Attitudes and experiences of community pharmacists towards paediatric off‐label prescribing: a prospective survey
Authors: Stewart Derek , Rouf Abdul , Snaith Ailsa , Elliott Kathleen , Helms Peter J. , McLay James S. 
Published: February 2007

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.