TY - JOUR
T1 - Psychotropic polypharmacy among youths with serious emotional and behavioral disorders receiving coordinated care services
AU - Wu, Benjamin
AU - Bruns, Eric J.
AU - Tai, Ming Hui
AU - Lee, Bethany R.
AU - Raghavan, Ramesh
AU - DosReis, Susan
N1 - Funding Information:
The paper was developed under grant CFDA 93.767 from the Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services (DHHS) (contract MHA#11–10628G/M00F1400411). The authors acknowledge the data contribution from the Hilltop Institute and support from the Institute for Innovation and Implementation at the University of Maryland. These contents do not necessarily represent the policy of DHHS, and one should not assume endorsement by the U.S. Government.
Publisher Copyright:
© 2018 American Psychiatric Association. All rights reserved.
PY - 2018/6
Y1 - 2018/6
N2 - OBJECTIVE: The study examined differences in psychotropic polypharmacy among youths with serious emotional and behavioral disorders who received coordinated care services (CCS) that used a wraparound model and a matched sample of youths who received traditional services.METHODS: A quasi-experimental design compared psychotropic polypharmacy one year before and one year after discharge from CCS. The cohort was youths with serious emotional and behavioral disorders who were enrolled in CCS from December 2009 through May 2014. The comparison group was youths with serious emotional and behavioral disorders who received outpatient mental health services during the same time. Administrative data from Medicaid, child welfare, and juvenile justice services were used. A difference-in-difference analysis with propensity score matching evaluated the CCS intervention by time effect on psychotropic polypharmacy.RESULTS: In both groups, most youths were male, black, and 10-18 years old, with attention-deficit hyperactivity disorder (54%-55%), mood disorder (39%-42%), depression (26%-27%), and bipolar disorder (25%-26%). About half of each group was taking an antipsychotic. The percentage reduction in polypharmacy from one year before CCS enrollment to one year after discharge was 28% for the CCS group and 29% for the non-CCS group, a nonsignificant difference. CCS youths excluded from the analysis had more complex mental health needs and a greater change in polypharmacy than the CCS youths who were included in the analytic sample.CONCLUSIONS: Mental health care coordination had limited impact in reducing psychotropic polypharmacy for youths with less complex mental health needs. Further research is needed to evaluate the effect on psychotropic polypharmacy among youths with the greatest mental health needs.
AB - OBJECTIVE: The study examined differences in psychotropic polypharmacy among youths with serious emotional and behavioral disorders who received coordinated care services (CCS) that used a wraparound model and a matched sample of youths who received traditional services.METHODS: A quasi-experimental design compared psychotropic polypharmacy one year before and one year after discharge from CCS. The cohort was youths with serious emotional and behavioral disorders who were enrolled in CCS from December 2009 through May 2014. The comparison group was youths with serious emotional and behavioral disorders who received outpatient mental health services during the same time. Administrative data from Medicaid, child welfare, and juvenile justice services were used. A difference-in-difference analysis with propensity score matching evaluated the CCS intervention by time effect on psychotropic polypharmacy.RESULTS: In both groups, most youths were male, black, and 10-18 years old, with attention-deficit hyperactivity disorder (54%-55%), mood disorder (39%-42%), depression (26%-27%), and bipolar disorder (25%-26%). About half of each group was taking an antipsychotic. The percentage reduction in polypharmacy from one year before CCS enrollment to one year after discharge was 28% for the CCS group and 29% for the non-CCS group, a nonsignificant difference. CCS youths excluded from the analysis had more complex mental health needs and a greater change in polypharmacy than the CCS youths who were included in the analytic sample.CONCLUSIONS: Mental health care coordination had limited impact in reducing psychotropic polypharmacy for youths with less complex mental health needs. Further research is needed to evaluate the effect on psychotropic polypharmacy among youths with the greatest mental health needs.
KW - Adolescent
KW - Attention Deficit Disorder with Hyperactivity/drug therapy
KW - Bipolar Disorder/drug therapy
KW - Child
KW - Delivery of Health Care, Integrated/statistics & numerical data
KW - Drug Prescriptions/statistics & numerical data
KW - Female
KW - Humans
KW - Male
KW - Maryland
KW - Medicaid/statistics & numerical data
KW - Mental Health Services/statistics & numerical data
KW - Mood Disorders/drug therapy
KW - Polypharmacy
KW - Psychotropic Drugs/therapeutic use
KW - United States
UR - http://www.scopus.com/inward/record.url?scp=85048078682&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048078682&partnerID=8YFLogxK
U2 - 10.1176/appi.ps.201700357
DO - 10.1176/appi.ps.201700357
M3 - Article
C2 - 29540121
AN - SCOPUS:85048078682
VL - 69
SP - 716
EP - 722
JO - Hospital and Community Psychiatry
JF - Hospital and Community Psychiatry
SN - 1075-2730
IS - 6
ER -