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. 2017 Apr;52(2):561-578.
doi: 10.1111/1475-6773.12539.

Decrease in Statewide Antipsychotic Prescribing After Implementation of Child and Adolescent Psychiatry Consultation Services

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Decrease in Statewide Antipsychotic Prescribing After Implementation of Child and Adolescent Psychiatry Consultation Services

Rebecca P Barclay et al. Health Serv Res. .
Free PMC article


Objective: To learn if a quality of care Medicaid child psychiatric consultation service implemented in three different steps was linked to changes in statewide child antipsychotic utilization.

Data sources/study setting: Washington State child psychiatry consultation program primary data and Medicaid pharmacy division antipsychotic utilization secondary data from July 1, 2006, through December 31, 2013.

Study design: Observational study in which consult program data were analyzed with a time series analysis of statewide antipsychotic utilization.

Data collection/extraction methods: All consultation program database information involving antipsychotics was compared to Medicaid pharmacy division database information involving antipsychotic utilization.

Principal findings: Washington State's total child Medicaid antipsychotic utilization fell from 0.51 to 0.25 percent. The monthly prevalence of use fell by a mean of 0.022 per thousand per month following the initiation of elective consults (p = .004), by 0.065 following the initiation of age/dose triggered mandatory reviews (p < .001), then by another 0.022 following the initiation of two or more concurrent antipsychotic mandatory reviews (p = .001). High-dose antipsychotic use fell by 57.8 percent in children 6- to 12-year old and fell by 52.1 percent in teens.

Conclusions: Statewide antipsychotic prescribing for Medicaid clients fell significantly at different rates following each implementation step of a multilevel consultation and best-practice education service.

Keywords: Antipsychotic agents; Medicaid; child and adolescent psychiatry; outcome assessment (health care); referral and consultation.


Figure 1
Figure 1
Ratio of Atypical Antipsychotic Users/Child Medicaid Enrollees Decreased after Implementation of Each Review Phase
Figure 2
Figure 2
Children Receiving Antipsychotics with Dose > Maximum Decreased after Initiation of Mandatory Antipsychotic Reviews

Note. *Shaded bar represents 9‐month period from start of reviews until change in use of antipsychotic at dose > maximum allowed stabilized.

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