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Abstract
Background: Resources are available for measuring adult medication use, but similar resources
have not been fully developed for measuring pediatric use. Policy decisions require
an understanding of the population affected, the number of children, their ages, sex,
geographic distribution, race and ethnicity, and insurance status, as well as trends
over time.
Objective: In this article, databases providing information about prescription drugs used in
the United States are reviewed with respect to pediatric populations.
Methods: A series of searches were conducted in MEDLINE using these terms: frequency, prevalence, drug utilization, children, pediatric, drug usage, medications, and prescriptions. Authors of selected articles were interviewed to identify salient issues in the
measurement of pediatric medication use. Preliminary analysis of several databases
followed within the context of government implementation of the Best Pharmaceuticals
for Children Act. This was followed by further MEDLINE searches and synthesis of the
literature.
Results: Databases with information about pediatric population medication use included 7 with
outpatient data and 4 with inpatient data. Outpatient data were available from government
and private sources, but inpatient data were available from private sources only.
Three of the government and 1 of the private databases with outpatient data had sample
sizes of several thousand, too small to allow analysis of frequency trends in pediatric
populations or subpopulations, in which many drugs are used by fewer than 0.01% of
patients.
Conclusions: Sample size needs are greater when measuring pediatric medication use because the
overall level of use is lower among children than adults. Databases resulting from
hospital quality efforts, conglomeration of pharmacy benefit records, and standardization
of state Medicaid records offer opportunities to describe prescription medication
use in samples of several hundred thousand to several million children but will require
dedicated resources.
Key words:
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References
- Drug research and children.FDA Consum. 2003; 37: 12-17
- Testing medications in children.N Engl J Med. 2002; 347: 1462-1470
- Changing requirements for evaluation of pharmacologic agents.Pediatrics. 2004; 113: 1128-1132
- The march toward rational therapeutics in children.Pediatr Infect Dis J. 2003; 22: 1119-1123
- Status of drug approval processes and regulation of medications for children.Curr Opin Pediatr. 1995; 7: 195-198
- Pediatric drug labeling: Improving the safety and efficacy of pediatric therapies.JAMA. 2003; 290: 905-911
- Pediatric pharmaceutical usage—request for comment.Federal Register. 2003; 68: 54912
- Medication therapy in ambulatory medical care: United States, 2003–04.Vital Health Stat. 2006; 13: 1-40
- Are minority children the last to benefit from a new technology? Technology diffusion and inhaled corticosteroids for asthma.Med Care. 2006; 44: 81-86
- Outpatient prescribing practices for nonapproved drugs in children.J Am Osteopath Assoc. 2005; 105: 24
- Treatment modalities among US children diagnosed with attention-deficit hyperactivity disorder: 1995–99.Int Clin Psychopharmacol. 2004; 19: 17-22
- Trends in medication prescribing for pediatric sleep difficulties in US outpatient settings.Sleep. 2007; 30: 1013-1017
- The Top Five Outpatient Prescription Drugs Ranked by Total Expense for Children, Adults, and the Elderly, 2004.Statistical Brief 180. July 2007http://www.meps.ahrq.gov/mepsweb/data_files/publications/st180/stat180.pdf(Accessed)Date: January 20, 2009
National Health and Nutrition Examination Survey. Patterns of Prescription Drug Use in the United States, 1988–94.
- http://www.cdc.gov/nchs/data/nhanes/databriefs/preuse.pdf(Accessed)Date: January 20, 2009
- Frequency of Medication Usage in the Pediatric Population: Detailed Report, Part 1 of 2. National Institute of Child Health and Human Development, Rockville, MD2005 (Contract no. GS-23F-8144H. Task order no. HHSN275200403388C)
- Variations in the use of medication for the treatment of childhood asthma in the Michigan Medicaid population, 1980 to 1986.Chest. 1993; 104: 1727-1732
- Building pharmacoepidemiological capacity to monitor psychotropic drug use among children enrolled in Medicaid.Am J Med Qual. 2000; 15: 126-136
- Trends in the prescribing of psychotropic medications to preschoolers.JAMA. 2000; 283: 1025-1030
- Psychotropic practice patterns for youth: A 10-year perspective.Arch Pediatr Adolesc Med. 2003; 157: 17-25
- Methylphenidate patterns among Medicaid youths.Psychopharmacol Bull. 1997; 33: 143-147
- Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland.J Am Acad Child Adolesc Psychiatry. 1998; 37: 179-184
- The Medicaid Analytic eXtract Chartbook. Centers for Medicare & Medicaid Services,
Baltimore, MD2007http://www.cms.hhs.gov/MedicaidDataSourcesGenInfo/Downloads/MAX_Chartbook_2007.pdf(Accessed)Date: January 20, 2009
- The role of databases in drug postmarketing surveillance.Pharmacoepidemiol Drug Saf. 2001; 10: 407-410
Transcript. Pediatric Subcommittee of the Anti-Infective Drugs Advisory, June 11, 2002.
- http://www.fda.gov/ohrms/dockets/ac/02/transcripts/3870T1.htm(Accessed)Date: January 20, 2009
- Rapid increase in the use of oral antidiabetic drugs in the United States, 1990–2001.Diabetes Care. 2003; 26: 1852-1855
- APS moves ahead on Express Scripts deal.Mod Healthc. 1996; 26: 58
- AmHs, Express Scripts plan partnership to build joint formularies.Healthc Syst Strategy Rep. 1995; 12: 9
- Course of antidepressant treatment with tricyclic versus selective serotonin reuptake inhibitor agents: A comparison in managed care and fee-for-service environments.Am J Manag Care. 1997; 3: 453-465
- The use of claims databases for outcomes research: Rationale, challenges, and strategies.Clin Ther. 1997; 19: 346-366
- Geographic variation in the prevalence of stimulant medication use among children 5 to 14 years old: Results from a commercially insured US sample.Pediatrics. 2003; 111: 237-243
- Gender- and age-related prescription drug use patterns.Ann Pharmacother. 2002; 36: 30-39
- Frequency of Medication Usage in the Pediatric Population: Detailed Report, Part 2 of 2. National Institute of Child Health and Human Development, Rockville, MD2005 (Contract no. GS-23F-8144H. Task order no. HHSN275200403388C)
- BPCA: The Annual Drug Prioritization Process, Presented at: 40th Annual Meeting of the Drug Information AssociationJune 16, 2004 (Washington, DC)
- Psychotherapeutic medication prevalence in Medicaid-insured preschoolers.J Child Adolesc Psychopharmacol. 2007; 17: 195-203
- Trends in use of inhaled corticosteroids for asthma management: 1994–1998.Ann Epidemiol. 2004; 14: 161-167
- Pharmacotherapy of obsessive-compulsive disorder in a health maintenance organization.Am J Health Syst Pharm. 2000; 57: 1972-1978
- Potential medication dosing errors in outpatient pediatrics.J Pediatr. 2005; 147: 761-767
- Off-label drug use in hospitalized children [published correction appears in Arch Pediatr Adolesc Med. 2007;161:655].Arch Pediatr Adolesc Med. 2007; 161: 282-290
- Healthcare Cost and Utilization Project (HCUP).in: HCUP Kids' Inpatient Database (KID). Agency for Healthcare Research and Quality, Rockville, MD2003
- Reported medication use in the neonatal intensive care unit: Data from a large national data set.Pediatrics. 2006; 117: 1979-1987
- Changing patterns of drug utilization in a neonatal intensive care population.Am J Perinatol. 2006; 23: 279-285
- Drug utilization in very premature infants in neonatal intensive care units.Dev Pharmacol Ther. 1991; 17: 167-171
- Variation among neonatal intensive care units in narcotic admin istration.Arch Pediatr Adolesc Med. 1998; 152: 844-851
- Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs.J Perinatol. 2001; 21: 272-278
- The Prevalence of Inpatient Pediatrics Prescribed and Administered Medications. National Institute of Child Health and Human Development, Rockville, MD2005 (Purchase Order # G/L-10148070)
US Dept of Health and Human Services Food and Drug Administration. Guidance for Industry: General Considerations for Pediatric Pharmacokinetic Studies for Drugs and Biological Products.
- http://www.fda.gov/CbER/gdlns/pedphrm.pdf(Accessed)Date: January 20, 2009
Specific Requirements on Content and Format of Labeling for Human Prescription Drugs; Revision of “Pediatric Use” Subsection in the Labeling; Final Rule. 21 CFR §201.
- www.fda.gov/cder/pediatric/pediatric_rule1994.htm(Accessed)Date: January 27, 2009
US Dept of Health and Human Services, Office for Human Research Protections (OHRP). Special Protections for Children as Research Subjects.
- http://www.hhs.govohrp/children(Accessed)Date: January 20, 2009
Guidance for Industry, E11: Clinical Investigation of Medicinal Products in the Pediatric Population. US Dept of Health and Human Services, December 2000.
- http://www.fda.gov/cder/guidance/4099FNL.pdf(Accessed)Date: January 28, 2009
- Criteria supporting the study of drugs in the newborn.Clin Ther. 2006; 28: 1385-1398
- CPT 2007 includes new, revised pediatric codes.AAP News. 2007; 28: 30
- The newborn drug development initiative.Pediatrics. 2006; 117: S1-S8
- Newborns and drug studies: The NICHD/FDA newborn drug development initiative.Clin Ther. 2005; 27: 796-813
- Patterns of drug utilization in a neonatal intensive care unit.J Clin Pharmacol. 2006; 46: 449-455
- Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder.Arch Pediatr Adolesc Med. 1999; 153: 1257-1263
- National trends in concomitant psychotropic medication with stimulants in pediatric visits: Practice versus knowledge.J Atten Disord. 2004; 7: 217-226
- National trends in the outpatient treatment of children and adolescents with antipsychotic drugs.Arch Gen Psychiatry. 2006; 63: 679-685
- 2002–2005 Trends in the prevalence of obesity-related chronic medication use in children, Presented at: American Public Health Association 135th Annual MeetingNovember 3–7, 2007 (Washington, DC)
- Antibiotics and upper respiratory infection: Do some folks think there is a cure for the common cold.J Fam Pract. 1996; 42: 357-361
- Pediatric stimulant and selective serotonin reuptake inhibitor prescription trends: 1992 to 1998.Arch Pediatr Adolesc Med. 2001; 155: 560-565
Meyer J. Age: 2000. Census 2000 Brief.
- http://www.census.gov/prod/2001pubs/c2kbr01-12.pdf(Accessed)Date: January 20, 2009
MEPS-HC Unweighted Sample Sizes by Policy Relevant Groups for 2005.
- http://www.meps.ahrq.gov/mepsweb/survey_comp/hc_sample_policy_group.jsp?year=2005&puf=HC%2D097(Accessed)Date: January 28, 2009
Unweighted Response Rates for NHANES 2003–2004 by Gender and Age.
- http://www.cdc.gov/nchs/data/nhanes/rrt0304mf.pdf(Accessed)Date: January 20, 2009
Agency for Healthcare Research and Quality. Prescribed Drug Estimates: 2005.
- http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/he/drugs/2005/hcdrugest_totexp2005.shtml(Accessed)Date: January 20, 2009
- Trends in Outpatient Prescription Drug Utilization and Expenditures, 1997 and 2004.Statistical Brief 168. April 2007http://www.meps.ahrq.gov/mepsweb/data_files/publications/st168/stat168.pdf(Accessed)Date: January 20, 2009
Article info
Publication history
Accepted:
December 15,
2008
Identification
Copyright
© 2009 Excerpta Medica Inc. All rights reserved. Published by Elsevier Inc.
