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New use of anticonvulsant medications among children enrolled in the Tennessee Medicaid Program
W O Cooper1, C F Federspiel, M R Griffin
1Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn, USA. william.cooper@mcmail.vanderbilt.edu
Insights
Many children in Tennessee Medicaid received anticonvulsant medications for non-epilepsy reasons. There was significant variation in prescription refills for children with epilepsy, highlighting a need for better treatment guidelines.
Area of Science:
- Pediatric pharmacology
- Health services research
- Neurology
Background:
- Anticonvulsant medications are commonly prescribed for epilepsy and other neurological conditions.
- Understanding prescribing patterns is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To describe the new use of anticonvulsant medications among children in the Tennessee Medicaid program.
- To identify indications for which these medications were prescribed.
Main Methods:
- Retrospective cohort study of children (aged 0-18 years) enrolled in Tennessee Medicaid in 1992.
- Categorization of new users based on diagnosis codes within 90 days of the first prescription.
- Logistic regression analysis to identify predictors of prescription filling.
Main Results:
- Of 647 new anticonvulsant users, 16% received prescriptions for non-epilepsy indications like jaundice, headaches, or psychiatric disorders.
- 16% had no clear diagnosis for which anticonvulsants are typically indicated.
- For children with epilepsy, white race and undergoing tests predicted more prescriptions.
Conclusions:
- A substantial proportion of pediatric anticonvulsant use in this population was for non-epilepsy indications.
- Significant variability exists in prescription filling for children with epilepsy.
- Further analysis can inform policies to improve anticonvulsant therapy and reduce unnecessary drug exposure.
Objective:
To describe the new use of anticonvulsant medications among children enrolled in the Tennessee Medicaid program.
Design:
A retrospective cohort study.
Patients:
New users of anticonvulsant medications in 1992 were identified from the 206,098 children (aged 0-18 years) enrolled continuously for 12 months in the Aid to Families With Dependent Children program or foster care program of Tennessee Medicaid.
Main Outcome Measures:
New users were categorized according to the diagnosis codes of health care encounters occurring 90 days before to 90 days after the first anticonvulsant prescription was filled as having diagnoses consistent with (1) epilepsy or convulsions, (2) neonatal seizures, (3) central nervous system disease, (4) no epilepsy diagnoses but diagnoses for which anticonvulsants might appropriately be used (jaundice, headaches, or psychiatric disorders), or (5) no diagnoses for which an anticonvulsant might appropriately be used. The children in each group were described according to sociodemographic variables, with logistic regression used to analyze variations in the subsequent filling of anticonvulsant prescriptions.
Results:
Of 647 children continuously enrolled in the Tennessee Medicaid program who were new anticonvulsant users in 1992, 58% had at least 1 health care encounter coded as epilepsy or convulsions, 2% had a diagnosis of neonatal seizures, 8% had central nervous system diagnoses, 16% had specific nonepilepsy diagnoses (jaundice, headache, or psychiatric diagnoses), and 16% had no diagnoses for which anticonvulsants might appropriately be prescribed. For children with epilepsy diagnoses, white race (P = .002) and undergoing tests (P < .001) were independent predictors of a child filling 6 or more prescriptions in the year following the first prescription
Conclusions:
A large proportion of new users of anticonvulsants among children enrolled in the Tennessee Medicaid program received these medications for indications other than epilepsy. For children with epilepsy diagnoses, there was considerable variation in the subsequent filling of prescriptions. Further analysis of these variations in practice will allow for the development of policies that will maximize benefit for children who need anticonvulsant therapy, while diminishing unnecessary exposure to potentially toxic drugs for children who do not.