Psychopharmaceutical prescription monitoring for children in the child welfare system

Rameela Raman*, Ryan T. Jarrett, Michael J. Cull, Kathy Gracey, April M. Shaffer, Richard A. Epstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Children in the child welfare system are more likely to receive psychotropic medication prescriptions than children in the general population. The authors used prescription- and administrative-level data to quantify variability in prescribing practices among prescribers for the child welfare population in a southern U.S. state. Methods: Using administrative- and prescription-level child data and Administration on Children, Youth and Families guidelines, the authors defined the primary outcome, potentially inappropriate psychotropic prescriptions (i.e., red-flagged prescriptions). A hierarchical-logistic regression model was fit to account for case complexity and estimate the adjusted probability of a prescription being red-flagged. A funnel plot was used to visualize standardized prescribing rates for every prescriber and identify outlying prescribers. Results: From May 2016 to September 2017, 506 prescribers issued 64,923 prescriptions for 4,093 children with a median (interquartile range) age of 14 (10–16) years. Most prescribers (76.9%) issued at least one red-flagged prescription, 1,263 (30.9%) children received at least one red-flagged prescription, and 14,806 (22.8%) prescriptions were red-flagged. The standardized prescribing rate for each prescriber was compared with a benchmark of 22.8%, defined a priori as the proportion of red-flagged prescriptions in the overall sample. Forty-seven prescribers (9%) prescribed red-flagged prescriptions between two and three standard deviations above the benchmark, and 72 prescribers (14%) more than three standard deviations above the benchmark. Conclusions: It is vital to monitor psychotropic prescriptions for children in the child welfare system. Quantifying variability in prescribing practices among prescribers for these children might be used to guide oversight.

Original languageEnglish (US)
Pages (from-to)295-301
Number of pages7
JournalPsychiatric Services
Volume72
Issue number3
DOIs
StatePublished - Mar 2021
Externally publishedYes

ASJC Scopus subject areas

  • Psychiatry and Mental health

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