The 130th Annual Meeting of APHA

Abstract #38954

Tierney E. Sherwin, MPA¹, Dorothy E. Stubbe, MD², Thomas J. Van Hoof, MD, MA³, Lawrence D. Scahill, MSN, PhD⁴, and Andrés Martin, MD⁴. (1) Quality Improvement Services, Qualidigm, 100 Roscommon Drive, Suite 200, Middletown, CT 06457, 860-632-6312, tsherwin@qualidigm.org, (2) Yale Child Study Center, Yale School of Medicine, 230 S. Frontage Rd., New Haven, CT 06520-7900, (3) Director of Education, Qualidigm, 100 Roscommon Drive, Suite 200, Middletown, CT 06457, (4) Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd, New Haven, CT 06520

This study reviewed the use of psychotropic medications by young children (< 5 years) in Connecticut’s Medicaid Managed Care (MMC) program. Based on administrative data, of the 9,447 children who were receiving a psychotropic medication (July 1, 1998- June 30, 1999), 462 (4.9%) were younger than five years old. Medical record abstraction sought to verify this use and to understand the rationale for such medications. The study set included 123 children who met study criteria. Demographically, 73.9% of children were older than 2 years, 76.4% were male, and the breakdown by race was 35.8% Hispanic, 35.8% Caucasian, and 27.6% African-American. The most common medication classes were stimulants (33.3%) and anxiolytics (33.3%), followed by alpha-2 agonists (15.4%), mood stabilizers (11.4%), antipsychotics (4.1%), and antidepressants (2.4%). Fifty-nine children (48.0%) in the study set had documentation within the medical record verifying the administrative data. Of those 59 children, 54 (91.5%) had a documented rationale supporting the use (i.e., a treatment, diagnosis, or procedure linked with the medication). Of the 54 children with a documented rationale, 64.8% had a mental health and 35.2% had a medical rationale. For those with a mental health rationale, stimulant medication (78.1%) was the most common class, and attention-deficit/disruptive behavior disorders (96.8%) was the most common diagnosis. For those with a medical rationale, mood stabilizer medication (62.5%) was the most common class, and seizure disorder (75.0%) was the most common diagnosis. This study raises questions about the accuracy and completeness of administrative data and highlights opportunities for further research.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Recognize the potential limitations of using administrative data in quality improvement or applied health service research projects
• Discuss the advantages and disadvantages of using medical record abstraction to assess the rationale for prescribing practices
• Discuss the research implications of early findings of the use of psychotropic medications in a population of young children in Medicaid Managed Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.