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P19 To what extent are paediatric patients accounted for in primary care formularies?
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  1. Alice McCloskey1,
  2. Kate Shemilt1,
  3. Octavio Aragon Cuevas2,
  4. Fahmida Reemi1,
  5. Holly Brace3,
  6. Lydia Aspinall1,
  7. Mariam Obaide1,
  8. Milad Cheraghi1,
  9. Mollie Pidduck1,
  10. Adam Rathbone3
  1. 1Liverpool John Moores University
  2. 2Alder Hey Children’s NHS Foundation Trust, Liverpool
  3. 3Newcastle University

Abstract

Aim Drug formularies should provide evidence-based information and guidance on safe and effective medication use. Formulary contents can have interregional variability,1 potentially leading to health inequalities, poorer patient outcomes and low prescribing confidence.2 We explored the contents of several primary care formularies in the North West (NW) and North East (NE) of England, North Wales (NWS), and Northern Ireland (NI) to determine if paediatric primary care access to medicines across these areas is equitable.

Method A documentation review of 9 primary care formularies was conducted NI, (Pan Mersey (PM), Cheshire (Ch), Lancashire & South Cumbria (LSC), NWS, Greater Manchester (GM), South Tyneside & Sunderland (STS), County Durham & Tees valley (CDTV), North of Tyne, Gateshead, & North Cumbria (NTGNC)). Drugs from the first six chapters of the British National Formulary for Children (BNFc) (2021) were analysed against their respective formulary entries. Data was collected in MSExcel and captured available working links to the BNF/BNFc/Summary of Product Characteristics, Red Amber Green (RAG) status, clear indication/s, paediatric inclusion statement/s, strength, formulation, and relevant supporting evidence. A scoring system for the quality of paediatric information (QuPI) was created, piloted and applied to the dataset (this ranged from 0-lowest quality/no entry to 5-best quality). Mean QuPI score and percentage RAG statuses were calculated for each formulary.

Results Overall, 383 medicines were recorded: 57 (15%) gastrointestinal, 136 (36%) infection, 51 (13%) cardiovascular, 47 (12%) respiratory, 60 (16%) central nervous system, and 32 (8%) endocrine.

The average QuPI rating of all formularies was 1.35. The highest scoring formulary was PM (mean = 2.37) and the lowest LSC (mean = 0.36).

LSC and GM had the highest number of medicines missing in comparison to the BNFc (76% and 45% respectively). Of the entries recorded in the NI formulary, 75% did not suggest a RAG category.

The NE formularies and Ch included a larger proportion of medicines within the ‘green’ RAG category (NTGNC- 67%, CDTV – 59%, STS- 50%, Ch-52%).

PM and LSC included the highest percentage of drugs listed in the amber/green+ category (58% and 44%). GM, NWS and CDTV had the highest percentage of drugs listed in the red category.

Conclusion QuPI scores were low overall. Support for clinicians in primary and secondary care to facilitate smooth continuity of care was poorest in NI, LSC and GM, with their formularies either not listing drugs or not stating their RAG category. PM and LSC had the highest percentage of amber medicines meaning that in these areas effective collaboration and communication between secondary and primary care providers is paramount. This study shows there is a lack of standardisation in formularies with striking differences most notable in NI, GM and LSC. The findings highlight that paediatric primary care medicines access is inconsistent potentially widening health inequalities. Further work is required to determine the true impact of these findings.

References

  1. Reynolds D, Fajemisin O, Wilds S. Local formularies. Br J Clin Pharmacol 2012;74:640–643. Available from: https://doi.org/10.1111/j.1365-2125.2012.04269.x

  2. What are healthcare inequalities? [Internet]. NHS choices. NHS; 2020 Available from: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcareinequalities-improvement-programme/what-are-healthcare-inequalities/ (Accessed 13 December 2023).

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