1. BACKGROUND Health Care Attitudes and Trends among the Pediatric Prescribing Community Mahesh Narayan 1 MB, MSE, Dimple Patel 1 MS, Peter C. Adamson 1,2,3 MD, Jeffrey S. Barrett 1,3 PhD FCP. 1 Division of Clinical Pharmacology and Therapeutics, 2 Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA. 3 Department of Pediatrics, The University of Pennsylvania School of Medicine. There is a great deal of disparity in the way pediatric caregivers manage the pharmacotherapy of their patients. Part of this is due to the diversity in the caregiver community with respect to their background (e.g., nurse, pharmacist or physician), area of specialization and clinical setting (inpatient vs. outpatient). An important consideration is the extent to which caregivers appreciate the need to adjust the dose in their patients and their satisfaction with the resources and approaches used to guide such adjustments. OBJECTIVES DESIGN / METHODS Assess pediatric caregiver’s knowledge regarding dosing guidance with respect to the caregiver’s role, specialty and location. Identify caregiver’s level of satisfaction with available compendial sources and the extent to which such sources are utilized. Detect the prevalence of dose adjustment within the pediatric practice and assess the caregiver’s appreciation for dose adjustments in their patients. Ascertain which drug classes are more vulnerable with respect to available dosing guidance and quantify the need for more dosing guidance. Identify the mechanism/comfort in calculating dose adjustments. Assess available resources for dosing guidance and need for additional tools. A 15 question survey was prepared with the guidance of clinical and administrative thought-leaders at the Children’s Hospital of Philadelphia (CHOP). The survey comprised of a mixture of six tick-box questions, seven 3-4 point scale responses (seven of which allowed comments) and two free text questions. An initial pilot questionnaire was conducted as proof-of-concept for feedback purposes. The survey was distributed through a web-application via internal email to roughly 900 hospital- based pediatric care givers within the Division of Pediatrics at CHOP and was kept open for a period of three weeks. Two reminders were sent (once a week) during this period. The pediatric caregivers comprised of Attending Physicians, Fellow Physicians, Residents, Nurse Practioners, Clinical Pharmacists, Physician Assistants and Clinical Nurse Specialists. Questionnaire categories included pediatric caregiver demographics, pharmacotherapy resources, dose adjustment and management, and evaluation of existing tools to provide improved pharmacotherapy guidance. The results were analyzed and summarized in SAS using simple descriptive statistics. RESULTS Interest for a predictive dosing guidance tool that would individualize patient treatment RESULTS Ranking of criterions that affect dose adjustment in pediatrics Level of Information in the Existing Dosing Compendiums Convenience of obtaining information pertaining to dosing guidance Percentage of Respondents Patients that receive dose modification outside the standard dose requirement Percentage of Respondents Pharmacotherapy tools commonly used to calculate dose requirements Drawbacks associated with current pharmacotherapy tools DISCUSSION AND CONCLUSIONS Dosing guidance is generally viewed important in Pediatrics. There exists a difference in the way medicines are prescribed with respect to the pediatric caregiver’s role, specialty and location. It is interesting to note that the responses of the Resident community closely resembles that of the Nursing community. This is due to the fact that these two groups do most of the ordering and prescribing. It is clearly evident that the existing dosing guidance resources are inadequate to guide recommendations for most pediatric drugs. A predictive tool with decision support capabilities is an unmet need in the pediatrics and will be well received if constructed properly. Our Pediatric Knowledgebase effort aims at addressing many of these observations. We are seeking validation of these findings by extending the questionnaire to regional, national and global centers of excellence. Figure 1: Figure 4: Figure 2: Figure 5: Figure 6: Figure 7: Figure 8: Table 1: Clinical role, specialization and setting of survey respondents Table 2: Pediatric Caregiver’s Source of dosing reference information RESULTS A total of 313 responses were obtained (response rate 33%). There are a variety of sources for obtaining dosing information (Table 2). Existing Pharmacotherapy tools are far from perfect (Figure 1). The top 3 criterions affecting dose are body weight, organ function and age. ~70% of pediatric caregivers modify doses in 1-20% of their patients (Figure 5). ~75% of the respondents would like to have access to a predictive tool that would allow personalized patient treatment (Figure 8) I : Pediatric Caregiver Demographics II : Pharmacotherapy Resources III : Dose Adjustment & Management Importance of Dose Adjustment in pediatrics? Percentage of Respondents Figure 3: Percentage of Respondents IV: Evaluation of Existing Tools Table 3: Medication classes most difficult to manage