Antipsychotic prescribing for behavioral disorders in US youth: physician specialty, insurance coverage, and complex regimens.
OBJECTIVE
To assess antipsychotic prescribing patterns according to insurance coverage type and physician specialty in the outpatient treatment of behavioral disorders (BD) in US youth.


METHODS
We used 2003-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data to compare antipsychotic prescribing in the outpatient treatment of BD in youth (6-19 years) according to insurance coverage (public vs. private) and physician specialty (psychiatrist vs. non-psychiatrist) using population-weighted Chi-square and multivariable analyses. Also, we examined co-prescribing of antipsychotics with other psychotropic medication classes. Subgroup analyses were conducted in BD visits with no other clinician-reported psychiatric diagnosis (non-comorbid BD visits).


RESULTS
A large majority (71.0%) of BD visits were provided by non-psychiatrists. However, psychiatrists prescribed antipsychotics far more frequently than non-psychiatrists (24.2% vs. 4.6%; adjusted odds ratio (AOR) = 5.1 [95% confidence interval (CI), 2.8-9.2]) in total BD visits as well as in non-comorbid BD visits (18.6% vs. 3.6%; AOR = 5.8 [95% CI, 3.2-10.5]). Antipsychotic prescribing was nearly two-fold greater in visits by publicly insured 6-12 year olds (11.3% vs. 5.8%; AOR = 1.9 [95% CI, 1.1-3.5]) and 13-19 year olds (16.2% vs. 8.9%; AOR = 2.0 [95% CI, 1.1-3.6]) compared with their privately insured counterparts. In more than one-third of antipsychotic-prescribed BD visits, antipsychotics were prescribed concomitantly with ≥2 psychotropic medication classes regardless of age group, insurance coverage, or even in the absence of psychiatric comorbidities.


CONCLUSIONS
In outpatient visits by youth for BD, antipsychotics were primarily prescribed by psychiatrists, concomitantly, and for the publicly insured. These treatment patterns merit further investigation.
Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA.
Mehmet
M
Burcu
Departments of Psychiatry and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Daniel J
DJ
Safer
Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA.|Department of Psychiatry, University of Maryland, Baltimore, MD, USA.
Julie M
JM
Zito
D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D002648:Child; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D014150:Antipsychotic Agents
antipsychotic medications; behavioral disorders; concomitant medications; insurance coverage; pharmacoepidemiology; physician specialty; youth