Psychotropic Medication Patterns Among Child and Youth Medicaid Beneficiaries

Background and Purpose: Longstanding safety concerns and recent surges in cost and utilization have brought increased scrutiny to psychotropic drug use among child Medicaid beneficiaries. Accurate information about psychotropic prescription practices in the child Medicaid population is required for informed practice and policy decisions. Current Medicaid data on psychopharmacological practices are limited by inconsistencies in methodology, narrowly-defined samples, and a general lack of information on drug classes used concomitantly. Also, most studies have utilized samples from the Northeastern U.S. To address these knowledge gaps, this study described psychotropic prescription patterns among an entire children's Medicaid population in a Midwestern state. Specifically, this study determined annual prevalence rates, polypharmacy rates, and demographic correlates of psychotropic medication prescriptions in a statewide sample of child Medicaid beneficiaries aged 0-17. Methods: This was a one-year retrospective cross-sectional study that used three state administrative databases to observe psychotropic prescription patterns among 210,278 child Medicaid beneficiaries in 2008. Data were merged from Medicaid pharmacy and outpatient claims, a statewide mental health database, and a statewide child welfare database. Dependent variables included: 1) any psychotropic drug use, defined as one or more paid prescriptions during the study year, and 2) interclass polypharmacy, defined as paid prescriptions for two or more unique drug classes concurrently for 60+ days. Predictor variables included demographic characteristics, diagnostic measures, and prescriber specialty. Data analyses involved univariate, bivariate, and multivariate statistics; logistic regression was the primary technique. Results are presented as odds ratios and 95% confidence intervals for unadjusted and adjusted models. Results: Of the 210,278 Medicaid enrolled youths in SFY2008, 18,820 had at least one paid claim for a psychotropic medication, yielding an annual prevalence rate of 9.0%. Children more likely to be prescribed psychotropic medications were: male, white, ten and older, in foster care, and had a serious emotional disturbance. The interclass polypharmacy rate was 31.4%. Statistically significant predictors of interclass polypharmacy were gender, age, SED, number of diagnoses, and prescriber specialty. Conclusions and Implications: Several study findings on demographic predictors of psychotropic drug use corroborate prior research; as in other studies, gender, age, race, and foster care status predicted psychotropic drug use among Medicaid-enrolled youths. Although prevalence was low among very young children (five or younger), the use of atypical antipsychotics was surprising and merits further scrutiny. The study contributed novel findings with regard to diagnostic factors, service factors, and polypharmacy rates. The highest prevalence was found in youths with significant mental health needs, as indicated by an SED and multiple diagnoses, both of which have been rarely studied. Moreover, our study confirmed that ADHD and stimulant prescriptions were very common in this population. Findings that demand further inquiry include the high and growing prevalence of antipsychotic use, even among very young children, and the presence of significant polypharmacy in the Medicaid youth population. The study's primary conclusion was that, absent an evidence base for some of the current prescribing patterns, state monitoring mechanisms are justified in flagging cases for special, in-depth review.