Article
The German National Survey for Children and Adolescents (KIGGS) : methodological aspects of the pharmacoepidemiological CAPI and first results
Der Kinder- und Jugendgesundheitssurvey (KIGGS) und die Arzneimittelgebrauchserfassung
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Published: | October 16, 2003 |
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Outline
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Context
Population representative data concerning usage of all (OTC and Rp) drugs for representative population segments are not available in Germany and world-wide. This is especially true for children and adolescents. The German National Survey for Children and Adolescents (KIGGS) has started in spring 2003 after a pre-test was done from March 2001 until March 2002 in two rural and two urban regions with 1476 participants. The main survey will cover approximately 18.000 study participants aged 0 - 18 years at 150 sample points in the Federal Republic of Germany.
Aim
To gain valid information concerning drug usage for all drugs in the above mentioned age segment of the population. This is of great value concerning not only for aspects of drug safety but also for pharmacoeconomic reasons. Multiple usage of drugs often is accompanied with higher rates of adverse drug reactions. To explore the pattern of comedication of Rp- and OTC-drugs and to look for the amount of self medication.
Methods
A standardised questionnaire which had been in use in former pharmaco-epidemiological surveys was adapted to a special software tool to perform the computer-assisted personal interview (CAPI) by the survey physicians. Data concerning the younger age groups (up to 13 years) are gained by asking their parents. The older age groups are can be asked directly too. Medical examinations and laboratory measurements of blood, serum and urine samples are done in the RKI-laboratory and in the laboratory of the German Heart Institute Berlin (Deutsches Herzzentrum Berlin, DHZB). All drug usage information will be gathered in two data banks. One of them is patient-oriented (SPSS-type) and the other is drug-oriented (Q&A-type). So it will be easily possible to retrieve the collected data with quite different kinds of questions.
Results
Pre-test data did show that the epidemiological instruments gave concise information concerning all aspects of drug usage. Prescriptional drugs had a high coincidence-level with the German GKV-index. This index is showing the reimbursement data of drugs by German HMOs. Pre-test data revealed clear differences between age- and sex-groups in their drug usage pattern. This was true for all ATC-groups especially for psychoanaleptics, contraceptives and thyroid drugs. The OTC market segment was shown clearly with high usage data for vitamins, minerals and fluorides. The additional laboratory data will hopefully enable us to create reference values for clinical chemistry and haematological data for children and adolescents. This will be of special value concerning the iodine-status in this population segment. The GC/MS-determination of methylphenidate is capable to verify the usage of the prescribed drugs Ritalin®, Medikinet® or Equasym®.
Conclusions
The pre-test has shown that additional information will be gained by combining drug-usage data with medical examination and laboratory data as well as serum- and urine-concentrations of selected substances like active components of drugs or of iodine. The survey will give thorough insight in drug usage patterns of all prescribed and OTC drugs and can promote drug safety.