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Prescription of psychotropics to children in office-based practice
K J Kelleher1, A A Hohmann, D B Larson
1Biometric and Clinical Applications Branch, National Institute of Mental Health, Rockville, Md.
Insights
Pediatric psychotropic medication use lacks adequate follow-up and psychotherapy. This study reveals that many children on these drugs in outpatient care may not receive optimal behavioral health management.
Area of Science:
- Pediatric medicine
- Psychiatry
- Health services research
Background:
- Close follow-up and psychotherapy are recommended for children on psychotropic drugs.
- Current practices regarding these supportive measures in pediatric settings are not well-documented.
Purpose of the Study:
- To investigate follow-up arrangements and concurrent psychotherapy for US children receiving psychotropic medications in office-based practices.
- To identify factors influencing psychotropic drug prescription in pediatric care.
Main Methods:
- Analysis of the 1985 National Ambulatory Medical Care Survey data.
- Examination of pediatric visits involving psychotropic medication prescriptions.
- Exploration of sociodemographic, clinical, and provider-related determinants.
Main Results:
- Few providers reported referral or concurrent psychotherapy for children on psychotropics.
- Follow-up plans did not differ significantly between children with and without psychotropic prescriptions.
- Mental health indicators, patient demographics, provider type, and familiarity predicted prescriptions.
Conclusions:
- Many children receiving psychotropic medications in outpatient settings may not be receiving optimal behavioral or emotional problem management.
- Current prescribing practices highlight a gap in integrated care for pediatric mental health.
- Further research is needed to improve care coordination for these children.
Abstract:
Multiple authors have stressed the need for close follow-up and simultaneous psychotherapy in most children treated with psychotropic drugs. However, little is known about the actual prescription of psychotropic medications in pediatric settings. Using the 1985 National Ambulatory Medical Care Survey, we investigated the frequency of follow-up arrangements and concurrent psychotherapy among US children in visits to office-based practices. We then explored determinants of psychotropic drug prescriptions. Mental health indicators, sociodemographic characteristics, provider type, and provider familiarity with the patient were important predictors of psychotropic prescriptions. Few providers report referral or concurrent psychotherapy for their patients receiving psychotropics, and follow-up plans were no different for children with or without psychotropics after controlling for other variables. This means that many children in outpatient care who are taking psychotropic medications may not be receiving optimal management for behavioral or emotional problems.