TY - JOUR
T1 - Systematic Review
T2 - System-wide Interventions to Monitor Pediatric Antipsychotic Prescribing and Promote Best Practice
AU - Mackie, Thomas I.
AU - Schaefer, Ana J.
AU - Karpman, Hannah E.
AU - Lee, Stacey M.
AU - Bellonci, Christopher
AU - Larson, Justine
N1 - Funding Information:
The evidence review presented in this article was supported by a consultancy arrangement established with Capital Consulting Corporation and sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Funding Information:
The evidence review presented in this article was supported by a consultancy arrangement established with Capital Consulting Corporation and sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).Disclosure: Dr. Mackie has received research support from the Patient-Centered Outcomes Research Institute (PCORI/IHS-1409-23194), the Agency for Healthcare Research and Quality (1R01HS026001-01A1), the National Institute of Mental Health (NIMH; RFA MH-14-100], the W.T. Grant Foundation, and the Department of Children and Families in the State of New Jersey. He has received payment as a consultant to the American Academy of Pediatrics to conduct research about the experience of early career pediatricians. Dr. Bellonci is the Medical Director of the National Technical Assistance Network for Children's Behavioral Health funded by SAMHSA. He has been a clinical consultant on a grant to support lesbian, gay, bisexual, and transgender youth in child welfare settings from the Children's Bureau, the Administration for Children and Families of the U.S. Department of Health and Human Services. He has provided expert witness testimony on behalf of Children's Rights and Disability Rights of Vermont. He has been a volunteer on the Boards of the Association of Children's Residential Centers and the National Alliance to Advance Adolescent Health. Drs. Karpman and Larson and Mss. Schaefer and Lee have reported no biomedical financial interests or potential conflicts of interest.
Publisher Copyright:
© 2020 American Academy of Child and Adolescent Psychiatry
PY - 2021/1
Y1 - 2021/1
N2 - Objective: Rapid growth of antipsychotic use among children and adolescents at the turn of the 21st century led Medicaid programs to implement 3 types of system-wide interventions: antipsychotic monitoring programs, clinician prescribing supports, and delivery system enhancements. This systematic review assessed the available evidence base for and relative merits of these system-wide interventions that aim to improve antipsychotic treatment and management. Method: Using PRISMA guidelines, eligible studies were written in English and evaluated system-wide interventions to monitor antipsychotic treatment or promote antipsychotic management among children and adolescents (0–21 years of age). Studies were identified through Ovid MEDLINE and PsychInfo (years 1990–2018) and an environmental scan. From an initial review of 824 publications, 17 studies met eligibility criteria. Two authors independently conducted quality assessments using the Crowe Critical Appraisal Tool. Findings were summarized descriptively. Results: Identified studies (n = 17) evaluated prior authorization programs (n = 10), drug utilization reviews (n = 2), quality improvement (n = 4), care coordination programs (n = 1), and multimodal initiatives (n = 2). Studies were predominantly pre-post analyses, without a comparison group. With the exception of care coordination and drug utilization reviews, more than half of the interventions in each category were associated with significant reduction in antipsychotic treatment or promotion of best practice parameters. Conclusion: This evidence review concludes that evaluations of prior authorization programs demonstrate reductions in antipsychotic treatment, though evidence of impact of other system-wide interventions and other outcomes is limited. Additional research is necessary to investigate whether interventions influenced antipsychotic prescribing independent of secular trends, the comparative effectiveness and cost-effectiveness of interventions, the effect on functional outcomes, and the potential for unintended consequences.
AB - Objective: Rapid growth of antipsychotic use among children and adolescents at the turn of the 21st century led Medicaid programs to implement 3 types of system-wide interventions: antipsychotic monitoring programs, clinician prescribing supports, and delivery system enhancements. This systematic review assessed the available evidence base for and relative merits of these system-wide interventions that aim to improve antipsychotic treatment and management. Method: Using PRISMA guidelines, eligible studies were written in English and evaluated system-wide interventions to monitor antipsychotic treatment or promote antipsychotic management among children and adolescents (0–21 years of age). Studies were identified through Ovid MEDLINE and PsychInfo (years 1990–2018) and an environmental scan. From an initial review of 824 publications, 17 studies met eligibility criteria. Two authors independently conducted quality assessments using the Crowe Critical Appraisal Tool. Findings were summarized descriptively. Results: Identified studies (n = 17) evaluated prior authorization programs (n = 10), drug utilization reviews (n = 2), quality improvement (n = 4), care coordination programs (n = 1), and multimodal initiatives (n = 2). Studies were predominantly pre-post analyses, without a comparison group. With the exception of care coordination and drug utilization reviews, more than half of the interventions in each category were associated with significant reduction in antipsychotic treatment or promotion of best practice parameters. Conclusion: This evidence review concludes that evaluations of prior authorization programs demonstrate reductions in antipsychotic treatment, though evidence of impact of other system-wide interventions and other outcomes is limited. Additional research is necessary to investigate whether interventions influenced antipsychotic prescribing independent of secular trends, the comparative effectiveness and cost-effectiveness of interventions, the effect on functional outcomes, and the potential for unintended consequences.
KW - antipsychotic agent
KW - drug utilization review
KW - prior authorization
KW - shared decision making
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U2 - 10.1016/j.jaac.2020.08.441
DO - 10.1016/j.jaac.2020.08.441
M3 - Review article
C2 - 32966838
AN - SCOPUS:85097727901
SN - 0890-8567
VL - 60
SP - 76-104.e7
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 1
ER -