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Decrease in Statewide Antipsychotic Prescribing after Implementation of Child and Adolescent Psychiatry Consultation

Rebecca P Barclay1, Robert B Penfold2, Donna Sullivan3

  • 1Seattle Children's Hospital PAL Program, Seattle, WA.

Health Services Research
|March 16, 2017
PubMed

Insights

A child psychiatric consultation service in Washington State significantly reduced antipsychotic use in children covered by Medicaid. This quality improvement initiative led to decreased overall and high-dose antipsychotic prescribing among pediatric patients.

Area of Science:

  • Child and Adolescent Psychiatry
  • Health Services Research
  • Public Health Policy

Background:

  • Child psychiatric consultation services are crucial for improving care quality.
  • Medicaid child antipsychotic utilization has been a growing concern.
  • Understanding the impact of consultation services on prescribing patterns is essential.

Purpose of the Study:

  • To evaluate the association between a quality of care Medicaid child psychiatric consultation service and changes in statewide child antipsychotic utilization.
  • To assess the impact of a multi-step implementation of a consultation service on prescribing practices.

Main Methods:

  • Observational study utilizing time series analysis.
  • Analysis of Washington State child psychiatry consultation program data (2006-2013).
  • Comparison of consultation data with Medicaid pharmacy division antipsychotic utilization data.

Main Results:

  • Statewide child Medicaid antipsychotic utilization decreased from 0.51% to 0.25%.
  • Significant reductions in monthly antipsychotic prevalence were observed following each implementation step of the consultation service.
  • High-dose antipsychotic use decreased by over 50% in children and adolescents.

Conclusions:

  • A multilevel consultation and best-practice education service was linked to significant reductions in statewide antipsychotic prescribing for child Medicaid clients.
  • Phased implementation of consultation services effectively decreased antipsychotic utilization.
  • Quality improvement initiatives in child psychiatric services can lead to substantial positive changes in medication prescribing.
Abstract

Keywords:
Antipsychotic agentsMedicaidchild and adolescent psychiatryoutcome assessment (health care)referral and consultation

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