title: Trends in Antipsychotic Prescribing in Medicaid-Eligible Youth.
abstract: To examine trends in the use of antipsychotic medication in Medicaid-eligible youth from 2008 to 2013 and the factors associated with this use.
  
  
  
  Youth aged 0 to 17 years with at least one claim indicating antipsychotic medication use were identified from the network of a behavioral health managed care organization (BHMCO). Demographic and clinical variables were derived from state eligibility data and service claims data from the BHMCO. Overall and specific prevalence rates of antipsychotic drug use were calculated over the course of 6 years (2008-2013). The probability of antipsychotic use during 2013 was further explored with logistic regression that included demographic and diagnostic groups.
  
  
  
  The overall trend in prevalence for antipsychotics for youth decreased from 49.52 per 1,000 members in 2008 to 30.54 in 2013 (p < .0001). Although rates decreased for all age groups, the rate per 1,000 members in 2013 for the youngest children was 3.79, versus 39.23 for 6- to 12-year-olds and 64.33 for 13- to 17-year-olds. Controlling for demographic and clinical variables, children 0 to 5 years old were 79% less likely to be prescribed antipsychotic medications compared to the oldest youth, 13 to 17 years of age (p < .0001). Rates were higher for males versus females regardless of age (odds ratio [95% CI] =1.48 [1.36-1.62], p < .0001). Children with a diagnosis of attention-deficit/hyperactivity disorder were less likely to be prescribed antipsychotics compared to those with diagnoses of autism spectrum disorder, bipolar disorder, psychoses, and depression.
  
  
  
  Prevalence rates decreased significantly over time for all socio-demographic groups. The largest decrease was observed for the youngest children, ages 0 to 5 years, with a rate in 2013 under half the rate for 2008. Clinical, policy, and managed care implications are discussed.
authors.affiliation: Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh. Electronic address: edelsohnga@ccbh.com.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Edelsohn
authors.affiliation: Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh.
authors.forename: Irina
authors.initials: I
authors.lastname: Karpov
authors.affiliation: Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh.
authors.forename: Meghna
authors.initials: M
authors.lastname: Parthasarathy
authors.affiliation: Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Hutchison
authors.affiliation: Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh.
authors.forename: Kim
authors.initials: K
authors.lastname: Castelnovo
authors.affiliation: Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh.
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Ghuman
authors.affiliation: Community Care Behavioral Health Organization, UPMC Insurance Division, Pittsburgh; Behavioral Health and Medicaid Services, Behavioral Health Integration, UPMC Insurance Division and University of Pittsburgh School of Medicine.
authors.forename: James M
authors.initials: JM
authors.lastname: Schuster
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States
chemical_list: D014150:Antipsychotic Agents
keywords: Medicaid; adolescents; atypical antipsychotics; children; prescribing trends