School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.
Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.
Health Serv Res. 2020 Aug;55(4):596-603. doi: 10.1111/1475-6773.13297. Epub 2020 Jun 21.
Prior authorization of prescription medications is a policy tool that can potentially impact care quality and patient safety.
To examine the effectiveness of a mandatory peer-review program in reducing antipsychotic prescriptions among Medicaid-insured children, accounting for secular trends that affected antipsychotic prescribing nationally.
Medicaid Analytical eXtracts (MAX) with administrative claims for health services provided between January 2006 and December 2011.
This retrospective, observational study examined prescription claims records from Washington State (Washington) and compared them to a synthetic control drawing from 20 potential donor states that had not implemented any antipsychotic prior authorization program or mandatory peer review for Medicaid-insured children during the study period. This method provided a means to control for secular trends by simulating the antipsychotic use trajectory that the program state would have been expected to experience in the absence of the policy implementation.
Before the policy implementation, antipsychotic use prevalence closely tracked those of the synthetic control (6.17 per 1000 in Washington vs. 6.21 in the synthetic control group). Within two years after the policy was implemented, prevalence decreased to 4.04 in Washington and remained stable in the synthetic control group (6.47), corresponding to an approximately 38% decline.
Prior authorization program designs and implementations vary widely. This mandatory peer-review program, with an authorization window and two-stage rollout, was effective in moving population level statistics toward safe and judicious use of antipsychotic medications in children.
处方药物的事先授权是一种政策工具，可能会影响医疗质量和患者安全。
考察强制性同行评议方案在减少医疗补助保险覆盖的儿童使用抗精神病药物方面的效果，同时考虑到影响全国范围内抗精神病药物处方的季节性趋势。
医疗补助分析提取（MAX），其中包含了 2006 年 1 月至 2011 年 12 月期间提供的健康服务的行政索赔数据。
本回顾性观察性研究考察了来自华盛顿州（华盛顿）的处方记录，并将其与在研究期间没有对医疗补助保险覆盖的儿童实施任何抗精神病药物事先授权方案或强制性同行评议的 20 个潜在捐赠州的合成控制进行了比较。这种方法提供了一种通过模拟计划州在没有实施政策的情况下预期会经历的抗精神病药物使用轨迹来控制季节性趋势的手段。
在政策实施之前，抗精神病药物的使用流行率与合成控制（华盛顿州为每 1000 人 6.17 例，合成对照组为 6.21 例）密切相关。在政策实施后两年内，华盛顿州的流行率下降到 4.04，而合成对照组则保持稳定（6.47），对应于大约 38%的下降。
事先授权方案的设计和实施差异很大。这种强制性同行评议方案，具有授权窗口和两阶段实施，在使人群水平的统计数据朝着安全和明智地使用抗精神病药物的方向发展方面是有效的。
