Medication Barriers and Challenges Experienced/Perceived by Caregivers in Pediatric Medication Management: A Scoping Review

Abstract

The objective of this scoping review was to identify the challenges and barriers non-professional caregivers such as parents, experience/perceive when managing the medications for pediatric patients with chronic disease states in an outpatient setting. Embase and Ovid Medline databases were searched for articles published from inception to May 18, 2024. The search was limited to English language articles. Studies conducted in countries with a developing or transitioning economy, or those based in an institutional setting were excluded. This review was conducted as per the Joanna Briggs Institute Manual for Evidence Synthesis scoping review methodology and adhered to the PRISMA-SCr 2020 Checklist. Evidence selection and data extraction was completed independently by 2 reviewers (AT and TB) and then combined. Medication barriers were identified, grouped and themed using thematic analysis. Eight articles were included in this review. After extraction, 20 medication barriers were identified and themed into the following categories: drug factors, drug burden/regimen, access to medications, caregiver factors, child factors, health care system challenges, and fear and stigma. Drug factor medication barriers were highly endorsed by non-professional caregivers (25% of total barriers), followed by caregiver factors (20% of total barriers). To increase the likelihood of pediatric medication administration success, research focused on improving these barriers should be identified, especially those related to drug formulation and caregiver medication knowledge and forgetfulness.

Introduction

In Canada, the incidence of chronic disease and prescription drug use in pediatric patients is increasing. In 2021, it was estimated that approximately 22% of individuals aged 0 to 18 years in primary care have a minimum of 1 long-term chronic illness which may require treatment with a medication.¹ Statistics Canada completed an analysis to review the use of prescription medication in the last 1 month in children aged 3 to 19 years old from 2012 to 2017. In a sample of 7892 children, an estimated 23% reported taking at least 1 prescribed medication.²

Non-professional caregivers such as parents or guardians, assume a vital role in managing and improving the course of their child’s chronic disease. Non-professional caregivers are required to assume a multifaceted and highly demanding role which includes attending medical appointments, communicating concerns for their child, being their advocate, and administering medications.³ Compared with adults, pediatric medication regimens may be more challenging because children often have a special set of requirements to ensure drug therapy has the greatest chance of being successful. For example, pediatric patients require weight-based doses and appropriate dosage forms that can be difficult to obtain, like non-commercially available oral solutions and suspensions.⁴ In Canada, strict federal and provincial regulations exist around pharmaceutical compounding that may limit patient access.^5,6 Most adult patients autonomously manage their medication regimens, whereas children heavily rely on their non-professional caregiver to initiate and maintain therapy.

There are several articles that discuss barriers and facilitators (i.e., factors that support or improve) that affect medication adherence.^7–11 However, even though pediatric patients may receive all their doses as prescribed, struggles can still exist that makes administering medication to children more difficult. Caregivers may be required to find strategies or take additional actions, like finding compounded products, manipulating solid dosage forms at home or obtaining approval for funding. Description of these issues are not readily found in existing literature. In our area, clinical pediatric pharmacists dedicate a large portion of their time to solving drug therapy problems related to dosage form, funding, and product availability with caregivers. Our clinical pharmacists assist mainly at patient discharge from the hospital to help children transition back into the outpatient setting. Knowing that these problems do arise, our research group is interested in understanding if these issues continue to afflict caregivers outside of the hospital. We believe a better characterization of what is already documented in the literature will help guide future research efforts.

Methods

This review was conducted as per the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis scoping review methodology and reporting adhered to the PRISMA for Scoping Review (PRISMA-SCr) 2020 guidelines.^12,13 An a priori scoping review protocol was developed for this scoping review and can be found in Supplemental S1.

Search Strategy

The complete search strategy can be found in Supplemental Table S2. With guidance from a medical librarian, Embase and Ovid Medline databases were searched for articles published from 1946 to May 18, 2024. The PICo (Population, Interest, Context) framework was used to focus the research question and guide the eligibility criteria for the inclusion of studies which included:

• Population of interest: non-professional caregivers to pediatric patients (0–18 years old) with at least 1 chronic disease state that required regular medication use

• Interest: medication barriers and challenges non-professional caregivers experience or perceive when managing pediatric medications

• Context: outpatient care, discharged patients, primary care, and non-hospital care

Medical Subject Headings (MeSH) were utilized to conduct appropriate searches. The search focused on peer-reviewed studies that used any qualitative methodology including cross-sectional surveys, literature reviews, semi- and fully structured interviews, self-report, focus groups and others. The search strategy was limited to full-text articles that were published in English. Peer-reviewed journals were confirmed by reviewing journal information on the respective website and evaluating article submission processes.

Eligibility Criteria.

Full inclusion and exclusion criteria are available in the Supplemental Table S3. Studies were eligible for inclusion if they were conducted in countries with developed economies. These economies likely serve as a better representation of Canada’s economy and health care system and are better suited for contextualization in Canada. Country eligibility was determined using the United Nations World Economic and Situations Prospects Table I.1.¹⁴ Countries listed under “Developed Economies” were included. Studies reporting on vaccination barriers were excluded since vaccination administration is nuanced and is beyond the scope of this paper.

Table 1.

Summary of Included Articles

Author	Article Type	Country of Origin	Aims/Purpose	Population	Methodology	Age of Caregiver(s)	Age of Pediatric Patient(s)	Chronic Disease States	Non-Professional Caregiver Medication Barrier Identified/Key Findings
Musial16	Original Research - Qualitative	USA	To highlight challenges encountered by caregivers of children with medical complexity within 1 wk of post-hospital stay and discharge.	•Eligible patients and families (67 caregivers) were discharged from a multidisciplinary inpatient complex care team between May and November 2018. •Patients met criteria for this team if they were technology dependent, required 3 or more active consults during admission, or were followed by the outpatient complex care medical home or hospice care team.	Telephone interview conducted after hospital discharge.	Not reported	Not reported	Complex Chronic Conditions of Participants included (n = 67): •Gastrointestinal (95.5%) •Neurologic and/or neuromuscular (93.2%) •Congenital and/or genetic defect (88.6%) •Cardiovascular (70.5%) •Respiratory (63.6%) •Metabolic (63.6%) •Miscellaneous (54.5%) •Renal and/or urologic (22%) •Neonatal (25%) •Hematology immunodeficiency (18.2%) •Malignancy 5 (11.4%).	Medication-Specific Barriers: •Missing required medications. •Awaiting previous authorization (insurance complications). •Unclear discharge instructions. •Other (e.g., dosage confusion, incorrect storage).
Venables19	Original Research - Mixed Methods	United Kingdom	The purpose of this study is to discover medication formulation barriers associated with orally administered drugs experienced by parents/carers of chronically ill children and pediatric patients (0–18 yr old) with long term illness(es) in a home environment.	•221 Parents/ caregivers of children (0–17 yr) AND 57 young people (at least 12 yr of age) recruited from the pediatric ward of University Hospital Coventry and Warwickshire. •Child must have been on a chronic oral medication.	Semi-structured face to face interviews.	Not reported	12–18 yr old	Not stated in patient demographics.	•Most common barrier was the taste of the medication which was associated with 64% of medication refusals. •Other barriers included texture, volume and quantity, size, color/appearance, and smell.
Jordan17	Original Research - Qualitative	USA	To gauge an understanding of caregiver(s) knowledge regarding their child’s asthma disease state and management and recognize areas that warrant improvement.	•50 non-professional caregivers/parents to pre-diagnosed asthmatic children who had visited the ED with asthma related complications/exacerbation (i.e., wheezing, cough etc).	Patient self-questionnaire	Not reported	0–17 yr old	Children (n = 50) •Asthma (100%)	•Caregiver’s knowledge of disease pathology and drug MOA. •Caregivers of asthmatic children described that they would benefit from increased education surrounding asthma acute and chronic disease management (i.e., asthma exacerbation action plan) and therapy in terms of mechanism of action and directions (rescue vs controller inhaler).
Burlo21	Original Research- Descriptive Study	Italy	To gain an understanding of thoughts/opinions centered around galenic compound daily administration regimens from the perspectives of caregiver(s) of children with medical complexity.	•34 caregivers of children with medical complexity who administer galenic compounds as part of their treatment regimen for their children.	Structured questionnaire	Not reported	0.7–19 yr old	Children (n = 34). Chronic Disease: •Neonatal asphyxia (23.5%) •Genetic condition (47.1%) •Congenital Condition (2.9%) •Acquired condition (11.8%) •Unknown (13.7%)	•Doubts or problems when delivering medication therapy. •Problems with the actual dosage form/storage of galenic formulation. •Largely time consuming. •Medication portability barriers.
Doyle20	Original Research - Qualitative	Ireland	To recognize challenges experienced by mother(s) when administering medication to their children with severe intellectual disabilities.	•15 caregivers to children diagnosed with severe intellectual disabilities.	Semi-structured face to face interviews and caregiver diaries.	Not reported	2–18 yr old	Specific chronic diseases not stated.	•Caregivers continuously being on standby to administer medications to their child. •Scheduling other life/daily tasks around their child’s medication regimen (lack of privacy to administer medications was also mentioned). •Long period of time spent to prepare medication. •Varying preparation technicalities, time, and methods of medications further complicating administration.
Harings18	Original Research - Qualitative	Germany	To gain a better understanding of thoughts and opinions surrounding the use of medications from parents of children with inborn errors of metabolism.	•108 parents of 119 children born with inborn errors of metabolism (IEM). •The children had to be taking medication for IEM.	Questionnaire administered via `telephone. Pediatric patient medication history review conducted along with a total review of medications present in the home(s) of the children.	24–54 yr old. Median: 38 yr old.	0–17 yr old Median: 8 yr old	Children (n = 119) •Major Chronic Disease: Various Inborn Errors of Metabolism (n = 100%)	There are several barriers listed under the categories of: •Difficulty incorporating medical routine into day-to-day life. •Forgotten doses. •Child does not want to take the medication (resistance to drug administration). •Adverse drug reactions (or fear thereof).
Santer22	Systematic Review and Synthesis of Qualitative Studies	Countries included: USA, UK, Belgium, Australia, Netherlands	To identify causes/reasons of prescription medication non-adherence in pediatric patients with chronic conditions informed directly by caregivers.	•Non-professional caregivers such as parents or others (excluding HCP) to children with chronic conditions (excluding disease states such as visual and hearing impairments, transplant, developmental, mental health, and behavioral conditions).	Review Type: Systematic review and thematic synthesis of qualitative studies. Databases Used: Medline, Embase, CINAHL, and PsycINFO. Selection Criteria: Studies published in English and German. Time Frame: 1996–2011	Not reported	0–18 yr old (though their focus was 12 and under)	Chronic conditions reported in studies (# of studies out of 19). •Asthma (6) •Cystic Fibrosis (4) •HIV (3) •Juvenile Arthritis (2) •Diabetes (3) •Various long-term conditions (1)	•Beliefs about the condition (i.e., future complications/threats and disease state symptom analysis) or treatment (i.e., side effects and efficacy). •Difficulty, complexity, or palatability of treatment regimen. •Child resistance, relationships within families (i.e., difference in views regarding treatment between child and caregiver(s) or between caregivers, conflict resulting from child resistance). •Preserving normal life, and input from HCPs.
					Inclusion Criteria: Studies were eligible if they reported qualitative findings (focus group, interviews). Studies were included if the caregiver was specifically instructed to follow a treatment/regimen. If not, the study was excluded. Exclusion Criteria: studies conducted in non-developed countries. Non-English or Non-German articles were excluded. The quality of the papers was assessed by an adapted Critical Appraisal Skills Program quality assessment tool by 2 independent reviewers. 19 papers out of 506 were eligible for the study.
Xiao15	Original Research - Qualitative	Canada	The aim of this paper is to recognize experiences informed by caregivers of children with spinal muscular atrophy related to disease modifying therapy.	•15 parents or non-professional caregivers to children with spinal muscular atrophy who have either received or are currently on/taking disease modifying therapy (nusinersen, onasemnogene abeparvovec and/or risdiplam).	Virtual semi-structured interviews	20–49 yr old	0–18 yr old	Children (n = 15) •Spinal Muscular Atrophy (n = 100%)	Major Barriers Listed: (1) Inequities in access to disease-modifying therapies •Variable regulatory approvals across jurisdictions: moving to different countries to access drugs or going elsewhere (i.e., USA). •Prohibitively expensive therapies. •Insufficient infrastructure to support the rapid delivery of therapeutics: delays in diagnosis, slow coverage approval of drugs etc. (2) Patient and family experiences with disease modifying therapies •Lack of family autonomy when selecting disease modifying drugs. •Due to the novel nature of disease modifying therapies, caregivers felt unsettled regarding the following topics: safety and efficacy of the drug in terms of the long-term effects which are yet to be explored, future eligibility and coverage of the disease modifying drugs.

ED, emergency department; HCP, health care professional; MOA, mechanism of action

Evidence Selection.

All search results were imported into a Microsoft Excel spreadsheet and duplicates were removed. Study titles and abstracts were assessed for eligibility by 2 independent reviewers (AT and TB) based on the inclusion criteria. Prior to conducting a complete evidence selection, a pilot evidence selection of 200 articles was conducted by these 2 reviewers to identify any methodological pitfalls that required modification.

In the case of a disagreement at any stage of the selection process, a consensus was achieved through mutual discussion between 2 reviewers. If a mutual agreement was not achieved, a third reviewer (AWT) was consulted to reach a consensus. Prior to a full extraction of the articles, a pilot extraction of a random sample of 5 full-text articles was completed by the 2 reviewers to identify and test the extraction form protocol for any aspects that required improvement. A data extraction form was developed by adapting the JBI template data extraction instrument.¹² Extracted data included the country of origin, population, age of caregiver(s), age of pediatric patients, aim/purpose of the study, qualitative methodology, and the non-professional caregiver medication barriers identified. The data extraction process was completed using Microsoft Excel. Medication barriers were characterized and thematically grouped for analysis as noted above.

Results

Both databases were searched on May 18, 2024 and 4770 articles were identified. After removing duplicates (n = 383), 4387 peer-reviewed articles were screened based on the title and abstract. Based on inclusion criteria, 22 articles were sought for retrieval. Four of the 22 articles were excluded because only the conference abstracts were available and did not offer enough detail for a thorough review. Eighteen full-text papers were successfully accessed and reviewed. A total of 10 articles were excluded for the following reasons: little or no focus on pediatric drug management (n = 3), did not speak to the caregiver experience or perspective when conducting pediatric medication management (n = 3), conducted in an underdeveloped economy (n = 2) and the aim of the study was deemed outside the scope of the research question (n = 2). Eight articles underwent data extraction and were included in this review. See Supplemental Figure S4 for a PRISMA flowchart of the study selection process.

The included studies report findings from 1996 to 2023 with publication years spanning between 2014 to 2023. Qualitative methodologies used in the studies incorporated patient self-questionnaires, semi-structured interviews, structured questionnaires, and telephone interviews. Seven articles consisted of qualitative research studies which were conducted in Canada, United States of America, Germany, United Kingdom, Ireland, and Italy.^15–21 One article was a systematic review of qualitative studies which included studies conducted in countries that met the eligibility criteria.²² None of the papers included in this systematic review were examined individually in this scoping review.

The included studies addressed medication barriers associated with the treatment of the following disease states, some categorizing them more broadly than others: gastrointestinal, neurologic or neuromuscular, genetic defects, cardiovascular, respiratory, metabolic, renal, hematologic immunodeficiency, malignancy, cystic fibrosis, human immunodeficiency virus, juvenile idiopathic arthritis, diabetes, asthma, spinal muscular atrophy, neonatal asphyxia, or unknown/miscellaneous (Table 1).

After data extraction, 20 barriers were identified. The barriers were thematically grouped into 7 categories: (1) drug factors, (2) drug burden/regimen, (3) access to medications, (4) caregiver factors, (5) child factors, (6) health care system challenges, and (7) fear and stigma. Table 2 highlights the specific barriers and the corresponding articles describing the barrier. Of note, studies that commented on caregiver apprehension or fear of adverse effects were included in category 1. It was determined that these were a property of the drug, which is why it was classified as “drug factors”. “Fear and stigma” (category 7) refers to the social implications caregivers reported in the studies (e.g., stigma associated with administering medications in public) and did not include fear of starting the drug due to perceived adverse effects.

Table 2.

Identified Medication Barriers Experienced/Perceived by Caregivers

Barrier Theme	Reported Barrier(s)	Frequency (N = 8) (%)	Corresponding Studies Reporting Specific Barrier
Drug factors: 5 barriers	Drug palatability	N = 2 (25.0)	Venables19, Santer22
	Dosage form	N = 3 (37.5)	Musial16, Burlo21, Doyle20
	Difficulty with medication storage/transport	N = 2 (25.0)	Musial16, Burlo21
	Fear/presence of adverse effects	N = 3 (37.5)	Harings18, Santer22, Xiao15
	Lack of medication efficacy or perception thereof	N = 1 (12.5)	Xiao15
Drug burden/regimen: 2 barriers	Medication schedule/lack of time	N = 3 (37.5)	Burlo21, Doyle20, Harings18
	Heavy pill burden	N = 2 (25.0)	Venables19, Santer22
Access to medication: 3 barriers	Running out of medication/lack of drug availability	N = 1 (12.5)	Musial16
	Cost of treatment	N = 1 (12.5)	Xiao15
	Lack of insurance/insurance barriers	N = 2 (25.0)	Musial16, Xiao15
Caregiver factors: 4 barriers	Parent forgetfulness	N = 1 (12.5)	Harings18
	Health beliefs about the condition	N = 1 (12.5)	Santer22
	Knowledge of medication or condition	N = 1 (12.5)	Jordan17
	Conflict between caregiver(s) or between caregiver and child	N = 1 (12.5)	Santer22
Child factors: 2 barriers	Child refusal	N = 3 (37.5)	Doyle20, Harings18, Santer22
	Preserving normal childhood	N = 1 (12.5)	Santer22
Health care system challenges: 3 barriers	Lengthy wait times to see practitioner	N = 1 (12.5)	Xiao15
	Variations in drug approval based on location	N = 1 (12.5)	Xiao15
	Unclear hospital discharge instructions	N = 1 (12.5)	Musial16
Fear and stigma: 1 barrier	Lack of privacy for administration	N = 1 (12.5)	Doyle20

The most endorsed medication barrier theme were drug factors (25%) and was documented in 7 of the included studies.^{15,16,18–22} These articles documented aspects like drug palatability or dosage form issues. The next most common type of barrier were those related to caregiver factors (20%) which included aspects like forgetfulness, knowledge about the child’s health or medication, and the relationship the caregiver had with the child. The least reported medication barrier was fear and stigma (12.5% of total barriers).²⁰ A chart summarizing the proportion of the different barrier themes can be found in the Figure.

Figure.

Pie chart of reported frequencies of major barrier themes.

Discussion

To our knowledge, there are no other scoping reviews that focus on this unique research area; our review identifies documented barriers experienced by caregivers across all aspects of managing pediatric medications while most literature identifies barriers and their effects on medication adherence. Even though pediatric patients may be adherent to their drug therapy regimens with their caregivers’ assistance, there may still be barriers they must overcome.

Drug factor barriers endorsed in the studies by non-professional caregivers included well known issues like a child’s dislike for the taste or texture of a medication, challenges with the dosage form like not having a liquid medication available, or only available in a concentration that requires the child to swallow a large volume making administration more difficult.^19,21,22 Complex medication schedules and heavy pill burdens were also identified as administration issues, which can be a struggle for many patients regardless of age.^18–22 Child refusal of medication was also prominent in 3 articles which is commonly encountered by pharmacists.^18,19,22

Limited availability of appropriate dosage forms like liquid products was identified as a barrier in this review. When child-friendly dosage forms are unavailable, pharmacists and caregivers may resort to pharmaceutical compounding or manipulation, which may not be available to all patients in an equitable manner.²³ Though the exact prevalence of pediatric compounding is not well known in Canada and is limited to the hospital setting, a recent study estimated that 23% of all prescriptions for enteral medications required some form of pharmacy-based manipulation and almost half of the children seen at their institution had at least 1 compounded enteral medication, suggesting that altering dosage forms is an essential component in pediatric medication management.²⁴ Dedicated efforts are beginning to emerge in the development of pediatric-appropriate dosage forms; however, because pediatric and neonatal drug markets may not be seen as lucrative as adult markets, there continues to be a limited availability of older, off-patent and newer medications frequently used in children.^25,26 The impact of finding a pharmacy that carries child-friendly dosage forms and how caregivers feel about navigating this sector of the health care system has yet to be described.

Related to compounded products, 2 studies also documented issues with medication storage and transport of these formulations.^16,21 Participants in the study by Burlo et al²¹ commented that portability can be a challenge because some medications need to be refrigerated. While there is a subset of medications that will always require refrigeration (e.g., injections, some commercially available suspensions), compounded medications are a unique aspect of pediatric care and storage is an extra consideration for caregivers.

Caregiver fear of medication adverse effects was also documented as a barrier in 3 studies which may impact a caregiver’s decision to initiate or continue treatment.^15,18,22 The study by Harings et al¹⁸ sought to understand parents’ perceptions about medication when treating inborn errors of metabolism. A parent decided to stop a medication because they feared the adverse effects and wanted to “avoid further reduction of the child’s quality of life”.¹⁸ This example illustrates the impact caregiver perception of adverse effects can have on their child’s treatment plan.

Other medication barriers that may not be as common but nonetheless important, are those related to financial issues with medications like the cost of treatment and medication insurance.^15,16 These factors can impact whether a medication is initiated or continued. Though only cited in 1 study, health care system challenges like lengthy wait times to see a practitioner and drug approval issues may also be important aspects to consider that are outside the direct influence of a pharmacist.¹⁵

Children were treated for a wide variety of chronic disease states within the included studies. It is difficult to understand if 1 chronic disease has more medication barriers associated with it than another because some articles described the included disease states very generally (e.g., respiratory or gastrointestinal) and were not specific. In one of the studies that evaluated barriers for patients receiving treatment for spinal muscular atrophy, included patients received disease-modifying medication.¹⁵ The most cited barrier was inequities in access to these therapies, especially related to policies within different countries and the drug being prohibitively expensive. This is likely a unique barrier encountered for this disease because of the limited type of drugs used to treat this condition. More research is needed to determine if the complexity of the disease state can affect the challenges a caregiver may encounter.

A noteworthy finding was the recognition of medication barriers associated with caregivers, which may not be as easy to assess in a clinical setting especially when care is focused on the pediatric patient. Examples of medication barriers stemming from caregiver factors included parent forgetfulness, knowledge of medications or conditions, and conflict between caregiver(s) or child and other caregivers.^17,22 The systematic review by Santer et al²² highlighted that caregivers within the same family may have conflict when making decisions about medication treatment for their child, which can alter treatment plans. This emphasizes that successful medication therapy in children relies on and can be affected by the quality of the relationship between multiple caregivers. Caregivers fulfill a complex and intricate role when providing care for their sick child as they enact roles of both a parent and health care provider.³ Therefore, caregiver wellbeing must be taken into consideration when mitigating medication barriers to achieve goals of therapy.

Lastly, the impact of perceived lack of data regarding efficacy and adverse effects of medications in pediatric patients remains unanswered. In Canada, there is an identified priority to study medications in pediatric populations to ensure they are safe and effective for children and youth.²⁷ Many medications are used “off-label” in children because of lack of data. It is important to know how this labelling affects caregivers’ decisions to treat their children and whether they see it as a barrier or facilitator to treatment.

Limitations

This review presents with a few limitations. Only peer-reviewed articles published in English and from developed countries were considered, which may exclude other reported barriers. However, given that lots of barriers can be due to specific health care system issues, we felt limiting to developed countries would allow us to better understand the medication barriers experienced by our patients in our local setting. Thus, these findings may not be universally applicable but present an opportunity to conduct further research that will specifically address clinically meaningful barriers in our patient population.

This scoping review also focused on medication treatment for ambulatory children with chronic diseases which limits the complete understanding of pediatric medication barriers, particularly when children receive a medication for an acute condition (e.g., antibiotics for infection). Children with chronic disease likely use medication regularly which increases the chance of a barrier occurring. It is suspected that medication challenges also exist for acute illnesses, but it is outside the scope of this review. More investigation should occur so a more thorough understanding of all barriers can be achieved.

Conclusions

This scoping review highlights a variety of barriers and challenges that non-professional caregivers encounter when providing medication to pediatric patients as documented in existing literature. Practitioners are likely familiar with drug administration barriers like poor palatability, inappropriate dosage forms, and parent forgetfulness that can cause non-adherence to drug regimens. However, this review also highlights that caregivers managing pediatric medications may also be navigating other hidden issues with funding and insurance policies, medication portability, and interactions with other caregivers. How specific disease states, the perceived lack of efficacy and safety data for medication use in children, and access to child-appropriate medication products affect non-professional caregivers still needs to be evaluated.

Dedicated research to better understand these reported barriers is essential to lay the groundwork for more targeted change within local health care systems. Once characterized, the next step can consist of developing approaches that focus on alleviating these barriers for caregivers. These are important aspects that make pediatric medication management unique, and it is imperative they are addressed to ensure equitable care regardless of patient age.

ABBREVIATIONS

JBI

Joanna Briggs’ Institute;

MeSH

Medical Subject Heading