State variation in psychotropic medication use by foster care children with autism spectrum disorder.
State variation in psychotropic medication use by foster care children with autism spectrum disorder.
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DOI：
10.1542/peds.2008-3713
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发表时间：
2009-08
期刊：
影响因子：
8
通讯作者：
Mandell DS
中科院分区：
文献类型：
--
作者：
Rubin DM;Feudtner C;Localio R;Mandell DS
本研究的目的是比较一个国家自闭症谱系障碍（ASD）儿童队列中寄养儿童和接受补充安全收入的残疾儿童同时使用≥3种精神药物的情况，并描述各州寄养儿童使用这些药物的差异。研究对象为同时使用≥3类精神药物的患者，这些患者来自2001年医疗补助申请的43 406名年龄在3至18岁之间且每年有≥1次ASD申请的儿童。对寄养儿童和残疾儿童的医疗补助登记情况进行了比较。在州一级聚类并控制人口统计学和合并症的多水平逻辑回归得出了同时使用≥3种药物的标准化（调整）估计值，以及各州内药物使用的估计变异值超过各州平均值的1和2个标准差。在寄养儿童中，20.8%同时使用≥3种药物，而被归类为残疾的儿童中这一比例为10.1%。在一个州内，药物的总体使用与差异的关系越来越大；一个州的残疾人口同时使用≥3种药物类别的人数每增加5%，该州寄养人口中儿童的使用人数就增加8.3%。43%（22）的州与同时使用≥3种药物的儿童的调整平均值差0.1 SD, 14%(7)的州超过2 SD。在ASD儿童中，寄养儿童比残疾儿童更有可能同时使用≥3种药物。州一级的差异强调了可能影响这一人群接受药物治疗的政策或规划差异。
The objective of this study was to compare on a national cohort of children with autism spectrum disorder (ASD) the concurrent use of ≥3 psychotropic medications between children in foster care and children who have disabilities and receive Supplemental Security Income, and to describe variation among states in the use of these medications by children in foster care. Studied was the concurrent use of ≥3 classes of psychotropic medications, identified from the 2001 Medicaid claims of 43 406 children who were aged 3 to 18 years and had ≥1 annual claim for ASD. Medicaid enrollment as a child in foster care versus a child with disabilities was compared. Multilevel logistic regression, clustered at the state level and controlling for demographics and comorbidities, yielded standardized (adjusted) estimates of concurrent use of ≥3 medications and estimated variation in medication use within states that exceeded 1 and 2 SDs from the average across states. Among children in foster care, 20.8% used ≥3 classes of medication concurrently, compared with 10.1% of children who were classified as having a disability. Differences grew in relationship to overall use of medications within a state; for every 5% increase in concurrent use of ≥3 medication classes by a state’s population with disabilities, such use by children in a state’s foster care population increased by 8.3%. Forty-three percent (22) of states were >1 SD from the adjusted mean for children who were using ≥3 medications concurrently, and 14% (7) of the states exceeded 2 SDs. Among children with ASD, children in foster care were more likely to use ≥3 medications concurrently than children with disabilities. State-level differences underscore policy or programmatic differences that might affect the receipt of medications in this population.
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影响因子：
8
作者：
Mandell, David S.;Morales, Knashawn H.;Polsky, Daniel E.
通讯作者：
Polsky, Daniel E.
DOI：
10.1300/j147v18n04_01
发表时间：
1994-01-01
期刊：
ADMINISTRATION IN SOCIAL WORK
影响因子：
--
作者：
GLISSON, C
通讯作者：
GLISSON, C
影响因子：
1.9
作者：
dosReis, S;Zito, JM;Owens, PL
通讯作者：
Owens, PL
DOI：
10.1001/archpedi.1995.02170160040006
发表时间：
1995-04-01
影响因子：
--
作者：
HALFON, N;MENDONCA, A;BERKOWITZ, G
通讯作者：
BERKOWITZ, G
影响因子：
3.8
作者：
Breland-Noble, AM;Elbogen, EB;Burns, BJ
通讯作者：
Burns, BJ