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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

Summary

This summary is machine-generated.

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.

Keywords:

Antipsychotic agents Medicaid child and adolescent psychiatry outcome assessment (health care)referral and consultation

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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.