Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. e157-e163 (doi:10.1542/10.1542/peds.2007-0212)
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ARTICLE

Psychotropic Medication Patterns Among Youth in Foster Care

Julie M. Zito, PhDa,b, Daniel J. Safer, MDc, Devadatta Sai, MSa, James F. Gardner, ScMa, Diane Thomas, BAd, Phyllis Coombes, MAd, Melissa Dubowski, BSd and Maria Mendez-Lewis, MPAd

Departments of a Pharmaceutical Health Services Research
b Psychiatry, University of Maryland, Baltimore, Maryland
c Department of Psychiatry and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland
d Office of the Texas Comptroller of Public Accounts, Austin, Texas

CONTEXT. Studies have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate >3 times that of Medicaid-insured youth who qualify by low family income. Systematic data on patterns of medication treatment, particularly concomitant drugs, for youth in foster care are limited.

OBJECTIVE. The purpose of this work was to describe and quantify patterns of psychotropic monotherapy and concomitant therapy prescribed to a randomly selected, 1-month sample of youth in foster care who had been receiving psychotropic medication.

METHODS. Medicaid data were accessed for a July 2004 random sample of 472 medicated youth in foster care aged 0 through 19 years from a southwestern US state. Psychotropic medication treatment data were identified by concomitant pattern, frequency, medication class, subclass, and drug entity and were analyzed in relation to age group; gender; race or ethnicity; International Classification of Diseases, Ninth Revision, psychiatric diagnosis; and physician specialty.

RESULTS. Of the foster children who had been dispensed psychotropic medication, 41.3% received ≥3 different classes of these drugs during July 2004, and 15.9% received ≥4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). The use of specific psychotropic medication classes varied little by diagnostic grouping. Psychiatrists prescribed 93% of the psychotropic medication dispensed to youth in foster care. The use of ≥2 drugs within the same psychotropic medication class was noted in 22.2% of those who were given prescribed drugs concomitantly.

CONCLUSIONS. Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety.

Key Words: concomitant medications • psychotropic medication • foster care • Medicaid • pharmacotherapy

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • SSRI—selective serotonin-reuptake inhibitor • ATC-MS—anticonvulsant mood stabilizer

Accepted May 29, 2007.


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