Pediatric Psychopharmacology in a Capitated Managed Care System: How Do Patients Fare?

Abstract

A retrospective chart review was designed to evaluate how pediatric and adolescent patients fare within a strictly managed, capitated outpatient psychiatric setting. The charts of 96 consecutively evaluated patients, treated by one psychiatrist, were reviewed. Standardized assessment tools were used to reach a DSM-IV diagnosis. The initial level of severity was defined by a Global Assessment of Functioning scale at the time of the evaluation, and improvement after pharmacologic treatment was measured by the Global Index of Improvement. Patients in this sample suffered from similar psychiatric disorders and similar levels of initial impairment when compared with those reported in other outpatient samples. Of the original 96 youths, nine patients were initially referred to their primary care physician for medication treatment, and 26 had been told that pharmacotherapy was not indicated. In the psychiatric clinic, psychopharmacotherapy was recommended for 61 of the 96 patients (64%), and 46 patients (48%) followed through with this plan. Of the 46 patients treated with medications, 72% improved within approximately 4 months of treatment, whereas 28% did not. Five of the 23 (22%) adolescent patients with major depression were hospitalized within 2 months of the initial evaluation. Most of these pediatric and adolescent psychiatric patients appeared to be treated satisfactorily, despite the strong limitations of a capitated outpatient service. However, significant limitations in time and resources necessitated a variety of clinical adaptations to maintain adequate delivery of mental health services.

Both Atomoxetine and Stimulants Improve Quality of Life in an ADHD Population Treated in a Community Clinic

“…This observation has been made in previous real-world outcome projects [5,12]. The exact reasons for this observation are unclear.…”

Recognition and Treatment of Mental Disorders in Children

“…Disparities between recommendation and adherence have also been reported for psychotropic medications. In a psychiatric clinic within a managed care setting in the US, Bastiaens [49] documented that 64% of children and adolescents received a recommendation for medication, while only 48% pursued such treatment. Similarly, studies examining stimulant treatment for ADHD have found low rates of long-term adherence to medication regimens.…”

Adolescents? Response to Antidepressant Treatment in a Community Mental Health Center

“…Frequently used research instruments, such as the Hamilton Depression Rating Scale, were not employed because of time constraints. No measure of adherence to concomitant psychosocial treatment was incorporated, although in a previous psychopharmacology study, psychotherapy did not appear to enhance response (Bastiaens, 1998). Outcome measures collected at 6 months only cannot differentiate non-response from relapse or recurrence.…”

“…It is therefore unclear how depressed pediatric patients, who are treated with SSRI over an extended period of time in a community clinic, fare. Even though a retrospective chart review reported a 76% response rate to Citalopram in depressed adolescents treated for 4 months in a community mental health clinic (Bostic, Prince, Brown, & Place, 2001), a study of pediatric psychopharmacology in a Health Maintenance Organization, reported that depressed adolescents did not fare as well as patients with other conditions (Bastiaens, 1998).…”