School of Public Health, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.
School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.
Health Serv Res. 2021 Jun;56(3):418-431. doi: 10.1111/1475-6773.13610. Epub 2020 Dec 28.
This article employs a best-worst scaling (BWS) experiment to identify the claims-based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs in the United States.
Patients and relevant parties, with pediatric antipsychotic oversight and treatment experience, completed a BWS experiment, including policymakers (n = 31), foster care alumni (n = 28), caseworkers (n = 23), prescribing clinicians (n = 32), and caregivers (n = 18).
Respondents received surveys with a scenario on antipsychotic monitoring programs and ranked 11 candidate claims-based outcomes as most and least important for program evaluation.
Stratified by respondent group, best-worst scores were calculated to identify the relative importance of the claims-based outcomes. A conditional logit examined whether candidate outcomes for safety, quality, and unintended consequences were preferred over reduction in antipsychotic treatment, the outcome used most often to evaluate antipsychotic monitoring programs.
Safety indicators (eg, antipsychotic co-pharmacy, cross-class polypharmacy, higher than recommended doses) ranked among the top three candidate outcomes across respondent groups and were an important complement to antipsychotic treatment reduction. Foster care alumni prioritized "antipsychotic treatment reduction" and "increased psychosocial treatment." Caseworkers, prescribers, and caregivers prioritized "increased follow-up after treatment initiation." Potential unintended consequences of an antipsychotic monitoring program ranked lowest, including increased use of other psychotropic medication classes (as a substitute), increased psychiatric hospital stays, and increased emergency room utilization. Results of the conditional logit model found only caregivers significantly preferred other indicators over antipsychotic treatment reduction, preferring improvements in follow-up care (5.78) and psychosocial treatment (4.53) and reduction in prescriptions of higher than recommended doses (3.64).
The BWS experiment supported rank ordering of candidate claims-based outcomes demonstrating the opportunity for future studies to align outcomes used in antipsychotic monitoring program evaluations with community preferences, specifically by diversifying metrics to include safety and quality indicators.
本文采用最佳最差标度法（Best-Worst Scaling，BWS）实验，以确定在美国评估儿科抗精神病药物监测项目时，患者和其他相关方最看重的基于诉求的结果。
具有儿科抗精神病药物监督和治疗经验的患者和相关方，包括政策制定者（n=31）、寄养院校友（n=28）、社工（n=23）、处方临床医生（n=32）和照护者（n=18），完成了 BWS 实验。
受访者收到了一个关于抗精神病药物监测项目的情景调查，并对 11 个候选基于诉求的结果进行了排名，将其列为最和最不重要的项目评估结果。
按受访者群体进行分层，计算最佳最差得分，以确定基于诉求的结果的相对重要性。条件逻辑检验候选的安全性、质量和意外后果结果是否优于抗精神病药物治疗的减少，这是最常用于评估抗精神病药物监测项目的结果。
安全性指标（如抗精神病药物合并用药、跨类别联合用药、高于推荐剂量）在各受访者群体中均位列前三项候选结果，是减少抗精神病药物治疗的重要补充。寄养院校友优先考虑“减少抗精神病药物治疗”和“增加心理社会治疗”。社工、处方医生和照护者优先考虑“增加治疗开始后的随访”。抗精神病药物监测项目的潜在意外后果排名最低，包括增加使用其他精神药物类别（作为替代品）、增加精神病院住院和增加急诊室就诊。条件逻辑模型的结果发现，只有照护者显著更倾向于将其他指标而不是抗精神病药物治疗减少作为首选，他们更希望改善随访护理（5.78）、心理社会治疗（4.53）和减少高于推荐剂量的处方（3.64）。
BWS 实验支持候选基于诉求的结果排序，这表明未来的研究有机会使抗精神病药物监测项目评估中使用的结果与社区偏好保持一致，特别是通过多样化指标，包括安全性和质量指标。
