Estimates of pediatric medication use in the United States: current abilities and limitations.

ABSTRACT

BACKGROUND: Resources are available for measuring adult medication use, but similar resources have not been fully developed for measuring pediatric use. Policy decisions require an understanding of the population affected, the number of children, their ages, sex, geographic distribution, race and ethnicity, and insurance status, as well as trends over time. OBJECTIVE: In this article, databases providing information about prescription drugs used in the United States are reviewed with respect to pediatric populations. METHODS: A series of searches were conducted in MEDLINE using these terms frequency, prevalence, drug utilization, children, pediatric, drug usage, medications, and prescriptions. Authors of selected articles were interviewed to identify salient issues in the measurement of pediatric medication use. Preliminary analysis of several databases followed within the context of government implementation of the Best Pharmaceuticals for Children Act. This was followed by further MEDLINE searches and synthesis of the literature. RESULTS: Databases with information about pediatric population medication use included 7 with outpatient data and 4 with inpatient data. Outpatient data were available from government and private sources, but inpatient data were available from private sources only. Three of the government and 1 of the private databases with outpatient data had sample sizes of several thousand, too small to allow analysis of frequency trends in pediatric populations or subpopulations, in which many drugs are used by fewer than 0.01% of patients. CONCLUSIONS: Sample size needs are greater when measuring pediatric medication use because the overall level of use is lower among children than adults. Databases resulting from hospital quality efforts, conglomeration of pharmacy benefit records, and standardization of state Medicaid records offer opportunities to describe prescription medication use in samples of several hundred thousand to several million children but will require dedicated resources.