Farmacotherapie bij kinderen: van kunst tot wetenschap

The Dutch Health Care Insurance Board commissioned RAND Europe to conduct a study to identify the barriers to effective prescribing for children, with an emphasis upon the absence of good clinical research within those barriers. The goals of this study are threefold. The first is to bring to awareness and to assess the importance of barriers to optimal pharmacotherapy for children. Here, the authors take the term "barriers" in its broadest sense, to include shortcomings in knowledge, communications, individual caregiver and patient behaviour, and the organizational structure of the health care delivery system. The second goal is to identify possible solution directions, or recommendations for change, that can reduce these barriers. These solution directions are also assessed in terms of their likelihood of reducing barriers. The final goal of the study is to assess the extent to which clinical research is a useful solution direction, and which aspects of such clinical research (specific drugs, clinical condition addressed, dosage, side effects, etc.) are most important. Financing problems, lack of scientific knowledge and lack of dissemination of existing knowledge were found to be the main problems in paediatric care in the Netherlands. A group of experts in the field discussed solution directions, in which governmental incentives are deemed critical.