266 - The Challenges of Managing Pediatric Polypharmacy for Children with Medical Complexity in the Primary Care Setting

Poster Number: 266
Publication Number: 266.40

Background: Healthcare providers (HCPs) for children with medical complexity (CMC) often manage pediatric polypharmacy (≥5 medications) without guidance or support. Consequently, complex care programs for CMC identify pharmacist support as a high-priority need. Designing a suitable pharmacist-based intervention to optimize the care and safety of CMC with polypharmacy requires improved understanding of current medication management practices and associated challenges faced by HCPs who manage polypharmacy.

Objective: 1) Describe contemporary medication management responsibilities within a large complex care program 2) Identify patient, clinic, and system-level challenges experienced by HCPs managing pediatric polypharmacy for CMC.

Design/Methods: Exploratory semi-structured interviews with HCPs involved in managing pediatric polypharmacy at a single academic center’s outpatient complex care program serving >5600 CMC annually. Interviews were recorded and transcribed. A thematic content analysis synthesized findings across participants identifying key polypharmacy management domains.

Results: We interviewed 16 HCPs representing both prescribing (n=9; MD, NP, PharmD) and non-prescribing (n=7; RN, MA) providers, most with >10 years in practice. Medication management tasks tend to be role-specific (Table 1). Prescribing providers focus on medication reviews with families to address medication effectiveness, dosing, administration, and side effects. Non-prescribing providers typically communicate with pharmacies, process prior authorizations, and troubleshoot practical medication-related questions and concerns from families. All HCPs described myriad challenges managing polypharmacy at the patient, clinic, and system levels (Table 2). Patient-level challenges include difficulties determining medication effectiveness, supervising drug interactions and side effects, and minimizing caregiver medication burden. At the clinic-level, participants described challenges around medication coordination between multiple prescribing specialists and a lack of centralized comprehensive medication documentation. System-level challenges include substantial time constraints and a medical culture fueling hesitancy toward deprescribing.

Conclusion(s): Considering current processes and challenges, proactive pharmacist involvement may help alleviate some identified challenges, optimize medication effectiveness, and promote safety for CMC with polypharmacy. The design of pharmacist-based interventions to manage pediatric polypharmacy must take a collaborative approach involving families, HCPs, and support staff.