Newland M Christopher, Ramey Erica S, Rapp John T
Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA.
School of Nursing, University of Alabama-Birmingham, Birmingham, Alabama, USA.
J Child Adolesc Psychopharmacol. 2025 Jul 2. doi: 10.1089/cap.2025.0022.
Investigators and government agencies have expressed concern about the high percentage of foster youth who receive psychotropic medication, the number of psychotropic medications prescribed, and the extended duration for which many foster youth receive psychotropic medication. One contributor to the duration of medication use is the absence of clear guidelines for de-prescribing in pediatric psychiatry. The present study evaluated whether medication review letters crafted by medical professionals and sent to caregivers prompted a reduction in psychotropic medication in foster youth. The caretaker or caseworker of 52 foster children, 38 males, under 16 years of age, who received medication through Medicaid, was sent a letter assessing the use of psychotropic medication and identifying areas of concern. Recipients were encouraged to discuss the letter with the child's prescriber. These children had been referred to a university-affiliated organization that provided behavioral interventions to other children, but the children in the present study did not receive behavioral interventions from the organization. The use of psychotropic medication was assessed for 18 months before and 24 months after the letter was sent. The control group had comparable demographics and medication-use parameters. The trajectories of medication count before and after a letter (for cases) or a "phantom" letter (for controls) was sent were compared. The medication review letter precipitated a decrease in medication count over the year after the letter was sent for 9- to 12-year-olds. For 13- to 16-year-olds, an increasing trend in medication use was halted. No effect was seen for 5- to 8-year-olds. No such changes occurred in the control groups. A single personalized letter, tailored to a child's medication list, was provided to caregivers to share with prescribers. This decreased or halted an increase in the use of psychotropic medications for children in foster care who were 9 years old or older.
研究人员和政府机构对接受精神药物治疗的寄养青年的高比例、所开精神药物的数量以及许多寄养青年接受精神药物治疗的延长时间表示担忧。药物使用时间的一个促成因素是儿科精神病学中缺乏明确的减药指南。本研究评估了由医学专业人员撰写并发送给照顾者的药物审查信是否能促使寄养青年减少精神药物的使用。52名16岁以下通过医疗补助计划接受药物治疗的寄养儿童（38名男性）的照顾者或个案工作者收到了一封信，信中评估了精神药物的使用情况并指出了关注领域。鼓励收件人与孩子的开处方医生讨论这封信。这些孩子被转介到一个与大学有关联的组织，该组织为其他孩子提供行为干预，但本研究中的孩子没有接受该组织的行为干预。在信件发送前18个月和发送后24个月对精神药物的使用情况进行了评估。对照组具有可比的人口统计学和药物使用参数。比较了发送信件（针对病例）或“虚拟”信件（针对对照组）前后药物数量的变化轨迹。对于9至12岁的儿童，药物审查信在信件发送后的一年中促使药物数量减少。对于13至16岁的儿童，药物使用的增加趋势得到了遏制。对于5至8岁的儿童则没有效果。对照组没有出现此类变化。向照顾者提供了一封根据孩子的药物清单量身定制的个性化信件，以便与开处方医生分享。这减少或遏制了9岁及以上寄养儿童精神药物使用的增加。
