Use of psych drugs in poor kids has leveled off

June 06--The good news is that the surge in use of antipsychotic medicines in poor kids peaked in 2008. The peak came a year later for those with private insurance.

The bad news is that prescriptions leveled off at the peak. Plus, many of the kids on the powerful drugs aren't getting psychosocial treatments, nor are they being monitored for metabolic problems. Newer antipsychotics are tied to weight gain and diabetes.

Those are the conclusions of a Rutgers University study published Monday in the journal Health Affairs.

The study points out that the "new normal" rate is still much higher than it was in the early 2000s.

"There's still a tremendous amount of work to be done," said Stephen Crystal, director of Rutgers' Center for Health Services Research on Pharmacotherapy, Chronic Disease Management and Outcomes.

Crystal, who led the study, said there is no ideal level of drug use, but said it likely is lower than current levels. However, he is confident that any child sick enough to need antipsychotics should also be getting a trial of psychosocial treatments, such as therapy, anger management or parenting interventions. And, every child on the powerful medicines should be getting metabolic monitoring.

"When those kinds of care processes start getting attention, you see the antipsychotic prescribing rates go down," he said.

The study, which looked primarily at children covered by Medicaid, used data from 20 states, none of which are in this region. Crystal said Pennsylvania and New Jersey are a little better than the national average.

Overuse of antipsychotics in foster kids has gotten more attention, and there was greater improvement for them on some measures than for the Medicaid population in general.

Experts expect more behavioral problems in foster children because they have often have had very difficult lives. "It's a miracle that any of them don't need some kind of counseling," Crystal said.

The study found that use of antipsychotics in all Medicaid-insured children peaked at 1.86 percent in 2008 and declined slightly to 1.73 percent in 2010, the last year in the analysis. It had been 1.09 percent in 2001. The rate was much higher in foster children: 9.26 percent in 2010 and 8.92 percent in 2010 -- up from 5.79 percent in 2001. Less than 1 percent of privately insured children were taking such medication in 2009.

Children's Hospital of Philadelphia's PolicyLab released a report last year on psychiatric drug use in Medicaid and foster children in Pennsylvania. It found that antipsychotic use among all 3- to 17-year-olds on Medicaid -- an older group than those in the Rutgers study -- peaked in 2008 at 5.7 percent and fell to 4 percent in 2012. For foster kids in the same age range, usage peaked in 2009 at 23.1 percent and fell to 18.2 percent in 2012.

In 2011, the Rutgers study found that almost two-thirds of foster children on antipsychotics received psychosocial care around the time they got their prescriptions -- more than twice the rate for non-foster children. Twenty-eight percent of foster children received some kind of metabolic monitoring, compared to 18 percent of non-foster children.

The research team suggested that special managed care plans for foster children, treatment guidelines and quality measures could spur further improvements.

"If you want to improve anything, you have to start by measuring it," Crystal said. "The way to go, given the realities of our health care ststem and also given the unmet needs of our kids, is to try to work on developing better evidence-based health-care interventions."

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