ABSTRACT
This retrospective study describes a second-opinion review program for the care of children in Washington State who received Medicaid coverage and who were prescribed five or more psychotropic medications, primarily by mental health specialists. In total, 136 second-opinion reviews from 2013 and 169 from 2018 were included in this study. Attention-deficit hyperactivity disorder (ADHD), behavioral difficulties, anxiety, and trauma were prevalent among these children, and participants were commonly prescribed ADHD medications, selective serotonin reuptake inhibitors, and second-generation antipsychotics. The incidence of reviews remained stable over the two periods, but psychosocial treatment increased significantly over this time. This study sheds light on the initiation, maintenance, and identification of polypharmacy psychotropic regimens and highlights psychosocial treatment as an intervention that increases best practice care for at-risk patients.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Psychotropic Drugs , Adolescent , Attention Deficit Disorder with Hyperactivity/drug therapy , Child , Humans , Medicaid , Polypharmacy , Psychotropic Drugs/therapeutic use , Retrospective Studies , United States , WashingtonABSTRACT
OBJECTIVE: To learn if a quality of care Medicaid child psychiatric consultation service implemented in three different steps was linked to changes in statewide child antipsychotic utilization. DATA SOURCES/STUDY SETTING: Washington State child psychiatry consultation program primary data and Medicaid pharmacy division antipsychotic utilization secondary data from July 1, 2006, through December 31, 2013. STUDY DESIGN: Observational study in which consult program data were analyzed with a time series analysis of statewide antipsychotic utilization. DATA COLLECTION/EXTRACTION METHODS: All consultation program database information involving antipsychotics was compared to Medicaid pharmacy division database information involving antipsychotic utilization. PRINCIPAL FINDINGS: Washington State's total child Medicaid antipsychotic utilization fell from 0.51 to 0.25 percent. The monthly prevalence of use fell by a mean of 0.022 per thousand per month following the initiation of elective consults (p = .004), by 0.065 following the initiation of age/dose triggered mandatory reviews (p < .001), then by another 0.022 following the initiation of two or more concurrent antipsychotic mandatory reviews (p = .001). High-dose antipsychotic use fell by 57.8 percent in children 6- to 12-year old and fell by 52.1 percent in teens. CONCLUSIONS: Statewide antipsychotic prescribing for Medicaid clients fell significantly at different rates following each implementation step of a multilevel consultation and best-practice education service.
Subject(s)
Antipsychotic Agents/therapeutic use , Child Psychiatry/organization & administration , Practice Patterns, Physicians'/statistics & numerical data , Referral and Consultation/organization & administration , Adolescent , Age Factors , Child , Child Psychiatry/statistics & numerical data , Child, Preschool , Drug Utilization Review , Female , Humans , Infant , Infant, Newborn , Male , Medicaid/statistics & numerical data , United States , WashingtonABSTRACT
Integrated care is a way to improve the prevention, identification, and treatment of mental health difficulties, including substance abuse, in pediatric care. The pediatrician's access, expertise in typical development, focus on prevention, and alignment with patients and families can allow successful screening, early intervention, and referral to treatment. Successful integrated substance abuse care for youth is challenged by current reimbursement systems, information exchange, and provider role adjustment issues, but these are being addressed as comfort with this care form and resources to support its development grow.
Subject(s)
Delivery of Health Care, Integrated , Pediatrics , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapy , Humans , Referral and ConsultationABSTRACT
BACKGROUND: Telepsychiatry has clinical efficacy with children, but questions remain about cost-effectiveness. State agencies and health systems need to know if a child telepsychiatry consult system can address system concerns and improve care quality while lowering costs. MATERIALS AND METHODS: To assist care in a rural state with few child and adolescent psychiatrists, an academic center coordinated a consult system of (1) televideo consults for high-needs children with Medicaid and state Multidisciplinary Team (MDT)/foster care involvement, (2) remote medication reviews for beyond guidelines prescribing, and (3) elective community provider telephone-based consults. Consult service data were collected and analyzed with Wyoming's Medicaid and Foster Care Divisions between the program start in January 2011 until March 2013. RESULTS: There were 229 televideo MDT/foster care consults, 125 mandatory medication reviews, and 277 elective phone consultations supporting community providers during this period. Following implementation, the number of Medicaid children ≤5 years of age using psychotropic medications decreased by 42% (p<0.001), and the number of children using psychotropic doses >150% of the Food and Drug Administration maximum decreased by 52% (p<0.001). Televideo consults redirected 60% of children slated by caseworkers for a psychiatric residential treatment facility admission into alternative community treatment and placements. A financial return on investment was 1.82 to 1 for combined services. CONCLUSIONS: This coordinated child telepsychiatry consult system for a state Medicaid division reduced outlier pediatric psychiatric medication prescribing, supported local community-delivered treatments, and reduced unnecessary hospitalizations in a financially advantageous manner that was well received by the practice community.
