Prescribing Practices of Inpatient Child Psychiatrists Under Three Auspices of Care

Abstract

To study prescribing practices of inpatient child psychiatrists under 3 auspices of care, 137 medicated patients were compared to 122 nonmedicated patients at a state hospital, a private hospital and a county-university hospital in New York during 1991. Overall, 79% of state, 76% of private, and 68% of county-university hospital patients received at least one dose of psychotropic medication, with the state versus county-university comparison significant (p < 0.05). Significantly more medicated patients at the private hospital (80%) than at the state or county-university hospitals (each 26%) received antidepressants (p's < 0.001). Significantly more county-university (74%) than private (35%) patients received antipsychotic medications, but the proportion of nonpsychotic patients receiving antipsychotic medication was statistically similar across the three hospitals. In nonpsychotic patients, antipsychotic agents were used to treat aggressive behavior. Patients 12 years of age or younger received more stimulants, and patients 13 years of age or older received more lithium (p's < 0.01). In a clinical review of medical charts of medicated patients from the 3 auspices of care, approximately 90% of the medication-treated patients were treated at an acceptable dose level and with an acceptable rationale based on symptom or diagnosis. These and other findings and other suggest that children in state hospitals are not over-medicated in comparison to children in private hospitals or university-county hospitals, and that prescribing practices among the three hospitals, despite their different funding sources, are comparable.

Observed Clinical and Health Services Outcomes in Pediatric Inpatients Treated with Atypical Antipsychotics: 1999–2003

“…These results are consistent with those from a study of medication practices (Kaplan and Busner 1997), in which adolescent inpatients who were treated with psychotropic drugs had significantly longer LOS (p Յ 0.0001) than non-FLANDERS ET AL. 322 FIG.…”

Psychotropic Medication Utilization in a Child and Adolescent Mental Health Service

“…The majority of prescribers in our study were psychiatrists, or trainee psychiatrists. Other studies have reported low rates of stimulant use in psychiatric settings (Kaplan and Busner 1997) and that psychiatrists are less likely to prescribe stimulants or combined stimulants and clonidine, compared to pediatricians or general practioners (GPs) (Efron et al 2003;Jensen et al 2003). This difference in prescriber profile may also be an explanation for the low rates of clonidine use in our study .…”

Trends in Psychotropic Drug Use in a Child Psychiatric Hospital from 1991–1998

“…Safer (1997) found that there was an increase in outpatient psychotropic drug prescribing in the community mental health center setting when comparing 1994 to the period from 1988-1992. Kaplan and Busner (1997) documented prescribing practices in three different inpatient settings in the year 1991, although they did not have data available for longitudinal comparison.…”