Challenges of Managing Pediatric Polypharmacy in a Pediatric Complex Care Program: A Qualitative Pilot Study.

Background: Pediatric polypharmacy is often necessary for symptom and disease management in children with medical complexity (CMC) but can result in medication-related problems. Little is known about how pediatric care teams coordinate efforts to manage polypharmacy. This limits the pragmatic design of interventions to comprehensively manage pediatric polypharmacy.

Objectives: In a large outpatient pediatric complex care program for CMC, we sought to understand 1) how pediatric polypharmacy is managed by a multidisciplinary team, 2) associated challenges, and 3) opportunities for improvement.

Methods: We conducted a qualitative pilot study of pediatric clinicians with prescribing and non-prescribing roles. Thematic content analysis was used to synthesize findings across participants and identify key themes.

Results: We interviewed 16 clinicians representing prescribing (n=9) and non-prescribing (n=7) clinicians. Three overarching themes emerged: 1) pediatric polypharmacy poses unique safety risks for CMC; 2) polypharmacy management requires careful collaboration between distinct clinical roles to accomplish numerous medication-related tasks; and 3) multiple prescribers across subspecialties complicates polypharmacy management, including challenges in identifying responsibility for certain medications. Clinicians described myriad challenges across different levels of the healthcare system (patient, clinic, hospital, and system) and endorsed the need for a pediatric pharmacist to help mitigate these challenges.

Conclusion: Interventions to manage pediatric polypharmacy for CMC will require a multi-level approach including the 1) curation of accessible highly centralized medication documentation, 2) delegation of certain medication-related tasks based on clinical expertise, and 3) coordination of medication management activities across healthcare organizations and settings of care. Integrated pediatric pharmacist support could address many of these needs.