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Attitudes and experiences of community pharmacists towards paediatric off-label prescribing: a prospective survey
Article first published online: 23 FEB 2007
DOI: 10.1111/j.1365-2125.2007.02865.x
Additional Information
How to Cite
Stewart, D., Rouf, A., Snaith, A., Elliott, K., Helms, P. J. and McLay, J. S. (2007), Attitudes and experiences of community pharmacists towards paediatric off-label prescribing: a prospective survey. British Journal of Clinical Pharmacology, 64: 90–95. doi: 10.1111/j.1365-2125.2007.02865.x
Publication History
- Issue published online: 23 FEB 2007
- Article first published online: 23 FEB 2007
- Received 30 August 2006 Accepted24 October 2006 Published OnlineEarly23 February 2007
- Abstract
- Article
- References
- Cited By
Keywords:
- attitudes;
- community pharmacy;
- off-label prescribing;
- paediatrics;
- questionnaire;
- survey
What is already known about this subject
• There are increasing concerns about the safety and efficacy of paediatric off-label medicines.
• In the UK, each year 26% of children receive an off-label prescription from their general practitioner.
• The community pharmacist is the final and key professional in the chain, with the responsibility to ensure that medicines are both prescribed and dispensed appropriately.
What this study adds
• The majority of community pharmacists are aware of off-label prescribing, but through work experience rather than undergraduate or postgraduate training or professional development.
• Community pharmacists, like UK general practitioners, underestimate the levels of paediatric off-label prescribing, and appear unclear as to the most common reasons for a prescription being off label.
• Most community pharmacists stated that they should inform the prescriber that a medicine was off label; however, when given specific practical examples, less than half would actually appear to do so.
• The majority of community pharmacists have been asked by the public to sell over-the-counter medicines for paediatric off-label use.
Aim
To identify community pharmacist experiences of, and attitudes towards paediatric off-label prescribing.
Methods
A prospective questionnaire-based study, with a 21-item questionnaire issued to 1500 randomly selected community pharmacies throughout the UK during 2005 on three separate occasions.
Results
Four hundred and eighty-two (32.1%) completed questionnaires were returned. Over 70% of respondents were familiar with the concept of off-label prescribing, primarily through dispensing experience rather than education, although only 40% were aware of having dispensed a paediatric off-label prescription within the previous month. The reasons given for a prescription being off label were younger age than recommended (84.6%, 297/351), primarily for antihistamines, analgesics and β2-agonists, and higher (73.9%, 229/310) or lower than (41%, 103/258) recommended dose, primarily antibiotics and analgesics. Over 60% of respondents had been asked by the public to sell paediatric over-the-counter medicines, such as antihistamines, analgesics and steroid preparations for off-label use. The majority of respondents used the British National Formulary or the Pack Insert rather than specialist formularies or guidelines as a source of specialist paediatric information. Although 78% of respondents believed they had a responsibility to inform the prescriber that a medicine was off label, only 66% believed that they had a similar responsibility to inform parents.
Conclusion
The community pharmacists who responded to this questionnaire appear to be aware of and concerned by the issues which surround paediatric off-label prescribing. Despite this, most gained relevant knowledge through work experience rather than undergraduate or postgraduate training or professional development.