The appropriateness of use of 3 classes of psychotropic medications in children and adolescents

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American Journal of Pharmacy Benefits


Objectives: Concerns have been raised about the increasing use and potential adverse effects of psychotropic medications in children and adolescents. The objective of this study was to estimate the degree of appropriate use, and rates of use, of 3 groups of psychotropic medications (Attention Deficit Hyperactivity Disorder [ADHD)], atypical antipsychotic, selective serotonin receptor inhibitor [SSRI] antidepressant) among children in a Medicaid population. Methods: The study population consisted of members of one state's Medicaid program and State Children's Health Insurance Program who were 17 years or younger and continuously enrolled during calendar year 2006. A retrospective analysis was conducted using pharmacy and medical claims databases. Age-specific appropriateness of care criteria were developed based on US Food and Drug Administration-approved package inserts, national guidelines, and the professional literature. Diagnoses were obtained from medical claims, using 3-digit International Classification of Diseases, Ninth Revision, Clinical Modification codes. Results: Data were available for 274,569 children. Seventy-five percent of their use of any study medication was consistent with study criteria. Eighty-two percent of children had ADHD medication use, 67% had antipsychotic medication use, and 63% had antidepressant medication use that was consistent with criteria. The prevalence of having at least 1 prescription for any psychotropic medication was 52.7 per 1000, with rates of ADHD medication use of 39.2 per 1000, antipsychotic medication of 21.2 per 1000, and an antidepressant of 13.3 per 1000. The prevalence of use of any medication for whites was 1.5 times higher than for blacks, 4.1 times higher than for Hispanics, and 7.3 times higher than for Native Americans. Conclusions: The majority of use of these medications was appropriate as determined by our evidence-based methodology. The prevalence of use was modest and consistent with previous literature. There was evidence of racial disparity in access to these medications.

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