Online Program

County level disparities in the prescription of antipsychotic drugs among children on Medicaid in Wisconsin

Monday, November 4, 2013

Kara Mandell, MA, Department of Population Health, University of Wisconsin-Madison, Madison, WI
Elizabeth Feder, PhD, Population Health Institute, University of Wisconsin, Madison, WI
OBJECTIVE: To identify disparities in the use of antipsychotic drugs among children who receive Medicaid in Wisconsin. METHODS: Study population included all children ages 0 to 18 in Wisconsin who were insured by Medicaid or were in foster care between 2008 and 2011 (n=439,567), including 13,187 children who received at least one antipsychotic fill. To identify disparities in prescribing practices, we used GIS mapping and multilevel modeling to explore the effects of county level demographic and economic characteristics, disease prevalence rates, and access to quality health care on antipsychotic prescription among children. RESULTS: GIS mapping shows that disparities exist in the number of children who were prescribed antipsychotics by geographic area. Children in foster care were more likely to be medicated, to be medicated for longer, and to experience polypharmacy than other children who received Medicaid. Children living in counties with higher median income (OR=.95, 95% CI: .92-.97) and higher rates of uninsured (OR=.84, 95% CI: .72-.98) are less likely to receive antipsychotics. We did not find relationships between quality of care, rates of adult disease, or rates of medical providers and child antipsychotic prescribing after controlling for median income. CONCLUSIONS: In Wisconsin, disparities in antipsychotic prescribing are not only racial, but also geographic and socio-economic. These disparities raise questions about prescribing practices, the impact of poverty on mental health, and the medicalization of poverty. Disparities in antipsychotic prescribing among children may lead to disparities in adult health, as antipsychotics have been associated with long-term negative health consequences.

Learning Areas:

Public health or related research

Learning Objectives:
Describe the geographic variation in antipsychotic prescription rate among children receiving Medicaid in Wisconsin. Discuss the county-level determinants of high and low rates of children’s antipsychotic prescriptions in Wisconsin. Discuss the policy and health ramifications of the disparities in antipsychotic prescribing practices among children who receive Medicaid in Wisconsin.

Keyword(s): Child and Adolescent Mental Health, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the analyses to be presented and wrote the abstract. My research is in behavioral health and health disparities across the life course.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.