Growth in the concurrent use of antipsychotics with other psychotropic medications in medicaid-enrolled children

Amanda R. Kreider, Meredith Matone, Christopher Bellonci, Susan Dosreis, Chris Feudtner, Yuan Shung Huang, Russell Localio, David M. Rubin

Research output: Contribution to journalArticle

Abstract

Objective Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children; however, there is limited understanding of the frequency of concurrent SGA prescribing with other psychotropic medications. This study describes the epidemiology of concurrent SGA use with 4 psychotropic classes (stimulants, antidepressants, mood stabilizers, and α-agonists) among a national sample of Medicaid-enrolled children and adolescents 6 to 18 years old between 2004 and 2008. Method Repeated cross-sectional design was used, with national Medicaid Analytic eXtract data (10.6 million children annually). Logit and Poisson regression, standardized for year, demographics, and Medicaid eligibility group, estimated the probability and duration of concurrent SGA use with each medication class over time and examined concurrent SGAs in relation to clinical and demographic characteristics. Results While SGA use overall increased by 22%, 85% of such use occurred concurrently. By 2008, the probability of concurrent SGA use ranged from 0.22 for stimulant users to 0.52 for mood stabilizer users. Concurrent SGA use occurred for long durations (69%-89% of annual medication days). Although the highest users of concurrent SGA were participants in foster care and disability Medicaid programs or those with behavioral hospitalizations, the most significant increases over time occurred among participants who were income-eligible for Medicaid (+13%), without comorbid ADHD (+15%), were not hospitalized (+13%), and did not have comorbid intellectual disability (+45%). Conclusion Concurrent SGA use with other psychotropic classes increased over time, and the duration of concurrent therapy was consistently long term. Concurrent SGA regimens will require further research to determine efficacy and potential drug-drug interactions, given a practice trend toward more complex regimens in less-impaired children/adolescents.

Original languageEnglish (US)
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume53
Issue number9
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Medicaid
Antipsychotic Agents
Growth
Demography
Drug Interactions
Intellectual Disability
Antidepressive Agents
Epidemiology
Hospitalization

Keywords

  • foster care
  • Medicaid
  • pediatric psychopharmacology
  • polypharmacy
  • second-generation antipsychotics

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology
  • Medicine(all)

Cite this

Growth in the concurrent use of antipsychotics with other psychotropic medications in medicaid-enrolled children. / Kreider, Amanda R.; Matone, Meredith; Bellonci, Christopher; Dosreis, Susan; Feudtner, Chris; Huang, Yuan Shung; Localio, Russell; Rubin, David M.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 53, No. 9, 2014.

Research output: Contribution to journalArticle

Kreider, Amanda R. ; Matone, Meredith ; Bellonci, Christopher ; Dosreis, Susan ; Feudtner, Chris ; Huang, Yuan Shung ; Localio, Russell ; Rubin, David M. / Growth in the concurrent use of antipsychotics with other psychotropic medications in medicaid-enrolled children. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2014 ; Vol. 53, No. 9.
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abstract = "Objective Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children; however, there is limited understanding of the frequency of concurrent SGA prescribing with other psychotropic medications. This study describes the epidemiology of concurrent SGA use with 4 psychotropic classes (stimulants, antidepressants, mood stabilizers, and α-agonists) among a national sample of Medicaid-enrolled children and adolescents 6 to 18 years old between 2004 and 2008. Method Repeated cross-sectional design was used, with national Medicaid Analytic eXtract data (10.6 million children annually). Logit and Poisson regression, standardized for year, demographics, and Medicaid eligibility group, estimated the probability and duration of concurrent SGA use with each medication class over time and examined concurrent SGAs in relation to clinical and demographic characteristics. Results While SGA use overall increased by 22{\%}, 85{\%} of such use occurred concurrently. By 2008, the probability of concurrent SGA use ranged from 0.22 for stimulant users to 0.52 for mood stabilizer users. Concurrent SGA use occurred for long durations (69{\%}-89{\%} of annual medication days). Although the highest users of concurrent SGA were participants in foster care and disability Medicaid programs or those with behavioral hospitalizations, the most significant increases over time occurred among participants who were income-eligible for Medicaid (+13{\%}), without comorbid ADHD (+15{\%}), were not hospitalized (+13{\%}), and did not have comorbid intellectual disability (+45{\%}). Conclusion Concurrent SGA use with other psychotropic classes increased over time, and the duration of concurrent therapy was consistently long term. Concurrent SGA regimens will require further research to determine efficacy and potential drug-drug interactions, given a practice trend toward more complex regimens in less-impaired children/adolescents.",
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T1 - Growth in the concurrent use of antipsychotics with other psychotropic medications in medicaid-enrolled children

AU - Kreider, Amanda R.

AU - Matone, Meredith

AU - Bellonci, Christopher

AU - Dosreis, Susan

AU - Feudtner, Chris

AU - Huang, Yuan Shung

AU - Localio, Russell

AU - Rubin, David M.

PY - 2014

Y1 - 2014

N2 - Objective Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children; however, there is limited understanding of the frequency of concurrent SGA prescribing with other psychotropic medications. This study describes the epidemiology of concurrent SGA use with 4 psychotropic classes (stimulants, antidepressants, mood stabilizers, and α-agonists) among a national sample of Medicaid-enrolled children and adolescents 6 to 18 years old between 2004 and 2008. Method Repeated cross-sectional design was used, with national Medicaid Analytic eXtract data (10.6 million children annually). Logit and Poisson regression, standardized for year, demographics, and Medicaid eligibility group, estimated the probability and duration of concurrent SGA use with each medication class over time and examined concurrent SGAs in relation to clinical and demographic characteristics. Results While SGA use overall increased by 22%, 85% of such use occurred concurrently. By 2008, the probability of concurrent SGA use ranged from 0.22 for stimulant users to 0.52 for mood stabilizer users. Concurrent SGA use occurred for long durations (69%-89% of annual medication days). Although the highest users of concurrent SGA were participants in foster care and disability Medicaid programs or those with behavioral hospitalizations, the most significant increases over time occurred among participants who were income-eligible for Medicaid (+13%), without comorbid ADHD (+15%), were not hospitalized (+13%), and did not have comorbid intellectual disability (+45%). Conclusion Concurrent SGA use with other psychotropic classes increased over time, and the duration of concurrent therapy was consistently long term. Concurrent SGA regimens will require further research to determine efficacy and potential drug-drug interactions, given a practice trend toward more complex regimens in less-impaired children/adolescents.

AB - Objective Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children; however, there is limited understanding of the frequency of concurrent SGA prescribing with other psychotropic medications. This study describes the epidemiology of concurrent SGA use with 4 psychotropic classes (stimulants, antidepressants, mood stabilizers, and α-agonists) among a national sample of Medicaid-enrolled children and adolescents 6 to 18 years old between 2004 and 2008. Method Repeated cross-sectional design was used, with national Medicaid Analytic eXtract data (10.6 million children annually). Logit and Poisson regression, standardized for year, demographics, and Medicaid eligibility group, estimated the probability and duration of concurrent SGA use with each medication class over time and examined concurrent SGAs in relation to clinical and demographic characteristics. Results While SGA use overall increased by 22%, 85% of such use occurred concurrently. By 2008, the probability of concurrent SGA use ranged from 0.22 for stimulant users to 0.52 for mood stabilizer users. Concurrent SGA use occurred for long durations (69%-89% of annual medication days). Although the highest users of concurrent SGA were participants in foster care and disability Medicaid programs or those with behavioral hospitalizations, the most significant increases over time occurred among participants who were income-eligible for Medicaid (+13%), without comorbid ADHD (+15%), were not hospitalized (+13%), and did not have comorbid intellectual disability (+45%). Conclusion Concurrent SGA use with other psychotropic classes increased over time, and the duration of concurrent therapy was consistently long term. Concurrent SGA regimens will require further research to determine efficacy and potential drug-drug interactions, given a practice trend toward more complex regimens in less-impaired children/adolescents.

KW - foster care

KW - Medicaid

KW - pediatric psychopharmacology

KW - polypharmacy

KW - second-generation antipsychotics

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