Identifying clinically questionable psychotropic prescribing practices for medicaid recipients in new york state.
OBJECTIVE
This study sought to identify and characterize rates of clinically questionable prescribing in New York State.


METHODS
As part of a quality improvement initiative, 34 national psychopharmacology experts identified a set of questionable prescribing practices recognizable from pharmacy claims data. Indicators of such practices were applied to Medicaid claims data for 217,216 beneficiaries in New York State who had an active psychotropic prescription on April 1, 2008.


RESULTS
A total of 156,103 (72%) of these beneficiaries had one or more continuing (>90 days) prescriptions for a psychotropic. About 10% of adults were prescribed four or more psychotropics concurrently, and 13% of children and 2% of older adults were prescribed three or more concurrently. Prescribing an antipsychotic with a moderate-to-high risk of causing metabolic abnormalities approached 50% (46%) among individuals who had existing cardiometabolic conditions. Among beneficiaries prescribed second-generation antipsychotics with a moderate-to-high risk of causing metabolic abnormalities, over half (60%) had not received a metabolic screening test in the past year. Among women of reproductive age prescribed mood stabilizers, over one-quarter (30%) were prescribed a valproic acid-based formulation despite its potential for teratogenicity. Only 2% of youths under age 18 were prescribed benzodiazepines; however, about half (48%) had trials over 90 days' duration.


CONCLUSIONS
Examination of pharmacy claims from Medicaid beneficiaries in New York State indicated that prescribing practices deemed clinically questionable by pharmacology experts are common. Aggregated pharmacy claims data can identify such practices, and reviews of these data can be a core component of efforts to improve prescribing practices.
Essock
Susan M
SM
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, USA. se2176@columbia.edu
Covell
Nancy H
NH
Leckman-Westin
Emily
E
Lieberman
Jeffrey A
JA
Sederer
Lloyd I
LI
Kealey
Edith
E
Finnerty
Molly T
MT
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D009518:New York; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D014481:United States
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs; D001569:Benzodiazepines