Decrease in Statewide Antipsychotic Prescribing after Implementation of Child and Adolescent Psychiatry Consultation Services

Barclay, Rebecca P.; Penfold, Robert B.; Sullivan, Donna; Boydston, Lauren; Wignall, Julia; Hilt, Robert J.

doi:10.1111/1475-6773.12539

Cited by 38 publications

(22 citation statements)

References 23 publications

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“…Consistent with research in Medicaid insured youth, 14‐16 we observed heterogeneity in the impact of PA across age groups. Despite an initial decrease in antipsychotic prevalence among adolescents, there was an upswing in use over the long‐term.…”

Section: Discussionsupporting

confidence: 84%

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Spillover effects of state medicaid antipsychotic prior authorization policies in US commercially insured youth

Spence

Reeves

dosReis

2020

Pharmacoepidemiology and Drug

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Purpose To evaluate spillover effects of Medicaid antipsychotic prior authorization (PA) policies among commercially insured youth. Methods Commercially insured youth residing in nine US states that implemented PA exclusively for antipsychotics in 2011 or 2012 were identified using a 10% random sample of enrollees in the IQVIA PharMetrics Plus database spanning 2007 to 2015. Youth were included if they were ≤18 years, met the age criteria of the PA at the time of dispensing, and had at least 1 month of prescription drug coverage from 2007 to 2015. The primary outcome of interest was the monthly prevalence of antipsychotics. We implemented segmented regression of interrupted time series analysis to estimate changes in the monthly prevalence of targeted medications, overall and stratified by age. Trends were compared in the 4‐year period before and the 3‐year period after implementation of PA policies. Results Antipsychotics prescribing significantly decreased 6.74/10 000 (95% CI, −9.04 to −4.44) enrollees per month immediately after PA implementation. However, PA was not associated with significant long‐term trend changes (−0.06; 95% CI, −0.16 to 0.03). Antipsychotic prescribing in children <12 years‐old significantly decreased 0.14/10 000 (95% CI, −0.21 to −0.07) enrollees per month after PA implementation, while prescribing in adolescents 12 to 18 years‐old significantly increased 0.32/10 000 (95% CI, 0.16 to 0.47) enrollees per month. Conclusion While Medicaid PA polices for antipsychotic oversight did not affect overall prescribing, there were spillover effects in U.S. commercially insured children <12 years‐old. This suggests that state‐level Medicaid policies intended to improve the quality of care and safe use of antipsychotics can have broad reach.

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Section: Discussionsupporting

confidence: 84%

“…Emerging evidence shows that PA has led to reduced antipsychotic prescribing among Medicaid insured youth, with estimates ranging from 30% to 49% decrease in prescribing. Additionally, children have a greater decrease in antipsychotic prescribing than adolescents, suggesting age differences in the impact of PA 14‐17 …”

Section: Introductionmentioning

confidence: 99%

Spillover effects of state medicaid antipsychotic prior authorization policies in US commercially insured youth

Spence

Reeves

dosReis

2020

Pharmacoepidemiology and Drug

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“…58 The PAL also demonstrated high utilization and high PCP program satisfaction, as well as its association with increased use of medication for ADHD and depression/anxiety and decreased use of antipsychotic medication among Medicaid-insured youth. 59,60 Project TEACH demonstrated increased PCP confidence in assessing severity of BH problems, developing BH treatment plans, and prescribing psychotropic medications. 61 While different structures and outcome measures preclude direct comparisons across programs, the findings from the current program, MCPAP, PAL, and TEACH, converge in their demonstration of high utilization and high satisfaction/perceived value among PCP participants.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Pediatricians’ Behavioral Health Competencies Through Child Psychiatry Consultation and Education

Walter

Kackloudis

Trudell

et al. 2017

Clin Pediatr (Phila)

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The objective of this study was to assess feasibility, utilization, perceived value, and targeted behavioral health (BH) treatment self-efficacy associated with a collaborative child and adolescent psychiatry (CAP) consultation and BH education program for pediatric primary care practitioners (PCPs). Eighty-one PCPs from 41 member practices of a statewide pediatric practice association affiliated with an academic medical center participated in a program comprising on-demand telephonic CAP consultation supported by an extensive BH learning community. Findings after 2 years of implementation suggest that the program was feasible for large-scale implementation, was highly utilized and valued by PCPs, and was attributed by PCPs with enhancing their BH treatment self-efficacy and the quality of their BH care. After participation in the program, nearly all PCPs believed that mild to moderate presentations of common BH problems can be effectively managed in the primary care setting, and PCP consultation utilization was congruent with that belief.

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“…Significant practice changes can result from a consult-and-review system that does not rely on Medicaid authorization denials (Zito, 2017). For instance, in Washington, the total statewide use of antipsychotics for Medicaid youth decreased by 50%, and in Wyoming there was a 40% decrease in children under 5 using psychotropics, all while receiving generally positive provider feedback about mandatory reviews (Barclay et al, 2017;Hilt et al, 2015).…”

Section: Role Of Psychotropic Medication Oversight Programsmentioning

confidence: 99%

Polypharmacy and the Pursuit of Appropriate Prescribing for Children and Adolescents

Baker

Bellonci

Huefner

et al. 2017

Child and Adolescent Psychopharmacology News

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This publication is intended to provide accurate and authoritative information regarding the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering medical, psychological, financial, legal, or other professional services. The recommended doses of medications cited in this newsletter are not meant to serve as a guide for prescribing of medications. Physicians, please check the manufacturer's product information sheet or the PHYSICIAN'S DESK REFERENCE for further information and contraindications. 1 • CAPN 22(1) Educational Objectives Upon completion of this activity, participants should be able to: • Enumerate reasons for polypharmacy in children and adolescents. • Describe methods to evaluate over prescribing or under prescribing of multiple medications for children and adolescents. Target Audience This CME activity is intended for child and adult psychiatrists, pediatricians and other healthcare professionals with an interest in the psychopharmacology and treatment practices for child and adolescent psychiatric disorders.

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Decrease in Statewide Antipsychotic Prescribing after Implementation of Child and Adolescent Psychiatry Consultation Services

Abstract: Statewide antipsychotic prescribing for Medicaid clients fell significantly at different rates following each implementation step of a multilevel consultation and best-practice education service.

Cited by 38 publications

References 23 publications

Spillover effects of state medicaid antipsychotic prior authorization policies in US commercially insured youth

Spillover effects of state medicaid antipsychotic prior authorization policies in US commercially insured youth

Enhancing Pediatricians’ Behavioral Health Competencies Through Child Psychiatry Consultation and Education

Polypharmacy and the Pursuit of Appropriate Prescribing for Children and Adolescents

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