Antipsychotic medication prescribing in children enrolled in Medicaid.
BACKGROUND
Although the increase in treatment of children and adolescents with antipsychotic medications has been well documented, much less is known about the factors related to the use of these agents and how closely the treatment follows best practice recommendations.


METHODS
Prescribers of each antipsychotic medication prescription issued for a Medicaid-insured child in Vermont aged <18 years were sent a prior authorization survey that assessed several domains including the clinical indication, other treatments, metabolic monitoring, prescriber specialty, and prescription origin. These variables were combined to categorize prescriptions as following indications approved by the US Food and Drug Administration (FDA) and best practice guidelines.


RESULTS
The response rate of the survey was 80%, with 677 surveys from 147 prescribers available for analysis; more than one-half of the respondents were primary care clinicians. Overall, the clinical indication for an antipsychotic prescription followed best practice guidelines 91.7% of the time, with overall best practice guidelines followed at a rate of 50.1%. An FDA indication was followed in 27.2% of cases. Psychiatrists were significantly more likely to follow best practice guidelines than nonpsychiatrists. Antipsychotic medications were typically used only after other pharmacologic and nonpharmacologic treatments were ineffective, although previous treatment with cognitive-behavioral therapy was uncommon (15.5%). Metabolic monitoring that included serial laboratory tests was reported in 57.2% of cases.


CONCLUSIONS
Current prescribing patterns of antipsychotic medications for children and adolescents follow best practice guidelines approximately one-half of the time, with nonadherence often related to lack of metabolic monitoring.
The Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, Vermont; Vermont Child Health Improvement Program, Department of Pediatrics, and david.rettew@med.uvm.edu.
David C
DC
Rettew
The Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, Vermont; Vermont Child Health Improvement Program, Department of Pediatrics, and.
Jeanne
J
Greenblatt
Vermont Child Health Improvement Program, Department of Pediatrics, and.
Jody
J
Kamon
Catamaran, Schaumburg, Illinois;
Diane
D
Neal
Vermont Child Health Improvement Program, Department of Pediatrics, and.
Valerie
V
Harder
Vermont Child Health Improvement Program, Department of Pediatrics, and.
Richard
R
Wasserman
Vermont Child Health Improvement Program, Department of Pediatrics, and.
Patricia
P
Berry
Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont;
Charles D
CD
MacLean
Department of Vermont Health Access, Williston, Vermont; and.
Nancy
N
Hogue
Vermont Department of Mental Health, Williston, Vermont.
William
W
McMains
D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003299:Cooperative Behavior; D016903:Drug Monitoring; D004363:Drug Utilization / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D033183:Interdisciplinary Communication; D008484:Medicaid / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry; D014481:United States; D014486:United States Food and Drug Administration
D014150:Antipsychotic Agents
antipsychotic medications; psychotropic