311881
Within State Geographic Variation in Antipsychotic Medication Treatment for Medicaid-insured Children and Adolescents in a U.S. Pacific State
OBJECTIVE: Despite widespread increased use of antipsychotic medications for the treatment of youth since the late ‘90s, little is known about regional variation and its relationship to quality and best practices. The objective of this study was to assess the impact of region of residence on the use of atypical antipsychotics (AATP) among continuously enrolled youth in a U.S. Pacific state Medicaid program in 2009.
METHODS:
A cross-sectional design was applied to computerized administrative claims data for 2,324,722 continuously enrolled Medicaid beneficiaries aged 2 to 18 years in a Pacific state. Bivariate and multivariable analyses were used to assess differences in the utilization of any atypical antipsychotic medication across the six large regions of the state. Regional percent prevalence of youth with one or more atypical antipsychotic dispensings during the year was further characterized by demographic and administrative factors. Multivariable findings were adjusted for age group, race/ethnicity, gender and Medicaid eligibility status and expressed as odds ratios.
RESULTS:
Across the 6 regions of the state, variations in the annual utilization of atypical antipsychotics were pronounced ranging from 1.1% to 3.1% of Medicaid eligible youth. Among 2 to 9 year olds, AATP percent prevalence ranged from 0.4% to 1.8% while regional racial/ethnic variations in AATP use were substantial regardless of race/ethnicity group. When compared to region 1, each of the remaining 5 regions had greater odds of receiving AATPs. After adjusting for age group, gender, race/ethnicity and Medicaid eligibility status, compared with region 1, the remaining 5 regions had significantly greater odds of receiving AATPs, i.e., from 22% to 84% increased use over use in region 1.
CONCLUSIONS:
Intrastate region of residence is a significant factor in accounting for the variation in antipsychotic treatment of Medicaid-insured youth in this Pacific state. Regional variation in use was prominent among 2 to 9 year olds, and those eligible by disability and foster care. The implications of the findings for policy and clinical practice will be discussed.
Learning Areas:
Biostatistics, economicsEpidemiology
Learning Objectives:
Identify concerns about the prevalence of use and quality implications of antipsychotic use variations in 6 different regions of a large Pacific state. Formulate and advocate for policy changes to improve oversight of antipsychotic medication in Medicaid-insured youth.
Keyword(s): Child/Adolescent Mental Health, Medicaid
Qualified on the content I am responsible for because: I am a second year PhD student who is currently an awardee of a state funded innovation grant that focuses on health disparities in minority children. My research interests include understanding and assessing racial and geographic health disparities in children and adolescents.
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.