Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz).
Psychiatr Serv. 2023 Dec 1;74(12):1218-1226. doi: 10.1176/appi.ps.20220375. Epub 2023 Jun 8.
An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics.
Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child's psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children's psychotropic medication treatment.
Black children (compared with White children; OR=1.84, 95% CI=1.53-2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08-2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor's degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61-0.89) were less likely to receive inadequate pharmacotherapy.
The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.
采用专家共识方法来确定儿童精神药理学治疗的充分性，并检查充分性是否因人口统计学或临床特征而有所不同。
数据来自 601 名 6-12 岁儿童的基线访谈，他们曾访问过 9 家门诊心理健康诊所中的一家，并参加了纵向评估躁狂症状研究。对儿童及其父母进行了儿童情绪障碍和精神分裂症日程表和儿童和青少年服务评估的访谈，分别评估儿童的精神科症状和终生心理健康服务使用情况。采用专家共识方法，该方法以已发表的治疗指南为依据，来确定儿童精神药物治疗的充分性。
黑人儿童（与白人儿童相比；OR=1.84，95%CI=1.53-2.23）和患有焦虑障碍的儿童（与无焦虑障碍相比；OR=1.55，95%CI=1.08-2.20）更有可能接受不充分的药物治疗；其照顾者具有学士学位或更高学历的儿童（与具有高中教育、普通同等学历文凭或低于高中教育的儿童相比；OR=0.74，95%CI=0.61-0.89）更不可能接受不充分的药物治疗。
共识评估者方法允许使用已发表的治疗效果数据和患者特征（例如，年龄、诊断、近期住院史和心理治疗）来评估药物治疗的充分性。这些结果复制了先前使用传统方法确定治疗充分性（例如，治疗次数最少）的研究中报告的种族差异发现，并强调了继续需要研究种族差异以及改善获得高质量护理的策略。
