title: Problems with oral formulations prescribed to children: a focus group study of healthcare professionals.
abstract: BACKGROUND
  There is evidence to suggest that adherence with prescribed medication is lower amongst adolescents and children than in adults. Medication adherence rates between 11 and 93 % in paediatric patients have been reported. More research needs to be carried out in order to understand why medicines adherence is low and how adherence can be improved in children with long-term conditions. Personal communication with paediatricians in secondary care has highlighted that problems are most likely to be encountered by parents, carers, nurses and children themselves when administering medicines for prevalent long-term childhood conditions.
  
  
  OBJECTIVE
  To explore problems with oral medicines prescribed to paediatric patients from the perspectives of medical practitioners, pharmacists and nurses. Setting Two NHS trusts in the West Midlands, UK.
  
  
  METHODS
  Four focus groups (FG) were conducted. Five nurses, eight medical practitioners and six pharmacists participated in focus groups. The themes explored were problems experienced when prescribing, dispensing and administering oral medicines for children. Main outcome measure Themes evolving from Healthcare professionals reports on problems with administering medicines to paediatric patients.
  
  
  RESULTS
  Two main themes: sensory and non-sensory emerged from the data. Included within these were taste, texture, colour, smell, size, swallowing, quantity, volume and manipulation with food. Taste was the most commonly reported barrier to medicines administration. Texture was reported to be a significant problem for the learning disability population. Medicines manipulation techniques were revealed across the groups, yet there was limited knowledge regarding the evidence base for such activity. Problems surrounding the supply of Specials medicines were discussed in-depth by the pharmacists.
  
  
  CONCLUSIONS
  Organoleptic and physical properties of medicines are key barriers to medicines administration. A robust scientific evidence-based approach is warranted to inform standardised protocols guiding healthcare professionals to support safe and effective medicines manipulation across all settings. Pharmacists' knowledge of Specials medicines needs to be recognised as a valuable resource for doctors. Findings of this study should help to optimise paediatric prescribing and direct future formulation work.
authors.affiliation: School of Pharmacy, Keele University, Keele, Staffordshire, ST5 5BG, UK. r.h.venables@keele.ac.uk.|Pharmacy and Therapeutics Section, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences (CMDS), Medical School Building, University of Birmingham, Edgbaston, B15 2TT, UK. r.h.venables@keele.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Venables
authors.affiliation: Paediatric Department, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK. heather.stirling@uhcw.nhs.uk.
authors.forename: Heather
authors.initials: H
authors.lastname: Stirling
authors.affiliation: Pharmacy and Therapeutics Section, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences (CMDS), Medical School Building, University of Birmingham, Edgbaston, B15 2TT, UK. h.k.batchelor@bham.ac.uk.
authors.forename: Hannah
authors.initials: H
authors.lastname: Batchelor
authors.affiliation: Pharmacy and Therapeutics Section, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences (CMDS), Medical School Building, University of Birmingham, Edgbaston, B15 2TT, UK. j.f.marriott@bham.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Marriott
mesh_terms: D000284:Administration, Oral; D002626:Chemistry, Pharmaceutical; D002648:Child; D064420:Drug-Related Side Effects and Adverse Reactions; D017144:Focus Groups; D006801:Humans; D055118:Medication Adherence; D009726:Nurses; D010290:Parents; D010372:Pediatrics; D010595:Pharmacists; D012574:Schools; D063127:Secondary Health Care; D012677:Sensation; D013649:Taste; D006113:United Kingdom
keywords: Adherence; Healthcare professionals; Medicines administration; Pediatrics; Prescribing