Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists
<b>Background/Objectives</b>: Off-label drug use is prevalent in pediatric care, particularly in pediatric palliative care (PPC), due to the scarcity of pediatric-specific formulations and clinical trials. Differences in perception between healthcare professionals regarding off-label pre...
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MDPI AG
2025-01-01
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| Online Access: | https://www.mdpi.com/2227-9067/12/2/124 |
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| author | Daniele Mengato Anna Zanin Fernando Baratiri Lisa Pivato Laura Camuffo Franca Benini Francesca Venturini |
| author_facet | Daniele Mengato Anna Zanin Fernando Baratiri Lisa Pivato Laura Camuffo Franca Benini Francesca Venturini |
| author_sort | Daniele Mengato |
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| description | <b>Background/Objectives</b>: Off-label drug use is prevalent in pediatric care, particularly in pediatric palliative care (PPC), due to the scarcity of pediatric-specific formulations and clinical trials. Differences in perception between healthcare professionals regarding off-label prescriptions underscore the complexity of this practice and highlight the need for improved collaboration to optimize therapeutic outcomes. <b>Methods</b>: A cross-sectional observational study was conducted from August to October 2021 at the PPC center of the University Hospital of Padova, Italy. Data were collected from medical records of 169 patients. Off-label prescriptions were independently assessed by two physicians and two clinical pharmacists using respective reference sources. Discrepancies were resolved through consensus. Statistical analyses included the χ<sup>2</sup>-test for categorical variables and <i>t</i>-tests for continuous data. <b>Results</b>: Among the 993 drug prescriptions analyzed, the pharmacists reported a higher proportion of off-label uses (32.9%) compared to the physicians (18.4%; <i>p</i> < 0.05). After a consensus, 26.5% of the prescriptions were identified as off-label, with 67.9% due to indications, 49.6% due to dosage, and 44.4% due to age discrepancies. <b>Conclusions</b>: This study suggests a high prevalence of off-label prescribing in pediatric palliative care (PPC) and highlights differing professional perspectives, underscoring the potential benefits of exploring standardized protocols and enhanced interdisciplinary collaboration. Enhanced communication between healthcare providers, alongside the development of registries and clinical trials, is essential for improving the safety and efficacy of off-label drug use in pediatric populations. A flexible regulatory framework and customized galenic formulations could further support these goals. |
| format | Article |
| id | doaj-art-4d14c1c99bfb4254a245d31b5ab4aca0 |
| institution | DOAJ |
| issn | 2227-9067 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj-art-4d14c1c99bfb4254a245d31b5ab4aca02025-08-20T03:12:08ZengMDPI AGChildren2227-90672025-01-0112212410.3390/children12020124Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and PharmacistsDaniele Mengato0Anna Zanin1Fernando Baratiri2Lisa Pivato3Laura Camuffo4Franca Benini5Francesca Venturini6Hospital Pharmacy Department, Azienda Ospedale-Università Padova, Via Giustiniani, 35128 Padua, ItalyPalliative Care and Pain Service, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3-35128 Padua, ItalyPalliative Care and Pain Service, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3-35128 Padua, ItalyHospital Pharmacy Department, Azienda Ospedale-Università Padova, Via Giustiniani, 35128 Padua, ItalyHospital Pharmacy Department, Azienda Ospedale-Università Padova, Via Giustiniani, 35128 Padua, ItalyPalliative Care and Pain Service, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3-35128 Padua, ItalyHospital Pharmacy Department, Azienda Ospedale-Università Padova, Via Giustiniani, 35128 Padua, Italy<b>Background/Objectives</b>: Off-label drug use is prevalent in pediatric care, particularly in pediatric palliative care (PPC), due to the scarcity of pediatric-specific formulations and clinical trials. Differences in perception between healthcare professionals regarding off-label prescriptions underscore the complexity of this practice and highlight the need for improved collaboration to optimize therapeutic outcomes. <b>Methods</b>: A cross-sectional observational study was conducted from August to October 2021 at the PPC center of the University Hospital of Padova, Italy. Data were collected from medical records of 169 patients. Off-label prescriptions were independently assessed by two physicians and two clinical pharmacists using respective reference sources. Discrepancies were resolved through consensus. Statistical analyses included the χ<sup>2</sup>-test for categorical variables and <i>t</i>-tests for continuous data. <b>Results</b>: Among the 993 drug prescriptions analyzed, the pharmacists reported a higher proportion of off-label uses (32.9%) compared to the physicians (18.4%; <i>p</i> < 0.05). After a consensus, 26.5% of the prescriptions were identified as off-label, with 67.9% due to indications, 49.6% due to dosage, and 44.4% due to age discrepancies. <b>Conclusions</b>: This study suggests a high prevalence of off-label prescribing in pediatric palliative care (PPC) and highlights differing professional perspectives, underscoring the potential benefits of exploring standardized protocols and enhanced interdisciplinary collaboration. Enhanced communication between healthcare providers, alongside the development of registries and clinical trials, is essential for improving the safety and efficacy of off-label drug use in pediatric populations. A flexible regulatory framework and customized galenic formulations could further support these goals.https://www.mdpi.com/2227-9067/12/2/124off-labelpalliative carepolypharmacypharmacovigilanceregulatory complianceclinical effectiveness |
| spellingShingle | Daniele Mengato Anna Zanin Fernando Baratiri Lisa Pivato Laura Camuffo Franca Benini Francesca Venturini Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists Children off-label palliative care polypharmacy pharmacovigilance regulatory compliance clinical effectiveness |
| title | Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists |
| title_full | Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists |
| title_fullStr | Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists |
| title_full_unstemmed | Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists |
| title_short | Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists |
| title_sort | polypharmacy in pediatric palliative care exploring discrepancies between physicians and pharmacists |
| topic | off-label palliative care polypharmacy pharmacovigilance regulatory compliance clinical effectiveness |
| url | https://www.mdpi.com/2227-9067/12/2/124 |
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