Second-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health.
Second-generation antipsychotic use among stimulant-using children, by organization of medicaid mental health.
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医疗补助心理健康组织在使用兴奋剂的儿童中使用第二代抗精神病药物。
DOI：
10.1176/appi.ps.201300574
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Rubin,David
中科院分区：
文献类型：
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作者：
Saloner,Brendan;Matone,Meredith;Kreider,AmandaR;Budeir,MSamer;Miller,Dorothy;Huang,Yuan-Shung;Raghavan,Ramesh;French,Benjamin;Rubin,David
减少医疗补助登记儿童中第二代抗精神病药物的过度使用是国家的优先事项，但对服务组织如何影响使用知之甚少。本研究比较了不同的医疗补助注册的儿童之间的第二代抗精神病药物的利用率收费服务，综合管理的医疗，并管理行为健康分割组织结构.MethodsOrganizational结构的医疗补助计划在82个不同的县在34个州进行了分类和链接到儿童水平的横截面索赔数据从医疗补助分析提取涵盖财政年度2004年，2006年和2008年。为了接近抗精神病药物治疗的风险人群，样本仅限于3至18岁的兴奋剂使用儿童（N= 419，226）。样本按医疗补助资格组分层，logistic回归模型估计第二代抗精神病药物使用的概率。模型包括县级组织结构的指标作为主要预测因子，并对个人和县级协变量进行顺序调整。结果随着对个人协变量的调整，在收费服务县的寄养青年中，第二代抗精神病药物的使用率比在创业县的青年高31（比值比[OR]=1.69，95%置信区间[CI]=1.26-2.27）。综合县寄养青少年的调整优势度第二高（OR=1.31，CI=1.08-1.58）。在有资格获得补充保障收入的青年中也发现了类似的使用模式，但在有资格获得贫困家庭临时援助的青年中则没有。差异持续调整后，县一级的characteristics.ConclusionsCarve-outs，与其他安排，与较低的第二代抗精神病药物的使用。未来的研究应探索有助于降低第二代抗精神病药使用的开创性特征（例如，对住院或限制性访问的更严格管理，以及护理协调）。
ObjectiveReducing overuse of second-generation antipsychotics among Medicaid-enrolled children is a national priority, yet little is known about how service organization affects use. This study compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures.MethodsOrganizational structures of Medicaid programs in 82 diverse counties in 34 states were categorized and linked to child-level cross-sectional claims data from the Medicaid Analytic Extract covering fiscal years 2004, 2006, and 2008. To approximate the population at risk of antipsychotic treatment, the sample was restricted to stimulant-using children ages three to 18 (N=419,226). The sample was stratified by Medicaid eligibility group, and logistic regression models were estimated for probability of second-generation antipsychotic use. Models included indicators of county-level organizational structure as main predictors, with sequential adjustment for personal and county-level covariates.ResultsWith adjustment for person-level covariates, second-generation antipsychotic use was 31% higher among youths in foster care in fee-for-service counties than for youths in counties with carve-outs (odds ratio [OR]=1.69, 95% confidence interval [CI]=1.26–2.27). Foster care youths in integrated counties had the second highest adjusted odds (OR=1.31, CI=1.08–1.58). Similar patterns of use also were found for youths eligible for Supplemental Security Income but not for those eligible for Temporary Assistance for Needy Families. Differences persisted after adjustment for county-level characteristics.ConclusionsCarve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use. Future research should explore carve-out features (for example, tighter management of inpatient or restricted access, as well as care coordination) contributing to lower second-generation antipsychotic use.