The impact of a state medicaid peer-review authorization program on pediatric use of antipsychotic medications

Dinci Pennap, Mehmet Burcu, Daniel J. Safer, Julie Magno Zito

Research output: Contribution to journalArticle

Abstract

Objective: This cross-sectional study assessed the impact of a peer-review program on the prevalence of pediatric antipsychotic use among Medicaid-insured youths in a Mid-Atlantic state. Methods: Medicaid claims (2010-2014) were assessed among continuously enrolled youths in the 12 months before and after implementation of peer review. The study identified children ages zero to four preimplementation (N=118,815) and postimplementation (N=121,431), ages five to nine preimplementation (N=98,681) and postimplementation (N=107,872), and ages 10 to 17 preimplementation (N= 154,696) and postimplementation (N=161,370). (Age ranges are inclusive of the final number). In each age group, multivariable logistic regression models with generalized estimating equations assessed the change in annual prevalence of antipsychotic use pre-To postimplementation.Use of other leading psychotropic classes and antipsychotic prescribing by medical specialty were also examined. Results: The annual pre-To postimplementation prevalence of antipsychotic use decreased significantly, from .07% to .03% (adjusted odds ratio [AOR]=.41) among children ages zero to four, from 1.57% to .86% (AOR=.54) among those ages five to nine, and from 3.28% to 2.40% (AOR=.72)among those ages 10 to 17. With the exception of alpha-Agonist use, which increased postimplementation (AOR=1.30) among those ages zero to four, no clinically significant pre-post change was noted in other leading psychotropic classes amongchildren ages zero to four and 10 to 17. By contrast, postimplementation use of other psychotropic medications decreased among those ages five to nine (AOR=.73). Conclusions: A state Medicaid peer-review program resulted in decreased antipsychotic use across all age groups, particularly among children younger than ten. No notable substitution of other psychotropic classes for antipsychotics was observed.

Original languageEnglish (US)
Pages (from-to)293-299
Number of pages7
JournalPsychiatric Services
Volume69
Issue number3
DOIs
StatePublished - Mar 1 2018

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Peer Review
Medicaid
Antipsychotic Agents
Pediatrics
Odds Ratio
Age Groups
Logistic Models
Cross-Sectional Studies
Medicine

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

The impact of a state medicaid peer-review authorization program on pediatric use of antipsychotic medications. / Pennap, Dinci; Burcu, Mehmet; Safer, Daniel J.; Zito, Julie Magno.

In: Psychiatric Services, Vol. 69, No. 3, 01.03.2018, p. 293-299.

Research output: Contribution to journalArticle

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abstract = "Objective: This cross-sectional study assessed the impact of a peer-review program on the prevalence of pediatric antipsychotic use among Medicaid-insured youths in a Mid-Atlantic state. Methods: Medicaid claims (2010-2014) were assessed among continuously enrolled youths in the 12 months before and after implementation of peer review. The study identified children ages zero to four preimplementation (N=118,815) and postimplementation (N=121,431), ages five to nine preimplementation (N=98,681) and postimplementation (N=107,872), and ages 10 to 17 preimplementation (N= 154,696) and postimplementation (N=161,370). (Age ranges are inclusive of the final number). In each age group, multivariable logistic regression models with generalized estimating equations assessed the change in annual prevalence of antipsychotic use pre-To postimplementation.Use of other leading psychotropic classes and antipsychotic prescribing by medical specialty were also examined. Results: The annual pre-To postimplementation prevalence of antipsychotic use decreased significantly, from .07{\%} to .03{\%} (adjusted odds ratio [AOR]=.41) among children ages zero to four, from 1.57{\%} to .86{\%} (AOR=.54) among those ages five to nine, and from 3.28{\%} to 2.40{\%} (AOR=.72)among those ages 10 to 17. With the exception of alpha-Agonist use, which increased postimplementation (AOR=1.30) among those ages zero to four, no clinically significant pre-post change was noted in other leading psychotropic classes amongchildren ages zero to four and 10 to 17. By contrast, postimplementation use of other psychotropic medications decreased among those ages five to nine (AOR=.73). Conclusions: A state Medicaid peer-review program resulted in decreased antipsychotic use across all age groups, particularly among children younger than ten. No notable substitution of other psychotropic classes for antipsychotics was observed.",
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N2 - Objective: This cross-sectional study assessed the impact of a peer-review program on the prevalence of pediatric antipsychotic use among Medicaid-insured youths in a Mid-Atlantic state. Methods: Medicaid claims (2010-2014) were assessed among continuously enrolled youths in the 12 months before and after implementation of peer review. The study identified children ages zero to four preimplementation (N=118,815) and postimplementation (N=121,431), ages five to nine preimplementation (N=98,681) and postimplementation (N=107,872), and ages 10 to 17 preimplementation (N= 154,696) and postimplementation (N=161,370). (Age ranges are inclusive of the final number). In each age group, multivariable logistic regression models with generalized estimating equations assessed the change in annual prevalence of antipsychotic use pre-To postimplementation.Use of other leading psychotropic classes and antipsychotic prescribing by medical specialty were also examined. Results: The annual pre-To postimplementation prevalence of antipsychotic use decreased significantly, from .07% to .03% (adjusted odds ratio [AOR]=.41) among children ages zero to four, from 1.57% to .86% (AOR=.54) among those ages five to nine, and from 3.28% to 2.40% (AOR=.72)among those ages 10 to 17. With the exception of alpha-Agonist use, which increased postimplementation (AOR=1.30) among those ages zero to four, no clinically significant pre-post change was noted in other leading psychotropic classes amongchildren ages zero to four and 10 to 17. By contrast, postimplementation use of other psychotropic medications decreased among those ages five to nine (AOR=.73). Conclusions: A state Medicaid peer-review program resulted in decreased antipsychotic use across all age groups, particularly among children younger than ten. No notable substitution of other psychotropic classes for antipsychotics was observed.

AB - Objective: This cross-sectional study assessed the impact of a peer-review program on the prevalence of pediatric antipsychotic use among Medicaid-insured youths in a Mid-Atlantic state. Methods: Medicaid claims (2010-2014) were assessed among continuously enrolled youths in the 12 months before and after implementation of peer review. The study identified children ages zero to four preimplementation (N=118,815) and postimplementation (N=121,431), ages five to nine preimplementation (N=98,681) and postimplementation (N=107,872), and ages 10 to 17 preimplementation (N= 154,696) and postimplementation (N=161,370). (Age ranges are inclusive of the final number). In each age group, multivariable logistic regression models with generalized estimating equations assessed the change in annual prevalence of antipsychotic use pre-To postimplementation.Use of other leading psychotropic classes and antipsychotic prescribing by medical specialty were also examined. Results: The annual pre-To postimplementation prevalence of antipsychotic use decreased significantly, from .07% to .03% (adjusted odds ratio [AOR]=.41) among children ages zero to four, from 1.57% to .86% (AOR=.54) among those ages five to nine, and from 3.28% to 2.40% (AOR=.72)among those ages 10 to 17. With the exception of alpha-Agonist use, which increased postimplementation (AOR=1.30) among those ages zero to four, no clinically significant pre-post change was noted in other leading psychotropic classes amongchildren ages zero to four and 10 to 17. By contrast, postimplementation use of other psychotropic medications decreased among those ages five to nine (AOR=.73). Conclusions: A state Medicaid peer-review program resulted in decreased antipsychotic use across all age groups, particularly among children younger than ten. No notable substitution of other psychotropic classes for antipsychotics was observed.

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