Penfold Robert B, Idu Abisola E, Coley R Yates, Cushing-Haugen Kara L, King Deborah, Glass Ashley, Phillips Rebecca C, Renz Anne D, Pabiniak Chester J, Graham Vina F, Thompson Ella E, Ralston James D, Simon Gregory E, Gonzalez Erin S, Myers Kathleen M, Beck Arne, Quintana LeeAnn M, Runkle Arthur J, Rogers Megan, Foster Deirdre M, Clarke Gregory N, Massimino Stefan, Crawford Phillip M, Cavese Julie A, Cordaro Anthony R, Chavez Laura I, Kelleher Kelly J, Schwartz Nadine, Jiner Kristina R, Liu Swan Bee, Condrac Sara, Hilt Robert J
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Seattle Children's Hospital, Seattle, WA, USA.
J Child Psychol Psychiatry. 2025 Mar;66(3):301-310. doi: 10.1111/jcpp.14059. Epub 2024 Oct 29.
Antipsychotic medications (AP) are inappropriately prescribed to young people. The goal of this pragmatic trial was to test a four-component approach to improved targeting of antipsychotic prescribing to people aged ≥3 and <18 years.
Clinicians in four health systems were cluster randomized by the number of previous AP orders and service line - specialty mental health and all others. Intervention arm clinicians received a best practice alert and child psychiatrist consultation and feedback. Families received system navigation and expedited access to psychotherapy. Primary outcomes were total days' supply of AP medication and proportion of youth with any AP supply at 6 months. We estimated the log-odds of AP use at 6 months and the relative rate of AP over 6 months. The Safer and Targeted Use of Antipsychotics in Youth (SUAY) trial took place between 3/2018 and 12/2020.
The trial enrolled 733 patients. The odds ratio (OR) comparing use at 6 months was 0.75 (95% CI: 0.52, 1.09). The mean number of days using AP was 118.5 for intervention patients and 128.2 for control patients (relative risk [RR] = 0.92; 95% CI: 0.81-1.04). Exploratory heterogeneity of treatment effects (HTE) was not detected in groups defined by age, gender, provider specialty, and insurance type. HTE by race/ethnicity was present: among youth of color, mean days' supply was 103.2 for intervention arm and 131.2 for the control arm (RR 0.79, 95% CI: 0.67-0.93). Among secondary outcomes, only new psychotherapy referrals differed with 44.3% (n = 154) of intervention participants having a new order for psychotherapy compared to 33.5% (n = 129) in the control arm (OR 1.47: 95% CI: 1.01-2.14).
This intervention did not result in less AP use at 6 months or a reduction in the days' supply of AP medication, although psychotherapy orders increased. The intervention may be effective for some subgroups.
抗精神病药物（AP）被不恰当地开给年轻人。这项务实试验的目的是测试一种四组分方法，以改善≥3岁且<18岁人群抗精神病药物处方的针对性。
四个卫生系统中的临床医生按先前AP订单数量和服务线（专科心理健康及其他所有科室）进行整群随机分组。干预组的临床医生收到最佳实践警报以及儿童精神科医生的咨询和反馈。家庭获得系统导航服务并能更快获得心理治疗。主要结局指标为AP药物的总供应天数以及6个月时使用任何AP药物的青少年比例。我们估计了6个月时使用AP的对数几率以及6个月内AP的相对使用率。青少年抗精神病药物安全与靶向使用（SUAY）试验于2018年3月至2020年12月期间进行。
该试验纳入了733名患者。比较6个月时使用情况的优势比（OR）为0.75（95%置信区间：0.52，1.09）。干预组患者使用AP的平均天数为118.5天，对照组患者为128.2天（相对风险[RR]=0.92；95%置信区间：0.81 - 1.04）。在按年龄、性别、医疗服务提供者专业和保险类型定义的组中未检测到治疗效果的探索性异质性。按种族/族裔存在治疗效果异质性：在有色人种青少年中，干预组的平均供应天数为103.2天，对照组为131.2天（RR 0.79，95%置信区间：0.67 - 0.93）。在次要结局指标中，只有新的心理治疗转诊存在差异，干预组有44.3%（n = 154）的参与者有新的心理治疗订单，而对照组为33.5%（n = 129）（OR 1.47：95%置信区间：1.01 - 2.14）。
尽管心理治疗订单有所增加，但该干预措施在6个月时并未减少AP的使用或AP药物的供应天数。该干预措施可能对某些亚组有效。
