Official Title: Comparative Safety of Atypical Antipsychotics in High-Risk US Children with ADHD
Research Lead: David M. Rubin, M.D., M.S.C.E.
Study Team: Meredith Matone, M.H.S., Vera Huang, M.S., Xianqun Luan, M.S., Chris Feudtner, M.D., Ph.D., Russell Localio, Ph.D.
Supported by: Agency for Healthcare Research and Quality
Dates: September 2010 - August 2013
Background
Previous research and federal reports have focused national attention on the high rates of use of psychotropic medications among children, in particular, children in foster care. Rates of utilization of second-generation antipsychotics (one class of psychotropic medications) and polypharmacy- prescribing three or more classes of psychotropic medications simultaneously to a single child for a month or more- have been identified as outcomes with concerning trends of increase. Recent research demonstrating serious side effects of these medications in children has prompted policy action at both the federal and state level. This national analysis aims to examine potential adverse effects of these medications in children, and likewise, the growth in their use among children receiving Medicaid.
Aims
- Describe variation in the use of antipsychotic medications across different populations of children within the Medicaid program, and across children living in different states.
- Identify system and state policy-level factors that influence the magnitude of antipsychotic medication among Medicaid-enrolled children against similar Medicaid-enrolled children who were not exposed to antipsychotics.
- Compare the prevalence of hypertension and diabetes among children who are exposed to antipsychotic medication among all Medicaid children exposed to antipsychotic medication and stratified by eligibility sub-populations.
Methods
Study Design: The sequential data analysis plan includes a repeated cross-sectional approach for assessment of prescribing trends over time, followed by a longitudinal approach for the identification of adverse events and case histories across years.
Population: Medicaid administrative data in 50 states for all children under 18 years old from 2001-2007.
Progress
Foster care analysis is complete. Full Medicaid analysis anticipated to be released Fall 2012.
Policy Focus
- By identifying policies that promote off-label antipsychotic use among children, the team hopes to identify appropriate targets for intervention to standardize practice.
- Reduce state to state differences by identifying system-level variations in the use of antipsychotic medications among vulnerable populations independent of child need.
Dissemination
Rubin D, Matone M, Huang Y-S, dosReis S, Feudtner C, Localio R. Interstate Variation in Trends of Psychotropic Medication Use among Medicaid-enrolled Children in Foster Care. Children and Youth Services Review. Epub April 15, 2012. Download a copy of the Research At-A-Glance study brief.
Rubin DM, Feudtner C, Localio R, Mandell DS. State variation in psychotropic medication use by foster care children with autism spectrum disorder. Pediatrics. 2009;124(2):e305-e312. Epub 2009 Jul 20.
