Asia N. Rashed

Aims: Polypharmacy exists in children and young people (CYP), generating clinician concern and a desire to deprescribe. This study validated and applied a questionnaire to assess the attitudes of CYP and their parents/guardians towards polypharmacy and deprescribing. Methods: A paediatric version of the Revised Patient Attitudes Towards Deprescribing (rPATD) was developed—the Child and Parent Attitudes Towards Deprescribing (CHATD) questionnaire. Validation included: Content evaluation, face validity, factor analysis, internal reliability and test re‐test reliability. Participants were prospectively recruited from three UK paediatric hospitals. The questionnaire comprised two global questions and four factors concerning participants medications: burden, appropriateness, concerns about stopping and involvement. Responses were recorded on a 5‐point Likert scale (1 = strongly disagree to 5 = strongly agree ; appropriateness reverse scored). Results: A total of 216 responses were analysed (149 parents, 67 CYP). Factor analysis supported the four‐factor structure, with good internal reliability (McDonald's ω _t ≥ 0.7) and test–retest reliability (all ICCs >0.75). Compared with parents, CYP reported greater medication burden (3.0 vs. 2.4, p = .003), lower perceived appropriateness (3.6 vs. 4.2, p = .008) and less involvement (3.8 vs. 4.8, p < .001). Most parents (70%) and 55% of CYPs were happy to have a medication deprescribed if the doctor agreed. Among CYP, higher appropriateness scores were associated with greater satisfaction with current medications (OR 9.34, 95% CI 3.39–25.77) and lower willingness to stop a medicine (OR 0.21, 95% CI 0.09–0.48). Conclusions: CHATD is a valid, reliable tool for assessing deprescribing attitudes among CYP and parents. Most respondents were willing to consider deprescribing under medical guidance.

Aim Polypharmacy exists in children and young people (CYP), generates clinician concern and a desire to undertake deprescribing, tempered by concerns about parental acceptability. The aim of this study was to validate and apply a questionnaire to assess the attitudes of CYP and their parents/guardians towards polypharmacy and deprescribing. Methods A paediatric version of the Revised Patient Attitudes Towards Deprescribing (rPATD) was developed – the Child and Parent Attitudes Towards Deprescribing (CHATD) questionnaire. Validation steps included: Content evaluation panel, face validity (piloting), factor analysis, internal reliability and test re-test reliability. Participants were prospectively recruited from three UK paediatric hospitals. The questionnaire includes two global questions and four factors concerning participants medications: burden, appropriateness, concerns about stopping, and involvement. Results 216 participant responses were analysed (149 parents, 67 CYP). Factor analysis showed the CHATD questionnaire aligned well with the underlying structure of the rPATD with good internal reliability and test-retest reliability. In comparison to their parents, CYP felt their medications were more burdensome (3.0 vs 2.4, p=0.003), less appropriate (3.6 vs 4.2 p=0.008) and wanted and experienced less involvement (3.8 vs 4.8 p<0.001). Most parents (70%) and 55% of CYPs were happy to have a medication deprescribed if the doctor agreed. Conclusions The CHATD questionnaire is a valid, reliable tool for assessing deprescribing attitudes among children, young people, and parents. Whilst CYP and their parents showed some concern over the stopping of their medications, most parents and CYP were willing to have a medication deprescribed under the guidance of their doctor.

Objectives: Previous studies have highlighted inconsistencies in dosage instructions on dispensed medicine labels, increasing the risk of medication errors. This challenge is especially relevant in paediatrics, where instructions often convey more complex numerical values and use of measuring devices. This study aimed to investigate parents’ and carers’ preferences and understanding of dosage instructions on dispensed paediatric medicine labels. Methods: An anonymous, paper-based, self-administered 9-item survey was conducted at 14 hospitals in England in 2024. Each hospital received 25 questionnaires, which were distributed to a convenience sample of parents and carers for completion during their child’s hospital visit. Participants’ socio-demographic and educational characteristics were collected. The study was approved as a quality improvement project; ethical approval was not required. Key findings: Two hundred and fifty respondents (71.4% response rate) from 12 hospitals were included in the analysis. 72.8% (150/206) of respondents without a healthcare background preferred millilitre (ml) alone for expressing oral liquid medication doses, compared to 46.9% (15/32) of those with healthcare backgrounds (P = 0.004). A greater proportion of non-healthcare respondents preferred the numerical format ‘1 tablet’ over the word form ‘one tablet’ (121/203 vs 11/33, P = 0.005). Overall, the proportion of respondents who correctly interpreted oral liquid medication doses expressed as ‘…ml’, ‘…ml (…mg)’ and ‘…mg (…ml)’ was 98.8%, 96.3%, and 74.5%, respectively (P < 0.05 for all pairwise comparisons). Conclusions: This study provides important insights, showing that parents and carers prefer simpler wording for dosage instructions and that the measurement unit in which doses are expressed can hinder comprehension.

The Paediatric Use Marketing Authorisation (PUMA) was introduced in the European Union to incentivise the development of off-patent medicines in children. However, there is limited data on the accessibility of PUMA products at the healthcare provider level. This study aimed to identify factors affecting real-world accessibility to PUMA products in the United Kingdom (UK). Inductive thematic analyses of the archives of the Neonatal and Paediatric Pharmacy Group (NPPG) online forum were conducted. A web-based survey was also distributed to NPPG members in September 2022 regarding the availability of PUMA products in their organisations. Thematic analysis generated five themes: authorisation, availability, affordability, appropriateness and acceptability. Restricted scope of the product’s marketing authorisation, market access variation, higher cost of PUMA products, product appropriateness and patient acceptability were reasons for continued off-label use and use of unlicensed products in clinical practice. Conclusion: Despite targeted legislative efforts to bring off-label uses in children into authorised use, this study provides evidence that authorisation alone does not equate to market availability, which in turn does not guarantee patient access. The study findings also suggest that cost pressure drives local procurement decisions and overshadows the long-standing problems associated with off-label use and manipulation of medicines in children. What is already known about this subject• The Paediatric Use Marketing Authorisation (PUMA) was introduced in the European Union (applied to the UK at the time) to incentivise the development of off-patient medicines exclusively for use in the paediatric population. • It is widely acknowledged that the PUMA concept has not achieved its intended goal, as evidenced by the few products authorised through this route. What this study adds• This study shows inequalities in children's access to PUMA products in the UK.• Determinants impeding patient access to child-appropriate paediatric medicines can be categorised into five dimensions: authorisation, availability, affordability, appropriateness, and acceptability.

Introduction A recent survey of healthcare professionals found that healthcare professionals concerns about patient and family anxiety was the main barrier to deprescribing. However, the attitudes of families, children and young people (CYP) have not previously been sought. Methods A questionnaire was designed to assess the attitudes of CYP and their parents towards polypharmacy and deprescribing based on a previously validated adult questionnaire (rPATD). Initial review and modification took place following input from a young person patient and public involvement group and a content evaluation panel of experts. Ethics approval was obtained, and a maximum of 22 participants (10% of the total study population) were to be recruited for the pilot. Inclusion criteria were CYP taking >2 for 28 days or more. The questionnaire was completed online using Microsoft Forms. Descriptive analysis was undertaken. Results Twenty participants completed the piloting process (12 parents, 5 CYP aged 10–15 years and 3 CYP aged 16–17 years), as saturation was achieved. The mean number of medicines taken was six. Most parents (67%) thought their children were taking many medicines, whereas only 38% of CYP agreed with this. Only one CYP in the 10–15yrs stated they wanted to be involved in decisions about their medicines, whereas all of the CYP in the 16–17yrs cohort, and 92% of parents, said they liked to be involved. Overall, 83% of parents and 63% of CYP stated they would like to try stopping one of their medicines if it was advised by a doctor. Conclusions The pilot data would suggest that CYP and their parents would be happy to consider stopping one of their medicines if advised to do so but data from the full study, which is currently recruiting, and statistically powered is awaited.

Introduction Paediatric polypharmacy is defined as two or more medicines, which is lower than the definition in adults (>5 medicines). A recent scoping review of paediatric polypharmacy found a mean prevalence of 39.7% with a large range from 0.9% to 98.4%. Methods Prescribing data from 85 active practices across Liverpool Clinical Commissioning Group (CCG), was extracted on the 6th January 2021 to include all patients below 18 years of age. Prescribing data was also obtained for Alder Hey Children’s Hospital from the electronic prescribing system, Meditech on the 12th January 2021. Descriptive analysis was performed. Results Of the 110,097 CYP registered in primary care, 17,271 (16%) were prescribed >2 medications, 3,507 (3·2%) >5, 715 (0·7%) ≥10, and 202 (0·2%) ≥15. The median number of CYP prescribed ≥10 and ≥15 medications per primary care practice was 7 (range 0–34) and 2 (range 0–11), respectively. Within Alder Hey Children’s Hospital, 139 inpatients were identified, with 126 patients (91%) prescribed two or more medicines. The most frequently prescribed medicine was paracetamol. When ‘as required’ and ‘one off’ medicines were removed, omeprazole was the most frequently prescribed medicine. Conclusions Many children within Liverpool CCG meet the definition for paediatric polypharmacy. Further research is required to assess the consequences of paediatric polypharmacy and address its management which is under recognised and underrepresented in the literature to date.

Little is known about the reason behind the underutilisation of community pharmacy (CP) for children. This study explored the experiences, barriers and recommendations of parents/carers and young people regarding their use of CP services for children. Two-stage facilitated, structured, audio-recorded interviews were conducted at each of four CPs in London, England, between May and November 2019 [1 month in each CP]. Parents/carers or young persons (aged 16-18 years) who visited CP for a child-related matter were invited to participate. Interviews were transcribed verbatim. Data were analysed both quantitatively and qualitatively, using thematic analysis to identify themes. In total, 249 (58.2% of 428 eligible) customers agreed to participate and completed the two interviews. Out of these, 82.3% (205/249) reported positive experiences with the CP. The general practitioner (GP) was the preferred healthcare provider for minor ailments (44.6%,111/249), while 35.7% (89/249) would choose CP. Eighty-two participants (33%) visited an Emergency Department in the last 12 months, with 13.4% (11/82) of them visited for cold and cough reasons. Where a child was present with parents/carer (128/249), there was a low level of interaction between children and pharmacists (13.3%, 17/128). Lack of awareness about the CP services provided for children and privacy were among the barriers identified by participants. Advertising of CP services and creating a child-friendly environment were recommendations suggested by participants. The findings of this paper show that CP remains an underutilised health service for children by parents/carers and young persons. More work is needed to increase public awareness of the roles of CP in children's health and well-being.

An overview of melatonin prescribing trends and variation in England is described in this study. Prescription reimbursement data for melatonin in England were extracted from publicly available primary care datasets between 2008–2019. Melatonin prescribing rates, cost and product license status were described over time. Potential factors associated with melatonin prescribing were investigated using Poisson regression. Melatonin prescribing increased from 2.0 to 19.9 per 1000 people between 2008 and 2019. While prescriptions for licensed products increased from 6.5% to 88.2%, spending on unlicensed products was £10 million and accounted for 23.3% of the total prescription cost in 2019. Practices with a higher proportion of children and older people and those serving more deprived patient populations were associated with a higher rate of prescribing (rate ratio = 1.51, 1.66 and 1.59, respectively). Melatonin prescribing in England has increased exponentially over the last decade, with substantial spending on unlicensed products of unknown quality. Patient‐level analysis research is needed.