Skip to main content
SpringerLink
Log in

Low Rates of Clinician Monitoring for Second Generation Antipsychotic Medications in Community Pediatric Practice

  • Brief Report
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Second generation antipsychotic (SGA) medications are frequently prescribed to pediatric patients in the United States. This retrospective observational study sought to ascertain the extent of adherence to established pediatric SGA monitoring guidelines in community practice. The team used the electronic health record to determine clinician adherence to SGA monitoring guidelines at baseline, 12-week, and annual times relative to prescribing an SGA. At the time of their SGA prescription, 5.5% of pediatric patients had received all of the orders according to the monitoring guidelines. Annually, 2.5% of patients had received the necessary orders to completely adhere to monitoring guidelines; 42% of patients received no monitoring orders. Monitoring was more likely for children who had multiple types of providers and interacted with the healthcare system beyond a traditional office visit. This research informs healthcare providers about the gap between prescribing and monitoring for SGA medications in community practice for pediatric populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  • Bazo-Alvarez, J. C., Morris, T. P., Carpenter, J. R., Hayes, J. F., & Petersen, I. (2020). Effects of long-term antipsychotics treatment on body weight: A population-based cohort study. Journal of Psychopharmacology, 34(1), 79–85.

    Article  Google Scholar 

  • Centers for Medicare & Medicaid Services. Atypical Antipsychotic Medications: Use in Pediatric Patients. (2014). Retrieved June 15, 2019, from https://cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/atyp-antipsych-pediatric-factsheet11-14.pdf.

  • Citrome, L., & Volavka, J. (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes: Response to consensus statement. Diabetes Care, 27(8), 2087–2088.

    Article  Google Scholar 

  • Connolly, J. G., Toomey, T. J., & Schneeweiss, M. C. (2015). Metabolic monitoring for youths initiating use of second-generation antipsychotics, 2003–2011. Psychiatric Services, 66(6), 604–609.

    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—Journal of the American Medical Association, 302(16), 1765–1773.

    Article  CAS  Google Scholar 

  • Coughlin, M., Goldie, C. L., Tranmer, J., Khalid-Khan, S., & Tregunno, D. (2018). Patient, treatment, and health care utilization variables associated with adherence to metabolic monitoring practices in children and adolescents taking second-generation antipsychotics. Canadian Journal of Psychiatry, 63(4), 240–249.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Delate, T., Kauffman, Y. S., Botts, S. R., Wong, C., & Gaughan, K. M. (2014). Metabolic monitoring in commercially insured pediatric patients newly initiated to take a second-generation antipsychotic. JAMA Pediatrics, 168(7), 679–681.

    Article  Google Scholar 

  • Edelsohn, G. A., Parthasarathy, M., Terhorst, L., Karpov, I. O., & Schuster, J. (2015). Measurement of metabolic monitoring in youth and adult medicaid recipients prescribed antipsychotics. Journal of Managed Care Pharmacy, 21(9), 769–777.

    Google Scholar 

  • Featherston, E. L., Dihigo, S., & Gilder, R. E. (2018). Improving adherence to atypical antipsychotic agent screening guidelines in pediatric patients: A quality improvement project within an integrated community mental health setting. Journal of the American Psychiatric Nurses Association, 24(4), 352–359.

    Article  Google Scholar 

  • Findling, R. L., Drury, S. S., Jensen, P. S., Rapoport, J. L., & The AACAP Committee on Quality Issues. (2012). Practice parameter for the use of atypical antipsychotic medications in children and adolescents. Academic Psychiatry, 31(2), 119–121.

    Google Scholar 

  • Hayden, J. D., Horter, L., Parsons, T., III., Ruble, M., Townsend, S., Klein, C. C., Duran, R. P., Welge, J. A., Crystal, S., Patel, N. C., Correll, C. U., & DelBello, M. P. (2020). Metabolic monitoring rates of youth treated with second-generation antipsychotics in usual care: Results of a large US national commercial health plan. Journal of Child and Adolescent Psychopharmacology, 30(2), 119–122.

    Article  Google Scholar 

  • Jiang, V., Brooks, E. M., Tong, S. T., Heintzman, J., & Krist, A. H. (2020). Factors influencing uptake of changes to clinical preventive guidelines. Journal of the American Board of Family Medicine, 33(2), 271–278.

    Article  Google Scholar 

  • Johnston, K. J., & Hockenberry, J. M. (2016). Are two heads better than one or do too many cooks spoil the broth? Health Services Research, 51(6), 2176–2205.

    Article  Google Scholar 

  • Jun, T., Kwang, H., Mou, E., Berube, C., Bentley, J., Shieh, L., & Hom, J. (2019). An electronic best practice alert based on choosing wisely guidelines reduces thrombophilia testing in the outpatient setting. Journal of General Internal Medicine, 34(1), 29–30.

    Article  Google Scholar 

  • Kadra, G., Stewart, R., Shetty, H., Jackson, R. G., Greenwood, M. A., Roberts, A., Chang, C. K., MacCabe, J. H., & Hayes, R. D. (2015). Extracting antipsychotic polypharmacy data from electronic health records: Developing and evaluating a novel process. BMC Psychiatry, 15, 166.

    Article  Google Scholar 

  • Kauffman, Y. S., Delate, T., & Botts, S. (2017). Metabolic monitoring in children 5 years of age and younger prescribed second-generation antipsychotic medications. Mental Health Clinician, 7(1), 1–6.

    Article  Google Scholar 

  • Leape, L. L., Weissman, J. S., Schneider, E. C., Piana, R. N., Gatsonis, C., & Epstein, A. M. (2003). Adherence to practice guidelines: The role of specialty society guidelines. American Heart Journal, 145(1), 19–26.

    Article  Google Scholar 

  • Lexicomp [Internet]. Hudson, OH: Wolters Kluwer Health, Inc. 1978–2019. Accessed 30 Sept 2019.

  • Liu, X. I., Schuette, P., Burckart, G. J., Green, D. J., La, J., Burnham, J. M., Rakhmanina, N., Robb, A., Huang, S. M., & van den Anker, J. N. (2019). A comparison of pediatric and adult safety studies for antipsychotic and antidepressant drugs submitted to the United States Food and Drug Administration. The Journal of Pediatrics, 208, 236-242.e3.

    Article  Google Scholar 

  • Maue, S. K., Segal, R., Kimberlin, C. L., & Lipowski, E. E. (2004). Predicting physician guideline compliance: An assessment of motivators and perceived barriers. The American Journal of Managed Care, 10(6), 383–391.

    PubMed  Google Scholar 

  • McClellan, J., Stock, S., American Academy of Child and Adolescent Psychiatry (AACAP), & Committee on Quality Issues (CQI). (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 976–990.

    Article  Google Scholar 

  • McClellan, J., Kowatch, R., Findling, R. L., & Work Group on Quality Issues. (2007). Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(1), 107–125.

    Article  Google Scholar 

  • Morrato, E. H., Nicol, G. E., Maahs, D., Druss, B. G., Hartung, D. M., Valuck, R. J., Campagna, E., & Newcomer, J. W. (2010). Metabolic screening in children receiving antipsychotic drug treatment. Archives of Pediatrics & Adolescent Medicine, 164(4), 344–351.

    Article  Google Scholar 

  • Petersen, I., Sammon, C. J., McCrea, R. L., Osborn, D., Evans, S. J., Cowen, P. J., & Nazareth, I. (2016). Risks associated with antipsychotic treatment in pregnancy: Comparative cohort studies based on electronic health records. Schizophrenia Research, 176(2–3), 349–356.

    Article  Google Scholar 

  • Raebel, M. A., Penfold, R., McMahon, A. W., Reichman, M., Shetterly, S., Goodrich, G., Andrade, S., Correll, C. U., & Gerhard, T. (2014). Adherence to guidelines for glucose assessment in starting second-generation antipsychotics. Pediatrics, 134(5), e1308–e1314.

    Article  Google Scholar 

  • Ramerman, L., Hoekstra, P. J., & de Kuijper, G. (2018). Exploring barriers and facilitators in the implementation and use of guideline recommendations on antipsychotic drug prescriptions for people with intellectual disability. Journal of Applied Research in Intellectual Disabilities, 31(6), 1062–1070.

    Article  Google Scholar 

  • Safran, C., Bloomrosen, M., Hammond, E., Labkoff, S., Markel-Fox, S., Tang, P. C., & Detmer, D. E. (2007). Toward a national framework for the secondary use of health. Journal of the American Medical Informatics Association, 14(1), 1–9.

    Article  Google Scholar 

  • Shanbhag, D., Graham, I. D., Harlos, K., Haynes, R. B., Gabizon, I., Connolly, S. J., & Van Spall, H. (2018). Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review. British Medical Journal Open, 8(3), e017765.

    Google Scholar 

  • Shekelle, P. G., Maglione, M., Bagley, S., Suttorp, M., Mojica, W., Carter, J., Rolón, C., Hilton, L., Zhou, A., Chen, S., Glassman, P., Newberry, S. (2007). Efficacy and comparative effectiveness of off-label use of atypical antipsychotics. Agency for Healthcare Research and Quality (US). Retrieved from http://europepmc.org/books/NBK43235. Accessed 30 Sept 2019.

  • Wakefield, S., Aligeti, M., Rachamallu, V., Baronia, R., Aynampudi, R., Parmar, A., Peterson, P., & Masodkar, K. (2020). Metabolic monitoring of child and adolescent patients on atypical antipsychotics by psychiatrists and primary care providers. American Journal of Therapeutics, 27(5), e425–e430.

    Article  Google Scholar 

  • Yood, U. M., Delorenze, G. N., Quesenberry, C. P., Jr., Oliveria, S. A., Tsai, A. L., Kim, E., Cziraky, M. J., McQuade, R. D., Newcomer, J. W., & L’italien, G. J. (2011). Association between second-generation antipsychotics andnewly diagnosed treated diabetes mellitus: Does the effect differ by dose? BMC Psychiatry, 11, 197.

    Article  Google Scholar 

  • Zito, J. M., Burcu, M., Ibe, A., Safer, D. J., & Magder, L. S. (2013). Antipsychotic use bymedicaid-insured youths: Impact of eligibility and psychiatric diagnosis across a decade. Psychiatric Services, 64(3), 223–229.

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge Melissa Medina for assisting in data extraction and Dr. Philip Kroth for guidance regarding preparation of the manuscript.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI, 49007, USA

    Sorabh Singhal

  2. Division of Epidemiology and Biostatistics, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008, USA

    Joseph Billian

  3. Ferris State University College of Pharmacy, 1201 S State St, Big Rapids, MI, 49307, USA

    Casey Kloosterman

  4. Ferris State University College of Pharmacy, 1000 Oakland Drive, Kalamazoo, MI, 49008, USA

    Teresa Bailey

  5. Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008, USA

    Neelkamal Soares

Authors
  1. Sorabh Singhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph Billian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Casey Kloosterman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Teresa Bailey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Neelkamal Soares
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neelkamal Soares.

Ethics declarations

Conflict of interest

No support received from any grant, funding source, or commercial interest related to this work. No financial conflict of interest to disclose for any of the authors.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved as exempt by the Institutional Review Board of Western Michigan University Homer Stryker M.D. School of Medicine.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singhal, S., Billian, J., Kloosterman, C. et al. Low Rates of Clinician Monitoring for Second Generation Antipsychotic Medications in Community Pediatric Practice. Community Ment Health J 58, 541–546 (2022). https://doi.org/10.1007/s10597-021-00852-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-021-00852-3

Keywords

Search

Navigation