Second-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health.

TitleSecond-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health.
Publication TypeJournal Article
Year of Publication2014
AuthorsSaloner B, Matone M, Kreider AR, M Budeir S, Miller D, Huang Y-S, Raghavan R, French B, Rubin D
JournalPsychiatr Serv
Volume65
Issue12
Pagination1458-64
Date Published2014 Dec 01
ISSN1557-9700
KeywordsAdolescent, Antipsychotic Agents, Central Nervous System Stimulants, Child, Child, Preschool, Eligibility Determination, Fee-for-Service Plans, Humans, Inappropriate Prescribing, Male, Managed Care Programs, Medicaid, Mental Disorders, Mental Health, United States
Abstract

OBJECTIVE: Reducing overuse of second-generation antipsychotics among Medicaid-enrolled children is a national priority, yet little is known about how service organization affects use. This study compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures.

METHODS: Organizational structures of Medicaid programs in 82 diverse counties in 34 states were categorized and linked to child-level cross-sectional claims data from the Medicaid Analytic Extract covering fiscal years 2004, 2006, and 2008. To approximate the population at risk of antipsychotic treatment, the sample was restricted to stimulant-using children ages three to 18 (N=419,226). The sample was stratified by Medicaid eligibility group, and logistic regression models were estimated for probability of second-generation antipsychotic use. Models included indicators of county-level organizational structure as main predictors, with sequential adjustment for personal and county-level covariates.

RESULTS: With adjustment for person-level covariates, second-generation antipsychotic use was 31% higher among youths in foster care in fee-for-service counties than for youths in counties with carve-outs (odds ratio [OR]=1.69, 95% confidence interval [CI]=1.26-2.27). Foster care youths in integrated counties had the second highest adjusted odds (OR=1.31, CI=1.08-1.58). Similar patterns of use also were found for youths eligible for Supplemental Security Income but not for those eligible for Temporary Assistance for Needy Families. Differences persisted after adjustment for county-level characteristics.

CONCLUSIONS: Carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use. Future research should explore carve-out features (for example, tighter management of inpatient or restricted access, as well as care coordination) contributing to lower second-generation antipsychotic use.

DOI10.1176/appi.ps.201300574
Alternate JournalPsychiatr Serv
PubMed ID25179737
PubMed Central IDPMC4757898
Grant ListR01 HS020269 / HS / AHRQ HHS / United States
R01 MH092312 / MH / NIMH NIH HHS / United States
R01HS01855001A1 / HS / AHRQ HHS / United States