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Selective Serotonin Reuptake Inhibitor Prescribing Within an Integrated Pediatric Primary Care Behavioral Health

Louis Vernacchio1, Jonas Bromberg2, Emily T Correa3

  • 1Pediatric Physicians' Organization at Children's (L Vernacchio, J Bromberg, ET Correa, M Fry and HJ Walter), Wellesley Hills, Mass; Department of Pediatrics (L Vernacchio), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (L Vernacchio and J Bromberg), Harvard Medical School, Boston, Mass.

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Summary
This summary is machine-generated.

Pediatric primary care clinicians (PCCs) significantly increased selective serotonin reuptake inhibitor (SSRI) prescribing after integrated behavioral health (BH) care implementation. While medication choices were appropriate, improved symptom tracking and follow-up are recommended.

Keywords:
behavioral healthprimary careselective serotonin reuptake inhibitors

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Area of Science:

  • Pediatric primary care
  • Behavioral health integration
  • Psychopharmacology

Background:

  • Selective serotonin reuptake inhibitor (SSRI) prescribing is expanding in primary care.
  • Limited data exist on pediatric primary care clinician (PCC) prescribing patterns post-integrated behavioral health (BH) care implementation.

Purpose of the Study:

  • To analyze trends in SSRI prescribing by PCCs and specialists in a pediatric network.
  • To evaluate the quality of SSRI initiation by PCCs following integrated BH care.

Main Methods:

  • Cross-sectional analysis of administrative claims data over 10 years.
  • Evaluation of SSRI prescribing rates by PCCs and specialists.
  • Analysis of electronic health record data for quality metrics of SSRI initiation by PCCs.

Main Results:

  • PCC SSRI prescribing increased over sevenfold (56 to 446 fills/1000 patient-years) in 10 years.
  • PCCs' share of total SSRI prescriptions rose from 19% to 54%, surpassing specialist prescribing.
  • High adherence to recommended SSRIs (99.6%) and starting doses (97.5%) by PCCs, with room for improvement in symptom scale documentation and follow-up consistency.

Conclusions:

  • Integrated BH care in pediatric primary care led to a substantial rise in SSRI prescribing by PCCs.
  • PCCs demonstrated appropriate medication selection and dosing but require enhanced use of validated symptom rating scales and follow-up protocols.
  • The findings highlight the evolving role of PCCs in managing pediatric mental health conditions.