The PIPc Study: development and validation of indicators of potentially inappropriate prescribing in children in primary care.

Talk Code: 
Emma Barry
Susan M Smith, Kirsty O'Brien, Janine A Cooper, Frank Moriarty, Patrick Redmond, Carmel M Hughes, Kathleen Bennett, Tom Fahey.
Author institutions: 
HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland.


There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle aged adults but few are relevant to children


A set of indicators, developed by literature search and a project steering group underwent a two round Delphi process. 15 panellists indicated their level of agreement with each indicator via a Likert scale. Criteria were accepted, rejected or revised based on the panel’s level of agreement. The indicators were then applied to the PCRS database to determine the prevalence of PIP in children. The cost of PIP in children was also examined.


12 indicators were identified following the Delphi process. The three most common PIPs in children were prescribing of carbocisteine to children < 2 years (3.3%); failure to prescribe a spacer device at least annually for children < 12 years who used a pressurised metered dose inhaler (70% of eligible children) and failure to prescribe an emollient for children prescribed more than one topical corticosteroid in a year (54% of eligible children).


Children’s PIP indicators are the first set of prescribing criteria developed for use in children in primary care. The prevalence of PIP in GMS eligible children was found to be low.

Submitted by: 
Emma Barry
Funding acknowledgement: 
This project forms part of an MSc by research and is partly funded by the HRB funding grant HRC/2007/1.