An Evaluation of a Multidisciplinary Pediatric Behavioral Health Medication Initiative Workgroup's Interventions on Medication Prescribing in a Population of Medicaid Patients
An Evaluation of a Multidisciplinary Pediatric Behavioral Health Medication Initiative Workgroup's Interventions on Medication Prescribing in a Population of Medicaid Patients
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DOI：
10.18553/jmcp.2018.24.8.746
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发表时间：
2018-08-01
影响因子：
2.1
通讯作者：
Jeffrey, Paul L.
中科院分区：
文献类型：
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作者：
Chiara, Ashley N.;Kashalikar, Neha;Jeffrey, Paul L.
背景：为了回应对儿童行为健康药物处方的关注，马萨诸塞州医疗补助计划实施了一项儿童行为健康药物倡议（phhmi），主动要求事先批准特定的行为健康药物和联合方案。在马萨诸塞州，一个多学科治疗类管理（TCM）工作组对复杂病例进行回顾性审查，并开展处方外展，以鼓励循证实践。目的：通过评估建议被接受、被修改、被接受或被拒绝的百分比，以及处方方对咨询的满意度，评估phhmi中医工作组进行的电话点对点咨询的推荐效果。方法：回顾性评价2015年9月1日至2016年8月28日完成点对点会诊的phhmi中医工作组病例。在点对点咨询后，根据药房索赔数据和事先重新提交的授权，评估接受、修改接受或拒绝的药物干预措施（例如，药物改变、剂量减少和消除行为健康药物类别内或跨行为健康药物类别的多重用药）的比例。药物类别和处方类型与接受、修改接受或拒绝结果相关。通过向参加开处方者外展的开处方者提供匿名调查来评估对中医工作组流程的满意度。结果：在评估期间，共有70例需要中医工作组儿童/青少年精神科医生进行点对点咨询的病例完成了外展尝试。点对点咨询的推荐接受率为31.4%(22/70)，修改接受率为44.3%(31/70)，拒绝率为24.3%（17/70）。30%（12/40）的儿童/青少年精神病医生拒绝了在完成了点对点咨询的非儿童/青少年精神病医生的建议（16.7% (5/30)）（P = 0.43）。抗精神病药物是最常被推荐用于治疗方案改变的药物。所有关于苯二氮卓类药物的建议都被开处方者接受。结果匿名处方调查评估满意度与点对点咨询过程中表现出不同的个人处方者的反应。结论：该观察性评价的小样本量和缺乏明确的对照组阻止了终点和结果之间的直接关联。需要进一步的研究来确定开处方者的专业和药物类别是否可能是影响推荐接受度的因素。版权所有：管理式医疗药房学会。版权所有。
BACKGROUND: In response to concerns surrounding pediatric behavioral health medication prescribing, the Massachusetts Medicaid PharmacyProgram implemented a Pediatric Behavioral Health Medication Initiative (PBHMI), proactively requiring prior authorization for specific behavioral health medications and combination regimens. A multidisciplinary therapeutic class management (TCM) workgroup retrospectively reviews complex cases and conducts prescriber outreach to encourage evidence-based practices in Massachusetts.OBJECTIVE: To evaluate recommendation outcomes of telephonic peer-to-peer consultations conducted by the PBHMI TCM workgroup by assessing the percentage of accepted, modified accepted, or rejected recommendations, as well as prescriber satisfaction with consultation.METHODS: This retrospective evaluation reviewed PBHMI TCM workgroup cases with completed peer-to-peer consultations from September 1, 2015, to August 28, 2016. The proportion of medication interventions (e.g., medication changes, dose reductions, and elimination of polypharmacy within or across behavioral health medication classes) accepted, modified accepted, or rejected were assessed based on pharmacy claims data and prior authorization resubmission, following a peer-to-peer consultation. The medication class and prescriber type were categorized in relation to the acceptance, modified acceptance, or rejection outcomes. Satisfaction with the TCM workgroup process was evaluated with an anonymous survey offered to prescribers who participated in prescriber outreach.RESULTS: A total of 70 cases requiring a peer-to-peer consultation by a TCM workgroup child/adolescent psychiatrist had a completed outreach attempt during the evaluation period. Peer-to-peer consultations resulted in a recommendation acceptance rate of 31.4% (22/70), modified acceptance rate of 44.3% (31/70), and a rejection rate of 24.3% (17/70). Recommendations made during a peer-to-peer consultation were rejected by 30% (12/40) of child/adolescent psychiatrists compared with 16.7% (5/30) of nonchild/adolescent psychiatrists with completed peer-to-peer consultations (P = 0.43). Antipsychotics were most frequently recommended for regimen changes. All recommendations pertaining to a benzodiazepine were accepted by the prescriber. Results of an anonymous prescriber survey assessing satisfaction with the peer-to-peer consultation process exhibited variable responses among individual prescribers.CONCLUSIONS: The small sample size in this observational evaluation and lack of a defined control group prevented direct associations between the endpoints and outcomes. Further research is required to determine if prescriber specialty and medication class may be influencing factors on recommendation acceptance. Copyright (C) 2018, Academy of Managed Care Pharmacy. All rights reserved.