PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique.
There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings.



Two-round modified Delphi consensus method.



Irish and UK general practice.



A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel.



47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2).



The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases.
Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
Emma
E
Barry
Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
Kirsty
K
O'Brien
Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
Frank
0000-0001-9838-3625
F
Moriarty
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.
Janine
J
Cooper
Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
Patrick
P
Redmond
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.
Carmel M
CM
Hughes
Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
Kathleen
K
Bennett
Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
Tom
T
Fahey
Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
Susan M
SM
Smith
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007223:Infant; D007494:Ireland; D010372:Pediatrics / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D006113:United Kingdom
Delphi method; children; explicit criteria; potentially inappropriate prescribing; prescribing indicators