title: Decrease in Statewide Antipsychotic Prescribing after Implementation of Child and Adolescent Psychiatry Consultation Services.
abstract: To learn if a quality of care Medicaid child psychiatric consultation service implemented in three different steps was linked to changes in statewide child antipsychotic utilization.
  
  
  
  Washington State child psychiatry consultation program primary data and Medicaid pharmacy division antipsychotic utilization secondary data from July 1, 2006, through December 31, 2013.
  
  
  
  Observational study in which consult program data were analyzed with a time series analysis of statewide antipsychotic utilization.
  
  
  
  All consultation program database information involving antipsychotics was compared to Medicaid pharmacy division database information involving antipsychotic utilization.
  
  
  
  Washington State's total child Medicaid antipsychotic utilization fell from 0.51 to 0.25 percent. The monthly prevalence of use fell by a mean of 0.022 per thousand per month following the initiation of elective consults (p = .004), by 0.065 following the initiation of age/dose triggered mandatory reviews (p < .001), then by another 0.022 following the initiation of two or more concurrent antipsychotic mandatory reviews (p = .001). High-dose antipsychotic use fell by 57.8 percent in children 6- to 12-year old and fell by 52.1 percent in teens.
  
  
  
  Statewide antipsychotic prescribing for Medicaid clients fell significantly at different rates following each implementation step of a multilevel consultation and best-practice education service.
authors.affiliation: Seattle Children's Hospital PAL Program, Seattle, WA.
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Barclay
authors.affiliation: Department of Health Services Research, University of Washington, Group Health Research Institute, Seattle, WA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.affiliation: Washington State Prescription Drug Program, Washington State Health Care Authority, Olympia, WA.
authors.forename: Donna
authors.initials: D
authors.lastname: Sullivan
authors.affiliation: Kootenai Health, Coeur d'Alene, ID.
authors.forename: Lauren
authors.initials: L
authors.lastname: Boydston
authors.affiliation: Seattle Children's Hospital PAL Program, Seattle, WA.
authors.forename: Julia
authors.initials: J
authors.lastname: Wignall
authors.affiliation: Seattle Children's Hospital PAL Program, Seattle, WA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hilt
mesh_terms: D000293:Adolescent; D000367:Age Factors; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D002665:Child Psychiatry / Q000458:organization & administration* / Q000706:statistics & numerical data; D002675:Child, Preschool; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000458:organization & administration*; D014481:United States; D014861:Washington
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic agents; Medicaid; child and adolescent psychiatry; outcome assessment (health care); referral and consultation