title: System struggles and substitutes: A qualitative study of general practitioner and psychiatrist experiences of prescribing antipsychotics to children and adolescents.
abstract: There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. We conducted a qualitative study using an interpretive phenomenological analysis of physicians' experiences of antipsychotic prescribing to children and adolescents. Prescribers participated in individual interviews and a focus group. We used a staged approach for data analysis of transcriptions. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We identified themes related to context, role and identity, and decision-making and filtering Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Our results provide knowledge regarding the prescribers' experience of antipsychotics for children and adolescents. Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents.
authors.affiliation: College of Pharmacy, Dalhousie University, Canada andrea.murphy@dal.ca.|Department of Psychiatry, Dalhousie University, Canada.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Murphy
authors.affiliation: College of Pharmacy, Dalhousie University, Canada.|Department of Psychiatry, Dalhousie University, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Gardner
authors.affiliation: School of Population Health, University of Queensland, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Kisely
authors.affiliation: Nova Scotia Department of Health and Wellness, Canada.
authors.forename: Charmaine A
authors.initials: CA
authors.lastname: Cooke
authors.affiliation: Department of Psychiatry, Dalhousie University, Canada.|Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University and IWK Health Centre, Canada.
authors.forename: Stanley P
authors.initials: SP
authors.lastname: Kutcher
authors.affiliation: School of Nursing, Dalhousie University, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D011307:Drug Prescriptions / Q000592:standards*; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D011570:Psychiatry / Q000592:standards*; D036301:Qualitative Research
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotics; children and adolescents; disruptive behavior disorders; physicians