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Providers’ Behaviors and Beliefs on Prescribing Antipsychotic Medication to Children: A Qualitative Study

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Abstract

Fragmentation in behavioral and mental health care to children has resulted in suboptimal care and high rates of psychotropic medication use, especially antipsychotic medications (APM). A qualitative study, based on the Theory of Planned Behavior (TPB), aimed to better understand prescribing practices, barriers to optimal treatment, and potential interventions to safeguard the use of APM for children in Kentucky. The most common barrier to optimal care was access to mental health specialists. Social norms and pressure from families contribute to increased medication use. We identify promising interventions to safeguard the use of APM through the lens of the TPB.

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References

  • Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Decision Making Processes, 50, 179–211.

    Article  Google Scholar 

  • Almandil, N. B., Liu, Y., Murray, M. L., Besag, F. M., Aitchison, K. J., & Wong, I. C. (2013). Weight gain and other metabolic adverse effects associated with atypical antipsychotic treatment of children and adolescents: A systematic review and meta-analysis. Paediatric Drugs, 15(2), 139–150.

    Article  Google Scholar 

  • American Academy of Child & Adolescent Psychiatry. (2009). Practice parameter on the use of psychotropic medication in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 48(9), 961–973. doi:10.1097/CHI.0b013e3181ae0a08.

    Article  Google Scholar 

  • American Psychiatric Association. (2013). Choosing wisely: Five things physicians and patients should question Retrieved December 4, 2015, from http://www.choosingwisely.org/societies/american-psychiatric-association/.

  • Arango, C., Giraldez, M., Merchan-Naranjo, J., Baeza, I., Castro-Fornieles, J., Alda, J. A., et al. (2014). Second-generation antipsychotic use in children and adolescents: a six-month prospective cohort study in drug-naive patients. Journal of the American Academy of Child & Adolescent Psychiatry, 53(11), 1179–1190. doi:10.1016/j.jaac.2014.08.009.

    Article  Google Scholar 

  • Becker, E. R., Constantine, R. J., McPherson, M. A., & Jones, M. E. (2013). Antipsychotic polypharmacy prescribing patterns and costs in the Florida adult and child Medicaid populations. Journal of Health Care Finance, 40(1), 40–67.

    PubMed  Google Scholar 

  • Bobo, W. V., Cooper, W. O., Stein, C. M., Olfson, M., Graham, D., Daugherty, J., et al. (2013). Antipsychotics and the risk of type 2 diabetes mellitus in children and youth. JAMA Psychiatry, 70(10), 1067–1075.

    Article  Google Scholar 

  • Carbon, M., Kapoor, S., Sheridan, E., Al-Jadiri, A., Azzo, S., Sarkaria, T., et al. (2015). Neuromotor adverse effects in 342 youth during 12 weeks of naturalistic treatment with 5 s-generation antipsychotics. Journal of the American Academy of Child & Adolescent Psychiatry, 54(9), 718–727. doi:10.1016/j.jaac.2015.06.015.

    Article  Google Scholar 

  • Carpenter-Song, E., & Snell-Rood, C. (2016). The changing context of rural America: A call to examine the impact of social change on mental health and mental health care. Psychiatric Services, appips201600024. doi:10.1176/appi.ps.201600024.

    Article  Google Scholar 

  • Correll, C. U., Manu, P., Olshanskiy, V., Napolitano, B., Kane, J. M., & Malhotra, A. K. (2009). Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA: The Journal of the American Medical Association, 302(16), 1765–1773. doi:10.1001/jama.2009.1549.

    Article  CAS  PubMed  Google Scholar 

  • Crystal, S., Olfson, M., Huang, C., Pincus, H., & Gerhard, T. (2009). Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges. Health Affairs, 28(5), w770–w781. doi:10.1377/hlthaff.28.5.w770.

    Article  PubMed  Google Scholar 

  • Davis, D. W., Smith, M. J., Feygin, Y., Myers, J., Lohr, D., Collins-Camargo, C., Williams, P. G., Jones, V. F. (2016). Medication prescribing to children insured by Kentucky Medicaid interim report December 2016. Unpublished data analysis. Pediatrics. University of Louisville. Louisville, KY.

  • De Hert, M., Dobbelaere, M., Sheridan, E. M., Cohen, D., & Correll, C. U. (2011). Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: A systematic review of randomized, placebo controlled trials and guidelines for clinical practice. European Psychiatry, 26(3), 144–158. doi:10.1016/j.eurpsy.2010.09.011.

    Article  PubMed  Google Scholar 

  • dosReis, S., Yoon, Y., Rubin, D. M., Riddle, M. A., Noll, E., & Rothbard, A. (2011). Antipsychotic treatment among youth in foster care. Pediatrics, 128(6), e1459–e1466. doi:10.1542/peds.2010-2970.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fairbrother, G. L., Emerson, H. P., & Partridge, L. (2007). How stable is medicaid coverage for children? Health Affairs, 26(2), 520–528. doi:10.1377/hlthaff.26.2.520.

    Article  PubMed  Google Scholar 

  • Findling, R., Drury, S., Jensen, P., & Rappaport, J. (2011). Practice parameter for the use of atypical antipsychotic medications in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). Washington, D.C.

  • Fraguas, D., Correll, C. U., Merchan-Naranjo, J., Rapado-Castro, M., Parellada, M., Moreno, C., et al. (2011). Efficacy and safety of second-generation antipsychotics in children and adolescents with psychotic and bipolar spectrum disorders: Comprehensive review of prospective head-to-head and placebo-controlled comparisons. European Neuropsychopharmacology, 21(8), 621–645. doi:10.1016/j.euroneuro.2010.07.002.

    Article  CAS  PubMed  Google Scholar 

  • Friedman, R. M., & Kutash, K. (1992). Challenges for child and adolescent mental health. Health Affairs, 11(3), 125–136.

    Article  CAS  Google Scholar 

  • Hilt, R. J., Romaire, M. A., McDonell, M. G., Sears, J. M., Krupski, A., Thompson, J. N., et al. (2013). The partnership access line: Evaluating a child psychiatry consult program in Washington State. JAMA Pediatrics, 167(2), 162–168.

    Article  Google Scholar 

  • Hilt, R. J., Barclay, R. P., Bush, J., Stout, B., Anderson, N., & Wignall, J. R. (2015). A statewide child telepsychiatry consult system yields desired health system changes and savings. Telemedicine Journal and E-health: The Official Journal of the American Telemedicine Association, 21(7), 533–537. doi:10.1089/tmj.2014.0161.

    Article  Google Scholar 

  • Hogan, M. F. (2003). The President’s New Freedom Commission: Recommendations to transform mental health care in America. Psychiatric Services, 54(11), 1467–1474. doi:10.1176/appi.ps.54.11.1467.

    Article  PubMed  Google Scholar 

  • Howie, L. D., Pastor, P. N., & Lukacs, S. L. (2014). Use of medication prescribed for emotional or behavioral difficulties among children aged 6–17 years in the United States, 2011–2012: NCHS data brief. Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • Knapp, P., Chait, A., Pappadopulos, E., Crystal, S., & Jensen, P. S. (2012). Treatment of maladaptive aggression in youth: CERT guidelines I. Engagement, assessment, and management. Pediatrics, 129(6), e1562–e1576. doi:10.1542/peds.2010-1360.

    Article  PubMed  Google Scholar 

  • Lohr, W. D., Chowning, R. T., Stevenson, M. D., & Williams, P. G. (2015). Trends in atypical antipsychotics prescribed to children six years of age or less on Medicaid in Kentucky. Journal of Child and Adolescent Psychopharmacology, 25(5), 440–443. doi:10.1089/cap.2014.0057.

    Article  PubMed  PubMed Central  Google Scholar 

  • Medco Health Solutions. (2011). America’s state of mind Retrieved February 1, 2017, from http://apps.who.int/medicinedocs/documents/s19032en/s19032en.pdf.

  • Morrato, E. H., Nicol, G. E., Maahs, D., Druss, B. G., Hartung, D. M., Valuck, R. J., et al. (2010). Metabolic screening in children receiving antipsychotic drug treatment. Archives of Pediatric and Adolescent Medicine, 164(4), 344–351. doi:10.1001/archpediatrics.2010.48.

    Article  Google Scholar 

  • Murphy, A. L., Gardner, D. M., Kisely, S., Cooke, C. A., Kutcher, S. P., & Hughes, J. (2015). System struggles and substitutes: A qualitative study of general practitioner and psychiatrist experiences of prescribing antipsychotics to children and adolescents. Clinical Child Psychology and Psychiatry. doi:10.1177/1359104515617518.

    Article  PubMed  PubMed Central  Google Scholar 

  • Olfson, M., Crystal, S., Huang, C., & Gerhard, T. (2010). Trends in antipsychotic drug use by very young, privately insured children. Journal of the American Academy of Child & Adolescent Psychiatry, 49(1), 13–23.

    Google Scholar 

  • Olfson, M., Blanco, C., Liu, S. M., Wang, S., & Correll, C. U. (2012). National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Archives of General Psychiatry, 69(12), 1247–1256. doi:10.1001/archgenpsychiatry.2012.647.

    Article  PubMed  Google Scholar 

  • Olfson, M., Blanco, C., Wang, S., Laje, G., & Correll, C. U. (2014). National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry, 71(1), 81–90. doi:10.1001/jamapsychiatry.2013.3074.

    Article  PubMed  Google Scholar 

  • Pidano, A. E., & Honigfeld, L. (2012). Pediatric psychopharmacology: Context, model programs, and considerations for care. Psychiatric Services, 63(9), 929–934. doi:10.1176/appi.ps.201100318.

    Article  PubMed  Google Scholar 

  • Pope, C., & Mays, N. (2006). Qualitative research in health care. Malden, MA: Blackwell.

    Book  Google Scholar 

  • Rosato, N. S., Correll, C. U., Pappadopulos, E., Chait, A., Crystal, S., & Jensen, P. S. (2012). Treatment of maladaptive aggression in youth: CERT guidelines II. Treatments and ongoing management. Pediatrics, 129(6), e1577–e1586. doi:10.1542/peds.2010-1361.

    Article  Google Scholar 

  • Rubin, D. M., Kreider, A. R., Matone, M., Huang, Y. S., Feudtner, C., Ross, M. E., et al. (2015). Risk for incident diabetes mellitus following initiation of second-generation antipsychotics among Medicaid-enrolled youths. JAMA Pediatrics, 169(4), e150285. doi:10.1001/jamapediatrics.2015.0285.

    Article  PubMed  Google Scholar 

  • Sarvet, B., Gold, J., Bostic, J. Q., Masek, B. J., Prince, J. B., Jeffers-Terry, M., et al. (2010). Improving access to mental health care for children: The Massachusetts Child Psychiatry Access Project. Pediatrics, 126(6), 1191–1200.

    Article  Google Scholar 

  • Seabury, S. A., Goldman, D. P., Kalsekar, I., Sheehan, J. J., Laubmeier, K., & Lakdawalla, D. N. (2014). Formulary restrictions on atypical antipsychotics: impact on costs for patients with schizophrenia and bipolar disorder in Medicaid. American Journal of Managed Care, 20(2), e52–e60.

    PubMed  Google Scholar 

  • Thomas, K. C., Ellis, A. R., Konrad, T. R., Holzer, C. E., & Morrissey, J. P. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services, 60(10), 1323–1328. doi:10.1176/ps.2009.60.10.1323.

    Article  PubMed  Google Scholar 

  • U.S. Department of Health and Human Services. (2013). The U.S. Health Workforce Chartbook Part 4: Behavioral and allied health. Rockville, MD: Health Resources and Services Administration (HRSA) and National Center for Health Workforce Analysis.

  • Zito, J. M., Safer, D. J., Zuckerman, I. H., Gardner, J. F., & Soeken, K. (2005). Effect of Medicaid eligibility category on racial disparities in the use of psychotropic medications among youths. Psychiatric Services, 56(2), 157–163. doi:10.1176/appi.ps.56.2.157.

    Article  PubMed  Google Scholar 

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Funding

The study was funded, in part, by a grant from Passport Health Plans, Louisville, Kentucky and from the Kentucky Cabinet for Health & Family Services, Department of Medicaid Services. The authors wish to thank the providers and their office staff for their participation.

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Authors and Affiliations

  1. Child and Adolescent Research Design and Support (CAHRDS) Unit, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, 40202, USA

    W. David Lohr, Kyle B. Brothers, Deborah Winders Davis, Carla A. Rich, Lesa Ryan, Michael Smith, Michelle Stevenson, Yana Feygin, Charles Woods, John Myers & Gilbert C. Liu

Authors
  1. W. David Lohr
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  2. Kyle B. Brothers
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  3. Deborah Winders Davis
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  4. Carla A. Rich
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  5. Lesa Ryan
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  6. Michael Smith
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  7. Michelle Stevenson
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  8. Yana Feygin
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  9. Charles Woods
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  10. John Myers
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  11. Gilbert C. Liu
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Correspondence to Gilbert C. Liu.

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Lohr, W.D., Brothers, K.B., Davis, D.W. et al. Providers’ Behaviors and Beliefs on Prescribing Antipsychotic Medication to Children: A Qualitative Study. Community Ment Health J 54, 17–26 (2018). https://doi.org/10.1007/s10597-017-0125-8

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  • DOI: https://doi.org/10.1007/s10597-017-0125-8

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