title: Ambulatory use of psychotropics by employer-insured children and adolescents in a national managed care organization.
abstract: OBJECTIVE
  To provide a description of the ambulatory use of psychotropic medications by children and adolescents in a large, geographically diverse employer-insured population.
  
  
  METHODS
  This retrospective observational study used administrative claims data for 1995-1999 for members under age 20 in 6 Independent Practice Association health plans affiliated with UnitedHealth Group. We calculated the prevalences of use for 4 major therapeutic drug classes: central nervous system stimulants (CNSSs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other antidepressants (OADs). Changes over time by age, gender, geographic region, and prescriber specialty were analyzed across drug classes.
  
  
  RESULTS
  The prevalence of CNSS, SSRI, and OAD use steadily increased over the 5-year period, whereas TCA use decreased. The prevalence of use of the most commonly used classes, the CNSS and SSRI classes, increased from 23.8 to 30.0 per 1000 and 7.9 to 12.8, respectively. There was variability across and within geographic regions. Pediatricians were the most frequent first prescribers of CNSS, and psychiatrists were most likely to prescribe SSRIs.
  
  
  CONCLUSIONS
  Acceleration of use of psychotropic medications is slower in an employer-insured national population. Since primary care physicians are frequent prescribers of psychotropics, their training and expertise are crucial.
authors.affiliation: Center for Health Care Policy and Evaluation, UnitedHealth Group, Minnetonka, MN 55343, USA. deborah_shatin@uhc.com
authors.forename: Deborah
authors.initials: D
authors.lastname: Shatin
authors.forename: Carol R
authors.initials: CR
authors.lastname: Drinkard
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000928:Antidepressive Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000928:Antidepressive Agents; D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs