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Antipsychotic prescriptions for children follow best practice guidelines 50% of the time

Clinicians who prescribe antipsychotic medications to Vermont Medicaid-insured children only follow best practice guidelines approximately 50% of the time, according to new study data.

However, researchers caution that it is possible that this percentage may be an overestimation due to a lack of metabolic monitoring self-reported by the clinicians included in the survey.

David C. Rettew

“Nevertheless, the findings suggest that improving access to child psychiatry consultations for these patients could be one way to improve adherence to best practice guidelines,” the researchers wrote.

The 677 eligible surveys returned consisted of 147 prescribers, including nurse practitioners (45.1%), child psychiatrists (22.2%) and 52.2% primary care providers (including pediatricians, 30.6%; and family physicians, 16%).

The children were a mean age of 13.2 years, with only two children aged younger than 5 years, according to data.

They found that the clinical indication for an antipsychotic prescription followed best practice guidelines 91.7% of the time, with a significant difference between psychiatrists (95.6%) and other prescribers (84%; P < . 001), according to data.

However, overall best practice guidelines were only followed 50.1% of the time, with a significant difference between psychiatrists (57.7%) and other prescribers (35.1%; P < .001), according to data.

An FDA indication was followed in 27.2% of cases, but there were no differences between psychiatrists and other prescribers.

The primary reason for a lack of best practice guidelines was related to metabolic monitoring of patients prescribed antipsychotics.

The researchers suggest the following actions to improve the percentage of youth that are being prescribed antipsychotics:

• improved access to child psychiatry consultation, and education on proper tapering of antipsychotic medications;
• improved ability to obtain treatment history;
• increased supply of therapists trained in evidence-based therapy and educating physicians about the effectiveness of different methods of pychotherapy; and
• reminders to start and continue metabolic monitoring at recommended intervals to improve adherence to metabolic recommendations. – by Samantha Costa

Disclosure: Rettew reports receiving royalties from W.W. Norton & Company and Psychology Today. Please see the full study for a list of all other authors’ relevant financial disclosures.