Cincinnati Children's Hospital Medical Center (C Tan, MV Greiner, K Nause and SJ Beal), Cincinnati, Ohio; University of Cincinnati College of Medicine (C Tan, MV Greiner, and SJ Beal), Cincinnati, Ohio.
Cincinnati Children's Hospital Medical Center (C Tan, MV Greiner, K Nause and SJ Beal), Cincinnati, Ohio; University of Cincinnati College of Medicine (C Tan, MV Greiner, and SJ Beal), Cincinnati, Ohio.
Acad Pediatr. 2023 Apr;23(3):675-680. doi: 10.1016/j.acap.2022.08.005. Epub 2022 Aug 27.
This study sought to examine how mental health diagnoses, health care utilization and foster care placement instability affect antipsychotic prescribing and how these factors may contribute to disproportionate antipsychotic prescribing among youth in foster care.
This retrospective cohort study utilized EHR data that were linked to administrative child welfare data. Two outcome variables were analyzed: 1) any antipsychotic prescription documented and 2) number of antipsychotic prescriptions documented. Predictor variables included foster care status, number of unique mental health diagnoses, counts of health care encounters over the study period, and counts of foster care placements. Covariates included gender, persons of color, and age in years. Models were estimated using logistic regression for the dichotomous outcome and Poisson regression for the count outcome.
Increased antipsychotic prescribing among children in foster care persists even after accounting for mental health diagnoses and health care utilization. However, the number of placements modified the effect of foster care involvement on antipsychotic prescribing such that after 2 placement changes, the odds of being prescribed an antipsychotic surpassed the effect of foster care involvement. More mental health diagnoses, more inpatient and emergency health care encounters, and more foster care placements were associated with an increased odds of being prescribed an antipsychotic and an increased count of antipsychotic prescriptions. Decreased primary care encounters were associated with increased odds of antipsychotic prescriptions, and decreased specialty encounters were associated with higher counts of antipsychotic prescriptions.
Placement instability is associated with disproportionate antipsychotic prescribing among youth in foster care.
本研究旨在探讨心理健康诊断、医疗保健利用情况和寄养安置不稳定如何影响抗精神病药物的处方情况，以及这些因素如何导致寄养中的青少年接受不成比例的抗精神病药物治疗。
本回顾性队列研究利用了与行政儿童福利数据相关的电子健康记录数据。分析了两个结果变量：1）记录的任何抗精神病药物处方和 2）记录的抗精神病药物处方数量。预测变量包括寄养状况、独特心理健康诊断数量、研究期间的医疗保健就诊次数计数和寄养安置次数计数。协变量包括性别、少数族裔和年龄。使用逻辑回归进行二项结果分析，使用泊松回归进行计数结果分析。
即使考虑了心理健康诊断和医疗保健利用情况，寄养儿童的抗精神病药物处方率仍然较高。然而，安置次数改变了寄养参与对抗精神病药物处方的影响，即经历 2 次安置变化后，被开抗精神病药物的可能性超过了寄养参与的影响。更多的心理健康诊断、更多的住院和急诊医疗保健就诊次数以及更多的寄养安置次数与被开抗精神病药物的可能性增加和抗精神病药物处方数量增加相关。初级保健就诊次数减少与抗精神病药物处方的可能性增加相关，而专科就诊次数减少与抗精神病药物处方数量增加相关。
安置不稳定与寄养中的青少年接受不成比例的抗精神病药物治疗有关。
