Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Blvd. MHC 2724, Tampa, Florida 33647, USA.
Psychiatr Serv. 2012 Dec;63(12):1257-60. doi: 10.1176/appi.ps.201100346.
This study assessed the impact of a prior-authorization process on the use of antipsychotic medications by children under six years old in Florida's fee-for-service Medicaid program.
Child psychiatrists reviewed requests for antipsychotic treatment (N=1,424) using forms and criteria created by a panel of Florida-based experts. Data on the characteristics of the children and clinicians involved were organized into 11 consecutive quarters beginning in July 2008. Multivariate generalized estimating equations were used to examine the association between each study variable and changes in the odds of submission of a new request over time.
Prior-authorization requests declined from 124 in the first quarter to 81 in the last quarter. Compared with applications from child psychiatrists, the odds of applications being submitted by adult psychiatrists, neurologists, and pediatricians increased over time.
Although applications declined, the diminished role of child psychiatry specialists raises questions about the impact of the program on the quality of care provided.
本研究评估了佛罗里达州医疗补助计划中，先批准程序对 6 岁以下儿童使用抗精神病药物的影响。
儿童精神科医生使用由佛罗里达州专家组制定的表格和标准，审查了抗精神病治疗的申请（N=1424）。将涉及儿童和临床医生的特征数据组织成 11 个连续季度，从 2008 年 7 月开始。采用多变量广义估计方程来检验每个研究变量与随着时间的推移新申请提交几率变化之间的关联。
在先批准请求中，从第一季度的 124 个下降到最后一个季度的 81 个。与儿童精神科医生的申请相比，成人精神科医生、神经科医生和儿科医生提交申请的几率随着时间的推移而增加。
尽管申请数量下降，但儿童精神科专家作用的减弱引发了对该计划对提供的护理质量影响的质疑。
