Prescribing practices of psychiatrists and primary care physicians caring for children with mental illness.
OBJECTIVE
Although several studies have found that the most effective treatment for both youths and adults diagnosed with mood disorders is the combination of psychotherapy and medications, psychiatrists have been increasingly providing psychotropic medications without psychotherapy to these populations. At the same time, primary care physicians (PCPs) have become increasingly involved in prescribing psychotropic medications. This study compared the prescribing patterns of PCPs and psychiatrists caring for children with mental illness.


METHODS
Data were extracted from the MarketScan database, which compiles claims from private health insurance plans nationwide. Of 40,639 children who received mental health services during calendar year 2000 (6.33% of all covered children), we identified 5485 who initiated a new episode of treatment. Multiple regression was use to adjust for differences in patient characteristics.


RESULTS
While PCPs were more likely to see young children and psychiatrists saw children with more numerous mental illnesses, there were no significant differences between PCPs and psychiatrists in either the proportion of patients who received psychotropic medication, the frequency of clinical contacts, or the dosages or types of medications prescribed. Patients seen in more actively managed Point of Service plans were more likely to receive medication than those seen in preferred provider or indemnity plans.


CONCLUSIONS
This study found no significant differences between psychiatrists and PCPs in psychotropic prescribing practices. In view of the limited availability of child psychiatrists and the decreased availability of psychotherapy in combination with medications, collaborative care models in which non-physician mental health specialists and PCPs work together may increase the availability of effective mental health services for youths.
Harpaz-Rotem
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I
Yale University School of Medicine, Psychiatry, New Haven, CT, USA. ilan.harpaz-rotem@yale.edu
Rosenheck
R A
RA
D000293:Adolescent; D000294:Adolescent Behavior; D017677:Age Distribution; D001008:Anxiety Disorders / Q000188:drug therapy; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D002648:Child; D002653:Child Behavior Disorders / Q000188:drug therapy; D004334:Drug Administration Schedule; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D019964:Mood Disorders / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D011570:Psychiatry; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017678:Sex Distribution; D013997:Time Factors
D011619:Psychotropic Drugs