Impact of a Statewide Drug Utilization Review on Indicators of Psychotropic Medication Safety for Youth in Foster Care
This paper examines whether a drug utilization review (DUR), implemented by a state child welfare agency, for psychotropic medication use among youth in foster care affects four prescribing indicators that raise specific safety concerns, including: the use of Second Generation Antipsychotics (SGAs), polypharmacy, use of SGAs without primary indication, and use of any psychotropic medication without primary indication.
Methods
In 2005, a state child welfare agency, located in the South, implemented a DUR process for psychotropic medication use among Medicaid-enrolled youth in foster care. Child welfare staff audited and provided feedback to clinicians in cases in which prescribed psychotropic medications did not align with established safety parameters. Employing Medicaid claims data from the Medicaid Analytic Extracts (MAX), the four prescribing indicators that raise concerns related to psychotropic medication safety were compared in the year before and in each of the two years following the implementation of the DUR process. General Estimating Equations, logistic regressions, independent and paired t-tests, and descriptive statistics were used. To control for secular trends, a comparison group of Medicaid-enrolled youth who are both not in foster care and for whom the DUR did not occur is employed.
Results
After controlling for secular trends among Medicaid-enrolled youth not in foster care, we find a decrease in the proportion of Medicaid-enrolled youth within foster care receiving SGAs, polypharmacy, and SGAs without primary indication of -4.90, -3.80, and -3.24 percentage points respectively. While there was a decrease in year two of the proportion of Medicaid-enrolled youth in foster care using any psychotropic medications without a primary indication, these reductions were not statistically significant.
Implications
While a robust literature examines the impact of DURs implemented by public and private insurance plans, this study provides new evidence as to the impact of a statewide DUR housed within a child welfare agency. Implementation of this statewide DUR demonstrated statistically significant reductions in the use of SGAs, polypharmacy, and SGAs without primary indication within two years. This study suggests that implementation of DURs by a child welfare agency can decrease indicators of psychotropic medication safety among this vulnerable sub-population, thus addressing some of the safety concerns surrounding psychopharmacology for youth in foster care.