Differences in Medicaid Antipsychotic Medication Measures Among Children with SSI, Foster Care, and Income-Based Aid

Abstract

This project was supported by grant number U18HS020503 from the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS). Additional support for Rutgers-based participants was provided from AHRQ grants R18 HS019937 and U19HS021112, as well as the New York State Office of Mental Health. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ, CMS, or the New York State Office of Mental Health. Finnerty has been the principle investigator on research grants/contracts from Bristol Myers Squibb and Sunovion, but her time on these projects is fully supported by the New York State Office of Mental Health. Scholle, Byron, and Morden work for the National Committee for Quality Assurance, a not-for-profit organization that develops and maintains quality measures. Neese-Todd was at Rutgers University at the time of this study and is now employed by the National Committee for Quality Assurance. The other authors have no financial relationships relevant to this article to disclose. Study concept and design were contributed by Finnerty, Neese-Todd, and Crystal, assisted by Scholle, Leckman-Westin, Horowitz, and Hoagwood. Scholle, Byron, Morden, and Hoagwood collected the data, and data interpretation was performed by Pritam, Bilder, Leckman-Westin, and Finnerty, with assistance from Scholle, Byron, Crystal, Kealey, and Neese-Todd. The manuscript was written by Leckman-Westin, Kealey, and Horowitz and revised by Layman, Crystal, Leckman-Westin, Finnerty, Scholle, Neese-Todd, and Horowitz, along with the other authors.

Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence

“…Other similarities to their study are the low incidence of prior treatment with cognitive behavioral interventions and the fact that younger children were less likely to have received prior treatment. In contrast to our findings, in over half of a sample of Medicaid insured children, there was no prior psychosocial treatment in the 3 months before the antipsychotic had been prescribed [32,38]. However, our study, as well as the study by Rettew et al [7] assessed all prior lifetime treatments, which might explain this difference.…”

“…The second study also focused on Medicaid-insured children and evaluated recommendations that were based on a review of guidelines from the United States [ 31 ], addressing antipsychotic polypharmacy, dosing, prior treatment, metabolic screening, and monitoring. The authors found substantial shortcomings across recommendations [ 32 ]. However, they noted that not all relevant data might be reflected in the claims database that was used to obtain information on the course of treatment.…”

CYP2D6 genotype and adverse events to risperidone in children and adolescents

“…However, atypical antipsychotics are most commonly prescribed in pediatric patients for off label uses including depression, obsessive-compulsive disorder (OCD), Tourette Syndrome, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD) (3–5). Atypical antipsychotic use in children peaked in the mid-2000s and was associated with a trend in initiating prescriptions at a younger age, although antipsychotic use has continued to rise in adolescents since that time (3,6).…”

Stranded on Antipsychotics: Role of the Pediatric Clinician

“…Off-label use of antipsychotic medications in pediatric patients increased rapidly through the 2000s, leveling off in 2008. 6 Off-label use occurs more frequently in vulnerable populations, including children in foster care, 7,8 children with Medicaid, 9,10 minority children, 11 and children with intellectual disabilities. 12 Some states have implemented stringent oversight programs to reduce and monitor prescriptions for psychotropic medications in general and antipsychotic medications in particular.…”