The Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, Vermont; Vermont Child Health Improvement Program, Department of Pediatrics, and
The Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington, Vermont; Vermont Child Health Improvement Program, Department of Pediatrics, and.
Pediatrics. 2015 Apr;135(4):658-65. doi: 10.1542/peds.2014-2260. Epub 2015 Mar 2.
Although the increase in treatment of children and adolescents with antipsychotic medications has been well documented, much less is known about the factors related to the use of these agents and how closely the treatment follows best practice recommendations.
Prescribers of each antipsychotic medication prescription issued for a Medicaid-insured child in Vermont aged <18 years were sent a prior authorization survey that assessed several domains including the clinical indication, other treatments, metabolic monitoring, prescriber specialty, and prescription origin. These variables were combined to categorize prescriptions as following indications approved by the US Food and Drug Administration (FDA) and best practice guidelines.
The response rate of the survey was 80%, with 677 surveys from 147 prescribers available for analysis; more than one-half of the respondents were primary care clinicians. Overall, the clinical indication for an antipsychotic prescription followed best practice guidelines 91.7% of the time, with overall best practice guidelines followed at a rate of 50.1%. An FDA indication was followed in 27.2% of cases. Psychiatrists were significantly more likely to follow best practice guidelines than nonpsychiatrists. Antipsychotic medications were typically used only after other pharmacologic and nonpharmacologic treatments were ineffective, although previous treatment with cognitive-behavioral therapy was uncommon (15.5%). Metabolic monitoring that included serial laboratory tests was reported in 57.2% of cases.
Current prescribing patterns of antipsychotic medications for children and adolescents follow best practice guidelines approximately one-half of the time, with nonadherence often related to lack of metabolic monitoring.
虽然已有大量文献记录了儿童和青少年抗精神病药物治疗的增加，但人们对这些药物使用相关的因素以及治疗与最佳实践建议的吻合程度知之甚少。
佛蒙特州医疗补助保险覆盖的年龄<18 岁的每位接受抗精神病药物治疗的儿童的处方医师均会收到一份事先授权调查，该调查评估了包括临床适应证、其他治疗方法、代谢监测、处方医师专业和处方来源在内的多个领域。这些变量结合起来将处方分为美国食品和药物管理局（FDA）批准的适应证和最佳实践指南。
调查的回复率为 80%，147 名处方医师中有 677 名提供了调查结果，可用于分析；超过一半的受访者是初级保健临床医生。总体而言，抗精神病药物处方的适应证符合最佳实践指南的时间为 91.7%，整体遵循最佳实践指南的比例为 50.1%。符合 FDA 适应证的比例为 27.2%。精神科医生遵循最佳实践指南的可能性显著高于非精神科医生。抗精神病药物通常仅在其他药物和非药物治疗无效后使用，尽管认知行为疗法的前期治疗并不常见（15.5%）。报告中有 57.2%的病例进行了包括连续实验室检查在内的代谢监测。
目前儿童和青少年抗精神病药物的处方模式大约有一半符合最佳实践指南，不遵循的情况通常与缺乏代谢监测有关。
