Barclay Rebecca P, Penfold Robert B, Sullivan Donna, Boydston Lauren, Wignall Julia, Hilt Robert J
Seattle Children's Hospital PAL Program, Seattle, WA.
Department of Health Services Research, University of Washington, Group Health Research Institute, Seattle, WA.
Health Serv Res. 2017 Apr;52(2):561-578. doi: 10.1111/1475-6773.12539.
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.
DATA SOURCES/STUDY SETTING: 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.
DATA COLLECTION/EXTRACTION METHODS: 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.
了解分三个不同阶段实施的医疗补助儿童精神科咨询服务的护理质量是否与全州儿童抗精神病药物使用情况的变化相关。
数据来源/研究背景：华盛顿州儿童精神病学咨询项目的原始数据以及2006年7月1日至2013年12月31日期间医疗补助药房部门抗精神病药物使用的二级数据。
一项观察性研究，通过对全州抗精神病药物使用情况进行时间序列分析来分析咨询项目数据。
数据收集/提取方法：将所有涉及抗精神病药物的咨询项目数据库信息与医疗补助药房部门涉及抗精神病药物使用的数据库信息进行比较。
华盛顿州医疗补助儿童抗精神病药物的总使用率从0.51%降至0.25%。在开始进行选择性咨询后，每月使用率平均每月每千人下降0.022（p = 0.004），在开始进行年龄/剂量触发的强制审查后下降了0.065（p < 0.001），然后在开始进行两项或更多项同时进行的抗精神病药物强制审查后又下降了0.022（p = 0.001）。6至12岁儿童的高剂量抗精神病药物使用量下降了57.8%，青少年下降了52.1%。
在多层次咨询和最佳实践教育服务的每个实施步骤之后，全州医疗补助客户的抗精神病药物处方量以不同的速率显著下降。
