Thomas I Mackie1, Ana J Schaefer2, Hannah E Karpman3, Stacey M Lee4, Christopher Bellonci5, Justine Larson6. 1. Rutgers School of Public Health and Institute for Health, Health Care Policy, and Aging Research, at Rutgers, the State University of New Jersey, New Brunswick. Electronic address: tmackie@ifh.rutgers.edu. 2. Rutgers School of Public Health and Institute for Health, Health Care Policy, and Aging Research, at Rutgers, the State University of New Jersey, New Brunswick. 3. Smith College School for Social Work. 4. Health Resources and Services Administration, Rockville, Maryland; Substance Abuse and Mental Health Services Administration, Rockville, Maryland. 5. Judge Baker Children's Center, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts. 6. Substance Abuse and Mental Health Services Administration, Rockville, Maryland.
Abstract
OBJECTIVE: Rapid growth of antipsychotic use among children and adolescents at the turn of the 21st century led Medicaid programs to implement 3 types of system-wide interventions: antipsychotic monitoring programs, clinician prescribing supports, and delivery system enhancements. This systematic review assessed the available evidence base for and relative merits of these system-wide interventions that aim to improve antipsychotic treatment and management. METHOD: Using PRISMA guidelines, eligible studies were written in English and evaluated system-wide interventions to monitor antipsychotic treatment or promote antipsychotic management among children and adolescents (0-21 years of age). Studies were identified through Ovid MEDLINE and PsychInfo (years 1990-2018) and an environmental scan. From an initial review of 824 publications, 17 studies met eligibility criteria. Two authors independently conducted quality assessments using the Crowe Critical Appraisal Tool. Findings were summarized descriptively. RESULTS: Identified studies (n = 17) evaluated prior authorization programs (n = 10), drug utilization reviews (n = 2), quality improvement (n = 4), care coordination programs (n = 1), and multimodal initiatives (n = 2). Studies were predominantly pre-post analyses, without a comparison group. With the exception of care coordination and drug utilization reviews, more than half of the interventions in each category were associated with significant reduction in antipsychotic treatment or promotion of best practice parameters. CONCLUSION: This evidence review concludes that evaluations of prior authorization programs demonstrate reductions in antipsychotic treatment, though evidence of impact of other system-wide interventions and other outcomes is limited. Additional research is necessary to investigate whether interventions influenced antipsychotic prescribing independent of secular trends, the comparative effectiveness and cost-effectiveness of interventions, the effect on functional outcomes, and the potential for unintended consequences.
OBJECTIVE: Rapid growth of antipsychotic use among children and adolescents at the turn of the 21st century led Medicaid programs to implement 3 types of system-wide interventions: antipsychotic monitoring programs, clinician prescribing supports, and delivery system enhancements. This systematic review assessed the available evidence base for and relative merits of these system-wide interventions that aim to improve antipsychotic treatment and management. METHOD: Using PRISMA guidelines, eligible studies were written in English and evaluated system-wide interventions to monitor antipsychotic treatment or promote antipsychotic management among children and adolescents (0-21 years of age). Studies were identified through Ovid MEDLINE and PsychInfo (years 1990-2018) and an environmental scan. From an initial review of 824 publications, 17 studies met eligibility criteria. Two authors independently conducted quality assessments using the Crowe Critical Appraisal Tool. Findings were summarized descriptively. RESULTS: Identified studies (n = 17) evaluated prior authorization programs (n = 10), drug utilization reviews (n = 2), quality improvement (n = 4), care coordination programs (n = 1), and multimodal initiatives (n = 2). Studies were predominantly pre-post analyses, without a comparison group. With the exception of care coordination and drug utilization reviews, more than half of the interventions in each category were associated with significant reduction in antipsychotic treatment or promotion of best practice parameters. CONCLUSION: This evidence review concludes that evaluations of prior authorization programs demonstrate reductions in antipsychotic treatment, though evidence of impact of other system-wide interventions and other outcomes is limited. Additional research is necessary to investigate whether interventions influenced antipsychotic prescribing independent of secular trends, the comparative effectiveness and cost-effectiveness of interventions, the effect on functional outcomes, and the potential for unintended consequences.
Authors: Thomas I Mackie; Ana J Schaefer; Justeen K Hyde; Laurel K Leslie; Emily A Bosk; Brittany Fishman; R Christopher Sheldrick Journal: Implement Sci Date: 2021-03-11 Impact factor: 7.327
Authors: Thomas I Mackie; Katherine M Kovacs; Cassandra Simmel; Stephen Crystal; Sheree Neese-Todd; Ayse Akincigil Journal: Health Serv Res Date: 2020-12-28 Impact factor: 3.402
Authors: Laura J Chavez; Kelly J Kelleher; Arne Beck; Gregory N Clarke; Robert B Penfold Journal: J Child Adolesc Psychopharmacol Date: 2021-06 Impact factor: 3.031