200 Polypharmacy in children and young people with life-limiting conditions: an observational cohort study in England

Background/Aims Polypharmacy, which refers to taking several medications concurrently, is often appropriate for children and young people (CYP) with life-limiting conditions (LLCs) but can increase the risk of drug-drug and drug-disease interactions, medication errors and non-adherence, and cause unnecessary burden for families as they manage complex medication schedules. Despite this, little is known about polypharmacy in this population. This study aims to determine the prevalence of polypharmacy in CYP with LLCs. Methods An observational cohort study of all CYP (age 0–19 years) with a diagnosed LLC in the Clinical Practice Research Datalink (primary care dataset in England) from 2000 to 2015 (n=15,630). Unique prescriptions were identified and common definitions of polypharmacy were used to determine the prevalence in each year for all medications and for regular medications (those with at least 3 prescriptions in a 12 month period). Regression analyses were used to explore factors associated with an increased risk of polypharmacy. Results In each year, approximately 30% of CYP were prescribed at least 5 unique medications, and 10% were prescribed at least 10 (medium annual average=2, range=0–52). When limiting polypharmacy to regular medications, 29% were prescribed at least 2 medications per year, and 14% were prescribed at least 4. Children with a primary respiratory, neurological, metabolic or circulatory diagnosis were at the greatest risk of polypharmacy. Having a second LLC or other co-morbidity were also risk factors. The proportion of children exposed to polypharmacy remained similar throughout the study period. Conclusion This ongoing study shows that CYP with LLCs are exposed to high rates of polypharmacy. Workshops with families and clinicians held as part of the study revealed that primary care data are likely to underestimate polypharmacy in this population, and allow for limited exploration of important factors that influence their exposure to inappropriate polypharmacy.