Laura J Chavez1, Kelly J Kelleher1, Arne Beck2, Gregory N Clarke3, Robert B Penfold4. 1. Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA. 2. Kaiser Permanente Colorado, Institute for Health Research, Denver, Colorado, USA. 3. Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA. 4. Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
Abstract
Objectives: Antipsychotic prescribing in children and adolescents increased sharply beginning in the 1990s, but recent reports among Medicaid enrollees suggest declining trends. However, few studies have included both commercially and publicly insured patients or focused on trends in new antipsychotic medications in children without documented psychotic disorders or other indicated conditions. The objective of the study was to report trends in new antipsychotic prescribing for pediatric patients (age 3-17 years) in a large children's health care system. Methods: Data were abstracted from electronic medical records (January 1, 2013 to December 31, 2017). New antipsychotic medication orders were defined as antipsychotic orders for patients without an order in the 180 days prior. Patients were excluded if the order was initiated in an emergency department or inpatient setting; they were diagnosed with psychotic disorder, mania, autism spectrum disorder, or intellectual disability; or the order was for prochlorperazine. The crude rate of new antipsychotic prescribing is reported quarterly with Poisson 95% confidence intervals in the total sample and by demographic subgroups (child vs. adolescent, female vs. male, public vs. private insurance, and white vs. nonwhite). Results: Antipsychotic orders decreased from 54.9 prescriptions per 10,000 person months in the first quarter of 2013 to 34.1 per 10,000 person months in the last quarter of 2017. Rates of antipsychotic prescribing were significantly higher for adolescents compared with children, patients who were commercially insured compared with Medicaid insured, and at most time points for white compared with non-white patients. However, prescribing rates did not differ significantly based on gender. Conclusions: Antipsychotic prescribing declined for both commercially and Medicaid-insured children in a pediatric hospital-based system, although white and commercially insured patients were more likely to be prescribed antipsychotics. More attention may be needed for reducing potentially avoidable prescribing of antipsychotics in previously understudied subgroups, such as commercially insured patients. Clinical Trial Registration Number: NCT03448575.
Objectives: Antipsychotic prescribing in children and adolescents increased sharply beginning in the 1990s, but recent reports among Medicaid enrollees suggest declining trends. However, few studies have included both commercially and publicly insured patients or focused on trends in new antipsychotic medications in children without documented psychotic disorders or other indicated conditions. The objective of the study was to report trends in new antipsychotic prescribing for pediatric patients (age 3-17 years) in a large children's health care system. Methods: Data were abstracted from electronic medical records (January 1, 2013 to December 31, 2017). New antipsychotic medication orders were defined as antipsychotic orders for patients without an order in the 180 days prior. Patients were excluded if the order was initiated in an emergency department or inpatient setting; they were diagnosed with psychotic disorder, mania, autism spectrum disorder, or intellectual disability; or the order was for prochlorperazine. The crude rate of new antipsychotic prescribing is reported quarterly with Poisson 95% confidence intervals in the total sample and by demographic subgroups (child vs. adolescent, female vs. male, public vs. private insurance, and white vs. nonwhite). Results: Antipsychotic orders decreased from 54.9 prescriptions per 10,000 person months in the first quarter of 2013 to 34.1 per 10,000 person months in the last quarter of 2017. Rates of antipsychotic prescribing were significantly higher for adolescents compared with children, patients who were commercially insured compared with Medicaid insured, and at most time points for white compared with non-white patients. However, prescribing rates did not differ significantly based on gender. Conclusions: Antipsychotic prescribing declined for both commercially and Medicaid-insured children in a pediatric hospital-based system, although white and commercially insured patients were more likely to be prescribed antipsychotics. More attention may be needed for reducing potentially avoidable prescribing of antipsychotics in previously understudied subgroups, such as commercially insured patients. Clinical Trial Registration Number: NCT03448575.
Authors: Nick C Patel; M Lynn Crismon; Kimberly Hoagwood; Michael T Johnsrud; Karen L Rascati; James P Wilson; Peter S Jensen Journal: J Am Acad Child Adolesc Psychiatry Date: 2005-06 Impact factor: 8.829
Authors: Thomas I Mackie; Ana J Schaefer; Hannah E Karpman; Stacey M Lee; Christopher Bellonci; Justine Larson Journal: J Am Acad Child Adolesc Psychiatry Date: 2020-09-20 Impact factor: 8.829
Authors: W David Lohr; Russell T Chowning; Michelle D Stevenson; Patricia Gail Williams Journal: J Child Adolesc Psychopharmacol Date: 2015-04-21 Impact factor: 2.576
Authors: Shannon N Saldaña; Brooks R Keeshin; Anna M Wehry; Thomas J Blom; Michael T Sorter; Melissa P DelBello; Jeffrey R Strawn Journal: Pharmacotherapy Date: 2014-07-03 Impact factor: 4.705
Authors: Stephen Crystal; Thomas Mackie; Miriam C Fenton; Shahla Amin; Sheree Neese-Todd; Mark Olfson; Scott Bilder Journal: Health Aff (Millwood) Date: 2016-06-01 Impact factor: 6.301
Authors: Luuk J Kalverdijk; Christian J Bachmann; Lise Aagaard; Mehmet Burcu; Gerd Glaeske; Falk Hoffmann; Irene Petersen; Catharina C M Schuiling-Veninga; Linda P Wijlaars; Julie M Zito Journal: Child Adolesc Psychiatry Ment Health Date: 2017-10-11 Impact factor: 3.033
Authors: Robert B Penfold; Ella E Thompson; Robert J Hilt; Kelly J Kelleher; Nadine Schwartz; Arne Beck; Gregory N Clarke; James D Ralston; Andrea L Hartzler; R Yates Coley; Mary Akosile; Benedetto Vitiello; Gregory E Simon Journal: Contemp Clin Trials Date: 2020-10-20 Impact factor: 2.226