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Outcome measures in pediatric polypharmacy research: a scoping review

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Abstract

Introduction

Various methods have been used to interpret the reports of pediatric polypharmacy across the literature. This is the first scoping review that explores outcome measures in pediatric polypharmacy research.

Objectives

The aim of our study was to describe outcome measures assessed in pediatric polypharmacy research.

Methods

A search of electronic databases was conducted in July 2017, including Ovid Medline, PubMed, Elsevier Embase, Wiley Cochrane Central Register of Controlled Trials (CENTRAL), EBSCO CINAHL, Ovid PsycINFO, Web of Science Core Collection, ProQuest Dissertations and Thesis A&I. Data were extracted about study characteristics and outcome measures, and also synthesized by harms or benefits mentioned.

Results

The search strategy initially identified 8169 titles and screened 4398 using the inclusion criteria after de-duplicating. After the primary screening, a total of 363 studies were extracted for the data analysis. Polypharmacy (prevalence) was identified as an outcome in 31.4% of the studies, prognosis-related outcomes in 25.6%, and adverse drug reactions in 16.5%. A total of 265 articles (73.0%) mentioned harms, including adverse drug reactions (26.4%), side effects (24.2%), and drug–drug interactions (20.9%). A total of 83 studies (22.9%) mentioned any benefit, 48.2% of which identified combination for efficacy, 24.1% combination for treatment of complex diseases, and 19.3% combination for treatment augmentation. Thirty-eight studies reported adverse drug reaction as an outcome, where polypharmacy was a predictor, with various designs.

Conclusions

Most studies of pediatric polypharmacy evaluate prevalence, prognosis, or adverse drug reaction-related outcomes, and underscore harms related to polypharmacy. Clinicians should carefully weigh benefits and harms when introducing medications to treatment regimens.

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Acknowledgements

We thank our expert stakeholders whose contribution at different stages of the project improved our research protocol, data quality, interpretation, and reporting: Dr. Joseph Calabrese, Dr. Faye Gary, Dr. Cynthia Fontanella, and Dr. Mai Pham. We are also grateful to Ms. Xuan Ma and Ms. Courtney Baker who conducted a great amount of study screening, data extraction, data cleaning, quality checks, processing, and analysis. This publication was made possible by the Clinical and Translational Science Collaborative Cleveland, KL2TR000440 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health (NIH) and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The funding body was not involved in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Dr. Feinstein was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health, under award number K23HD091295. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. School of Pharmacy, University of Washington, Seattle, Washington, USA

    Negar Golchin

  2. Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA

    Hannah Johnson, Paul M. Bakaki, Neal Dawson, Rujia Liu & Shari D. Bolen

  3. Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA

    Shari D. Bolen

  4. Epilepsy Center/Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA

    Elia M. Pestana Knight

  5. UH Rainbow Center for Child Health and Policy, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA

    Sharon B. Meropol & Lawrence C. Kleinman

  6. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora, CO, USA

    James A. Feinstein

  7. Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA

    Neal Dawson & Shari D. Bolen

  8. Department of Clinical Sciences, University of Louisiana at Monroe College of Pharmacy, Monroe, Louisiana, USA

    Alexis Horace

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  1. Negar Golchin
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Golchin, N., Johnson, H., Bakaki, P.M. et al. Outcome measures in pediatric polypharmacy research: a scoping review. Drugs Ther Perspect 35, 447–458 (2019). https://doi.org/10.1007/s40267-019-00650-8

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