Robert B Penfold1, Ella E Thompson2, Robert J Hilt3, Nadine Schwartz4, Adelaide S Robb5, Christoph U Correll6, Douglas Newton7, Kelly Rogalski8, Marian F Earls9, Robert A Kowatch4, Arne Beck10, Bobbi Jo H Yarborough11, Stephen Crystal12, Benedetto Vitiello13, Kelly J Kelleher4, Gregory E Simon2. 1. Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle. Electronic address: robert.b.penfold@kp.org. 2. Drs. Penfold, Simon, and Ms. Thompson are with Kaiser Permanente Washington Health Research Institute, Seattle. 3. Dr. Hilt is with Seattle Children's Hospital, Washington. 4. Drs. Schwartz, Kowatch, and Kelleher are with Nationwide Children's Hospital, Columbus, Ohio. 5. Dr. Robb is with Children's National Hospital, Washington, DC. 6. Dr. Correll is with The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; The Feinstein Institute for Medical Research, Manhasset, New York; and Charité Universitätsmedizin Berlin, Germany. 7. Dr. Newton is with Sondermind, Denver, Colorado. At the time of the study, Dr. Newton was with Optum Behavioral Health, Denver, Colorado. 8. Dr. Rogalski is with Henry Ford Health System, Detroit, Michigan. 9. Dr. Earls is with Community Care of North Carolina, Raleigh. 10. Dr. Beck is with Kaiser Permanente Colorado Institute for Health Research, Denver. 11. Dr. Yarborough is with Kaiser Permanente Northwest Center for Health Research, Portland, Oregon. 12. Dr. Crystal is with Rutgers University, Brunswick, New Jersey. 13. Dr. Vitiello is with Università degli Studi di Torino, Turin, Italy.
Abstract
OBJECTIVE: To develop a new approach to prescribing guidelines as part of a pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. METHOD: A nominal group technique was used to identify first- to nth-line treatments for target symptoms and potential diagnoses. The panel included US pediatricians, child and adolescent psychiatrists, and psychopharmacology experts. Meeting materials included information about Medicaid review programs, systematic reviews, prescribing guidelines, and a description of the pragmatic trial. Afterward, a series of 4 webinar discussions were held to achieve consensus on recommendations. RESULTS: The panel unanimously agreed that the guideline should focus on target symptoms rather than diagnoses. Guidance included recommendations for first- to nth-line treatment of target mental health symptoms, environmental factors to be addressed, possible underlying diagnoses that should first be considered and ruled out, and general considerations for pharmacological and therapeutic treatments. CONCLUSION: Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. Our approach addresses some of these concerns. If the approach proves successful in our ongoing pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY), it may serve as a model to state Medicaid programs and health systems to support clinicians in delivering high-quality mental health care to youths. CLINICAL TRIAL REGISTRATION INFORMATION: Safer Use of Antipsychotics in Youth; http://clinicaltrials.gov/; NCT03448575.
OBJECTIVE: To develop a new approach to prescribing guidelines as part of a pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. METHOD: A nominal group technique was used to identify first- to nth-line treatments for target symptoms and potential diagnoses. The panel included US pediatricians, child and adolescent psychiatrists, and psychopharmacology experts. Meeting materials included information about Medicaid review programs, systematic reviews, prescribing guidelines, and a description of the pragmatic trial. Afterward, a series of 4 webinar discussions were held to achieve consensus on recommendations. RESULTS: The panel unanimously agreed that the guideline should focus on target symptoms rather than diagnoses. Guidance included recommendations for first- to nth-line treatment of target mental health symptoms, environmental factors to be addressed, possible underlying diagnoses that should first be considered and ruled out, and general considerations for pharmacological and therapeutic treatments. CONCLUSION: Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. Our approach addresses some of these concerns. If the approach proves successful in our ongoing pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY), it may serve as a model to state Medicaid programs and health systems to support clinicians in delivering high-quality mental health care to youths. CLINICAL TRIAL REGISTRATION INFORMATION: Safer Use of Antipsychotics in Youth; http://clinicaltrials.gov/; NCT03448575.
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