Complex Medication Regimens Among Youth in a System of Care: How Common Are They and Does It Matter?

Background and Purpose: The use of multiple psychotropic medications has been increasing among adolescents with serious emotional and behavioral problems (Olfson et al., 2002). This practice occurs despite ongoing concerns related to adherence, efficacy and the potential for dangerous drug interactions (Safer et al., 2003). However, medication regimen complexity has likely been underestimated because studies have not reported the use of medications prescribed for chronic physical health conditions that disproportionately occur in this population (Ortega et al., 2002). With comprehensive data on adolescents enrolled in a System of Care (SOC) evaluation study, the presentation addresses two main aims: (i) identify characteristics associated with concurrent use of psychotropics and medications prescribed for chronic health conditions (hereafter referred to as “complex medication regimens” or CMR); and (ii) test hypotheses that CMR is associated with lower medication adherence and lower perceptions of efficacy. Methods: Data are from computer-assisted personal interviews with youths (n=97) ages 11-18 years enrolled in the Albany County (New York) SOC evaluation between 01/01/2006 to 12/31/2008. Current use (past 6 months) of medications include psychotropics (e.g., antipsychotics, stimulants), and medications related to a chronic physical health problem (e.g., asthma, diabetes). Respondents were asked about beneficial effects of their psychotropic medication (perceived efficacy), and whether they took their medication as prescribed (adherence), measured on a 5-point Likert scale (ranging from strongly disagree to strongly agree). Characteristics included sociodemographic variables (age, gender, race-ethnicity, and payment source), clinical variables (DSM-IV diagnosis, other substance use (e.g., marijuana, alcohol)), and prescriber. Subsequent to examination of frequency distributions, all variables were dichotomized for analyses. SPSS was used to conduct chi-square analysis and stepwise logistic regressions. All significance tests were two-tailed, p<.05. Results: The majority (78%) of the adolescents used a medication: 14% had a regimen limited to chronic health medications, 34% had a regimen limited to psychotropics, and 30% had a CMR. Only two variables in multivariate regression models were significantly associated with CMR: a youth whose medications were prescribed by a child psychiatrist rather than any other type of doctor was significantly less likely to have a CMR (odds ratio=0.20), and a youth with public versus private insurance was significantly more likely to have a CMR (OR=5.30). Consistent with expectations, a smaller percentage of youth with a CMR were adherent compared to youth with a psychotropic only regimen. However, perceived efficacy was higher for youth with a CMR than a psychotropic only regimen. Conclusions and Implications: A substantial proportion of youth in the SOC evaluation study have a CMR. Non-clinical factors, such as provider type and payment source are significant factors in having a CMR, raising policy-relevant questions about access and quality of care. Social workers involved with adolescents and their family members are in a unique position to gather and share information about the full range of prescribed medications, and help give voice to the youths' own experiences with medications. These roles can inform the development of best-prescribing practices.