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Systematic Review: System-wide Interventions to Monitor Pediatric Antipsychotic Prescribing and Promote Best Practice
Thomas I Mackie1, Ana J Schaefer1, Hannah E Karpman2
1Rutgers School of Public Health and Institute for Health, Health Care Policy, and Aging Research, at Rutgers, the State University of New Jersey, New Brunswick.
Journal of the American Academy of Child and Adolescent Psychiatry
|September 23, 2020
Summary
System-wide interventions like prior authorization programs reduced antipsychotic use in youth. However, evidence for other interventions and long-term effects remains limited, necessitating further research.
Area of Science:
- Child and Adolescent Psychiatry
- Health Services Research
- Pharmacological Interventions
Background:
- Antipsychotic medication use in children and adolescents increased significantly in the early 21st century.
- Medicaid programs implemented system-wide interventions to manage this trend, including monitoring, prescribing support, and delivery system enhancements.
Purpose of the Study:
- To systematically review and assess the evidence for system-wide interventions aimed at improving antipsychotic treatment and management in pediatric populations.
- To evaluate the relative merits of different intervention types.
Main Methods:
- Systematic review adhering to PRISMA guidelines, evaluating studies from 1990-2018.
- Searches conducted in Ovid MEDLINE and PsychInfo, supplemented by an environmental scan.
- 17 eligible studies were identified and quality assessed; findings were summarized descriptively.
Main Results:
- Prior authorization programs (10 studies) were most frequently evaluated and showed reductions in antipsychotic treatment.
- Quality improvement initiatives (4 studies) also demonstrated positive impacts on antipsychotic prescribing.
- Evidence for the impact of drug utilization reviews, care coordination, and multimodal initiatives was more limited.
Conclusions:
- Prior authorization programs show promise in reducing antipsychotic treatment in youth.
- Limited evidence exists for the effectiveness of other system-wide interventions on antipsychotic prescribing and functional outcomes.
- Further research is needed to confirm intervention effectiveness, cost-effectiveness, and potential unintended consequences.
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