title: Small geographic area variations in prescription drug use.
abstract: BACKGROUND
  Despite the frequency of pediatric prescribing little is known about practice differences across small geographic regions and payer type (Medicaid and commercial).
  
  
  OBJECTIVE
  The goal of this research was to quantify variation in prescription drug use among northern New England children.
  
  
  METHODS
  Northern New England, all-payer administrative data (2007-2010) permitted study of prescriptions for 949 821 children ages 0 to 17 years (1.75 million person-years [PYs]; 54% Medicaid, 46% commercial). Age- and gender adjusted overall and drug group-specific prescription use was quantified according to payer type (Medicaid or commercial) and within payer type across 69 hospital service areas (HSAs). We measured prescription fills per PY (rate) and annual, mean percentage of the population with any drug group-specific fills (prevalence).
  
  
  RESULTS
  Overall mean annual prescriptions per PY were 3.4 (commercial) and 5.5 (Medicaid). Generally, these payer type differences were smaller than HSA-level variation within payer type. HSA-level rates of attention-deficit/hyperactivity disorder drug use (5th-95th percentile) varied twofold in Medicaid and more than twofold in commercially insured children; HSA-level antidepressant use varied more than twofold within each payer type. Antacid use varied threefold across HSAs and was highest in infants where commercial use paradoxically exceeded Medicaid. Prevalence of drug use varied as much as rates across HSAs.
  
  
  CONCLUSIONS
  Prescription use was higher among Medicaid-insured than commercially insured children. Regional variation generally exceeded payer type differences, especially for drugs used in situations of diagnostic and therapeutic uncertainty. Efforts should advance best pediatric prescribing discussions and shared decision-making.
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; shelsey.j.weinstein.med@dartmouth.edu.
authors.forename: Shelsey J
authors.initials: SJ
authors.lastname: Weinstein
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire;
authors.forename: Samantha A
authors.initials: SA
authors.lastname: House
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire;Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire;The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire; andDepartment of Community and Family Medicine Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.affiliation: The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire; and.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Wasserman
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire; and Department of Community and Family Medicine Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: David C
authors.initials: DC
authors.lastname: Goodman
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire; and Department of Community and Family Medicine Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Morden
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009511:New England / Q000453:epidemiology; D011159:Population Surveillance; D055553:Prescription Drugs / Q000627:therapeutic use*
chemical_list: D055553:Prescription Drugs
keywords: antibiotic use; attention-deficit/hyperactivity disorder; gastroesophageal reflux; geography; methylphenidate; pharmacotherapy