title: Polypharmacy reduction in youth in a residential treatment center leads to positive treatment outcomes and significant cost savings.
abstract: OBJECTIVE
  The purpose of this study was to assess whether polypharmacy regimens can be safely and effectively reduced for youth placed in a residential treatment center, and to assess the cost savings achieved from medication reductions.
  
  
  METHODS
  Data were collected for 131 youth ages 11-18, who were admitted to and discharged from a residential treatment center between 2007 and 2011. Six month postdischarge data were available for 51 youth. Data include demographics, admission and discharge medications, place of discharge, and postdischarge stability level.
  
  
  RESULTS
  Upon admission, 30 youth were not on medication, at discharge 48 were not; a 60% increase. Mean number of admission medications was 2.16 (SD=0.97) versus 1.55 (SD=0.70) upon discharge. Upon admission, one youth was on five and nine were on four medications. At end-point, only one youth was on four medications. The number of youth needing two or more medications declined by 55%, and the number of those needing three or more declined by 69%. The largest reduction was seen in the number of antipsychotics and antidepressants. Mood stabilizer and antipsychotic combinations declined by 65%. Youth with medication reduction were more likely to be discharged to a less restrictive setting than were youth without medication reduction (72.6% vs. 53.8%), p=0.03. At 6 months postdischarge, of the 51 out of 131 youth with available follow-up data, 71% were doing well. Cost analysis based on discontinued medication by class showed monthly savings of $21,365, or $256,368 yearly. The largest contributor was the reduction in the use of antipsychotics, accounting for $205,332 of the total savings.
  
  
  CONCLUSIONS
  Our study indicates that comprehensive treatment can lead to significant reductions in polypharmacy, and positive short- and longer-term treatment outcomes. Judicial prescribing also resulted in significant cost reduction in an already costly healthcare system.
authors.affiliation: 1 The Children's Center of Hamden , Hamden, Connecticut.
authors.forename: Pieter Joost
authors.initials: PJ
authors.lastname: van Wattum
authors.forename: Caroline
authors.initials: C
authors.lastname: Fabius
authors.forename: Corey
authors.initials: C
authors.lastname: Roos
authors.forename: Cheryl
authors.initials: C
authors.lastname: Smith
authors.forename: Todd
authors.initials: T
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D002648:Child; D017046:Cost Savings; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000191:economics; D010343:Patient Admission; D010351:Patient Discharge; D019338:Polypharmacy; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D012114:Residential Treatment / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs