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Meng M, Hu J, Liu X, Tian M, Lei W, Liu E, Han Z, Li Q, Chen Y. Barriers and facilitators to guideline for the management of pediatric off-label use of drugs in China: a qualitative descriptive study. BMC Health Serv Res 2024; 24:435. [PMID: 38580958 PMCID: PMC10998389 DOI: 10.1186/s12913-024-10860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Despite being a global public health concern, there is a research gap in analyzing implementation strategies for managing off-label drug use in children. This study aims to understand professional health managers' perspectives on implementing the Guideline in hospitals and determine the Guideline's implementation facilitators and barriers. METHODS Pediatric directors, pharmacy directors, and medical department directors from secondary and tertiary hospitals across the country were recruited for online interviews. The interviews were performed between June 27 and August 25, 2022. The Consolidated Framework for Implementation Research (CFIR) was adopted for data collection, data analysis, and findings interpretation to implement interventions across healthcare settings. RESULTS Individual interviews were conducted with 28 healthcare professionals from all over the Chinese mainland. Key stakeholders in implementing the Guideline for the Management of Pediatric Off-Label Use of Drugs in China (2021) were interviewed to identify 57 influencing factors, including 27 facilitators, 29 barriers, and one neutral factor, based on the CFIR framework. The study revealed the complexity of the factors influencing managing children's off-label medication use. A lack of policy incentives was the key obstacle in external settings. The communication barrier between pharmacists and physicians was the most critical internal barrier. CONCLUSION To our knowledge, this study significantly reduces the implementation gap in managing children's off-label drug use. We provided a reference for the standardized management of children's off-label use of drugs.
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Affiliation(s)
- Min Meng
- Chevidence Lab of Child & Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, USA
| | - Xiao Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Min Tian
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Wenjuan Lei
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Enmei Liu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhu Han
- College of Pharmacy, Gansu University of Chinese Medicine, Lanzhou, China
| | - Qiu Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Yaolong Chen
- Chevidence Lab of Child & Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences(2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
- Lanzhou University GRADE Center, Lanzhou, China.
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