteroid (54% of eligible children). PIPc by omission was significantly higher in males compared with females (relative risk (RR) 1.3; 95% CI 1.0 to 1.7) but no different for PIPc by commission (RR 1.0; 95% CI 0.7 to 1.6).

Conclusion This study shows that the overall prevalence of PIP in children is low, although results suggest room for improved adherence to asthma guidelines.

  • potentially inappropriate prescribing
  • children
  • asthma
  • prescribing indicators
  • primary care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022876

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    Footnotes

    • Contributors EB analysed the prevalence data and drafted the manuscript. SMS conceived and supervised the study. KB extracted the prevalence data. FB provided statistical support and FM provided pharmaceutical and academic expertise. All authors reviewed the manuscript.

    • Funding This study was partly funded by the HRB Centre for Primary Care Research, funding grant HRC/2007/1 and formed part of an MSc by Research. KB is funded by the Health Research Board (RL-15-1579).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was approved by the Royal College of Surgeons in Ireland Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Additional data available by request from the corresponding author.