Second opinions improve ADHD prescribing in a medicaid-insured community population
| Autor: | Alan C. Kwan, Terry Lee, Robert Hilt, Jeffery N. Thompson, Jon McClellan, Eric Trupin, Christopher K. Varley, Taik Lee |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Washington medicine.medical_specialty Adolescent Drug-Related Side Effects and Adverse Reactions Atomoxetine Hydrochloride Medication prescription Drug Administration Schedule Drug Costs Cost Savings Developmental and Educational Psychology medicine Attention deficit hyperactivity disorder Humans Medical prescription Psychiatry Child Referral and Consultation Evidence-Based Medicine Adrenergic Uptake Inhibitors Dose-Response Relationship Drug Propylamines business.industry Medicaid Public health Second opinion Primary care physician medicine.disease United States Psychiatry and Mental health Treatment Outcome Attention Deficit Disorder with Hyperactivity Child Preschool Central Nervous System Stimulants Female Health Expenditures business Atomoxetine hydrochloride |
| Zdroj: | Journal of the American Academy of Child and Adolescent Psychiatry. 48(7) |
| ISSN: | 1527-5418 |
| Popis: | Objective The appropriate use of psychotropic medications in youths is an important public health concern. In this article, we describe a review process developed to monitor the use of stimulants and atomoxetine for attention-deficit/hyperactivity syndrome (ADHD) in youths receiving fee-for-service Medicaid services. Method Washington State Medicaid developed threshold safety parameters for ADHD medications through a process involving the community. A second opinion was mandated when safety thresholds based on dose, combination therapies, or age was exceeded. Use and cost were compared 2 years before and after the program began. Results From May 2006 to April 2008, 5.35% of ADHD prescriptions exceeded safety thresholds, resulting in 1,046 second-opinion reviews. Of those, 538 (51.4%) resulted in a prescription adjustment. Adjustments were made to primary care physician (52%), psychiatrist (50%), nurse practitioner (54%), and physician assistant–written (51%) prescriptions. When the preperiod and postperiod were compared, second opinions reduced ADHD medication at high doses (53%), in combinations (44%), and for patients 5 years of age and younger (23%). The review process resulted in a savings of $1.2 million, with 538 fewer patients exceeding safety thresholds. This was a 10:1 return over administrative costs; however, the overall Medicaid expenditures for ADHD medication still increased because of higher unit costs and the preferential use by clinicians of newer brands entering the market. Conclusions A statewide second-opinion process reduced outlier ADHD medication prescription practices and was cost-effective. Suggestions for process and quality improvements in prescribing to children diagnosed with ADHD are discussed. J. Am. Acad. Child Adolesc. Psychiatry , 2009;48(7):740–748 |
| Databáze: | OpenAIRE |
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