Brown School, Washington University, St. Louis, MO 63130, USA.
Child Maltreat. 2010 May;15(2):121-31. doi: 10.1177/1077559509360916.
Geographic variations in service utilization have emerged as sentinels of quality of care. We used data from the National Survey of Child and Adolescent Well-Being (NSCAW), the Kaiser Family Foundation, and the Area Resource File to examine interstate variations in psychotropic medication use among children coming into contact with child welfare agencies. Mean probabilities of medication use differed by 13% between California (7.1%) and Texas (20.1%). On regression analyses, children in California had a fifth of the odds of medication use compared to children in Texas, principally, because child characteristics of age, gender, foster care placement, and mental health need seem to be evaluated differently in Texas compared to in other states. These findings suggest that interstate variations in psychotropic medication use are driven by child characteristics, rather than by mental health need. Understanding the clinical contexts of psychotropic medication use is necessary to assure high-quality care for these children.
地理区域的服务利用差异已经成为医疗质量的监测指标。我们利用来自国家儿童和青少年健康调查（NSCAW）、凯泽家庭基金会和区域资源档案的数据，研究了接触儿童福利机构的儿童中，精神药物使用的州际差异。进入儿童福利机构的儿童中，加利福尼亚（7.1%）和德克萨斯州（20.1%）的药物使用率相差 13%。在回归分析中，加利福尼亚的儿童使用药物的几率是德克萨斯州的五分之一，主要是因为加利福尼亚州和其他州相比，对儿童的年龄、性别、寄养安置和心理健康需求等特征的评估方式不同。这些发现表明，精神药物使用的州际差异是由儿童特征驱动的，而不是由心理健康需求驱动的。了解精神药物使用的临床背景对于确保这些儿童得到高质量的护理是必要的。
