Ms. Pennap, Dr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore. Dr. Zito is also with the Department of Psychiatry, University of Maryland, Baltimore. Dr. Safer is with the Departments of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore.
Psychiatr Serv. 2018 Mar 1;69(3):293-299. doi: 10.1176/appi.ps.201700177. Epub 2017 Nov 15.
This cross-sectional study assessed the impact of a peer-review program on the prevalence of pediatric antipsychotic use among Medicaid-insured youths in a Mid-Atlantic state.
Medicaid claims (2010-2014) were assessed among continuously enrolled youths in the 12 months before and after implementation of peer review. The study identified children ages zero to four preimplementation (N=118,815) and postimplementation (N=121,431), ages five to nine preimplementation (N=98,681) and postimplementation (N=107,872), and ages 10 to 17 preimplementation (N=154,696) and postimplementation (N=161,370). (Age ranges are inclusive of the final number). In each age group, multivariable logistic regression models with generalized estimating equations assessed the change in annual prevalence of antipsychotic use pre- to postimplementation. Use of other leading psychotropic classes and antipsychotic prescribing by medical specialty were also examined.
The annual pre- to postimplementation prevalence of antipsychotic use decreased significantly, from .07% to .03% (adjusted odds ratio [AOR]=.41) among children ages zero to four, from 1.57% to .86% (AOR=.54) among those ages five to nine, and from 3.28% to 2.40% (AOR=.72) among those ages 10 to 17. With the exception of alpha-agonist use, which increased postimplementation (AOR=1.30) among those ages zero to four, no clinically significant pre-post change was noted in other leading psychotropic classes among children ages zero to four and 10 to 17. By contrast, postimplementation use of other psychotropic medications decreased among those ages five to nine (AOR=.73).
A state Medicaid peer-review program resulted in decreased antipsychotic use across all age groups, particularly among children younger than ten. No notable substitution of other psychotropic classes for antipsychotics was observed.
本横断面研究评估了同行评议计划对马里兰州中大西洋地区医疗补助保险青少年中抗精神病药物使用流行率的影响。
在实施同行评审前后的 12 个月内，评估了医疗补助索赔（2010-2014 年）。研究确定了实施前（N=118815）和实施后（N=121431）的 0 至 4 岁儿童、实施前（N=98681）和实施后（N=107872）的 5 至 9 岁儿童以及实施前（N=154696）和实施后（N=161370）的 10 至 17 岁儿童。（年龄范围包括最后一个数字）。在每个年龄组中，使用广义估计方程的多变量逻辑回归模型评估了实施前后抗精神病药物使用的年度流行率的变化。还检查了其他主要精神药物类别和医疗专业的抗精神病药物处方情况。
儿童 0 至 4 岁组抗精神病药物使用的年度实施前至实施后患病率从 0.07%显著下降至 0.03%（调整后的优势比[OR]=0.41），5 至 9 岁组从 1.57%下降至 0.86%（OR=0.54），10 至 17 岁组从 3.28%下降至 2.40%（OR=0.72）。除了 0 至 4 岁儿童的 alpha-agonist 使用增加（OR=1.30）外，0 至 4 岁和 10 至 17 岁儿童中其他主要精神药物类别的临床显著实施前后变化并不明显。相比之下，5 至 9 岁儿童其他精神药物的使用减少（OR=0.73）。
州医疗补助同行评审计划导致所有年龄段的抗精神病药物使用减少，尤其是 10 岁以下儿童。没有观察到抗精神病药物的其他精神药物类别的显著替代。
