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American Academy of Pediatrics
Article

Antipsychotic Medication Prescribing in Children Enrolled in Medicaid

David C. Rettew, Jeanne Greenblatt, Jody Kamon, Diane Neal, Valerie Harder, Richard Wasserman, Patricia Berry, Charles D. MacLean, Nancy Hogue and William McMains
Pediatrics April 2015, 135 (4) 658-665; DOI: https://doi.org/10.1542/peds.2014-2260
David C. Rettew
aThe Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, Vermont;
bVermont Child Health Improvement Program, Department of Pediatrics, and
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Jeanne Greenblatt
aThe Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, Vermont;
bVermont Child Health Improvement Program, Department of Pediatrics, and
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Jody Kamon
bVermont Child Health Improvement Program, Department of Pediatrics, and
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Diane Neal
cCatamaran, Schaumburg, Illinois;
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Valerie Harder
bVermont Child Health Improvement Program, Department of Pediatrics, and
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Richard Wasserman
bVermont Child Health Improvement Program, Department of Pediatrics, and
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Patricia Berry
bVermont Child Health Improvement Program, Department of Pediatrics, and
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Charles D. MacLean
dDepartment of Medicine, University of Vermont College of Medicine, Burlington, Vermont;
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Nancy Hogue
eDepartment of Vermont Health Access, Williston, Vermont; and
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William McMains
fVermont Department of Mental Health, Williston, Vermont
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Abstract

BACKGROUND: Although the increase in treatment of children and adolescents with antipsychotic medications has been well documented, much less is known about the factors related to the use of these agents and how closely the treatment follows best practice recommendations.

METHODS: Prescribers of each antipsychotic medication prescription issued for a Medicaid-insured child in Vermont aged <18 years were sent a prior authorization survey that assessed several domains including the clinical indication, other treatments, metabolic monitoring, prescriber specialty, and prescription origin. These variables were combined to categorize prescriptions as following indications approved by the US Food and Drug Administration (FDA) and best practice guidelines.

RESULTS: The response rate of the survey was 80%, with 677 surveys from 147 prescribers available for analysis; more than one-half of the respondents were primary care clinicians. Overall, the clinical indication for an antipsychotic prescription followed best practice guidelines 91.7% of the time, with overall best practice guidelines followed at a rate of 50.1%. An FDA indication was followed in 27.2% of cases. Psychiatrists were significantly more likely to follow best practice guidelines than nonpsychiatrists. Antipsychotic medications were typically used only after other pharmacologic and nonpharmacologic treatments were ineffective, although previous treatment with cognitive-behavioral therapy was uncommon (15.5%). Metabolic monitoring that included serial laboratory tests was reported in 57.2% of cases.

CONCLUSIONS: Current prescribing patterns of antipsychotic medications for children and adolescents follow best practice guidelines approximately one-half of the time, with nonadherence often related to lack of metabolic monitoring.

  • antipsychotic medications
  • psychotropic
  • Accepted January 22, 2015.
  • Copyright © 2015 by the American Academy of Pediatrics

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Pediatrics
Vol. 135, Issue 4
1 Apr 2015
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Antipsychotic Medication Prescribing in Children Enrolled in Medicaid
David C. Rettew, Jeanne Greenblatt, Jody Kamon, Diane Neal, Valerie Harder, Richard Wasserman, Patricia Berry, Charles D. MacLean, Nancy Hogue, William McMains
Pediatrics Apr 2015, 135 (4) 658-665; DOI: 10.1542/peds.2014-2260

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Antipsychotic Medication Prescribing in Children Enrolled in Medicaid
David C. Rettew, Jeanne Greenblatt, Jody Kamon, Diane Neal, Valerie Harder, Richard Wasserman, Patricia Berry, Charles D. MacLean, Nancy Hogue, William McMains
Pediatrics Apr 2015, 135 (4) 658-665; DOI: 10.1542/peds.2014-2260
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