Antipsychotic Polypharmacy in the Treatment of Children and Adolescents in the Fee-for-Service Component of a Large State Medicaid Program
Antipsychotic Polypharmacy in the Treatment of Children and Adolescents in the Fee-for-Service Component of a Large State Medicaid Program
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DOI：
10.1016/j.clinthera.2010.04.021
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发表时间：
2010-05-01
影响因子：
3.2
通讯作者：
Tandon, Rajiv
中科院分区：
文献类型：
--
作者：
Constantine, Robert J.;Boaz, Timothy;Tandon, Rajiv
目的：本研究的目的是量化和描述抗精神病药多药使用的患者年龄在6至12岁（儿童）和13至17岁（青少年），并确定多药recipients.Methods的特点：数据从患者参加佛罗里达的医疗补助费为服务计划和接受治疗的抗精神病药。抗精神病药物多药治疗定义为同时接受抗精神病药物治疗>60天，在多药治疗中没有间隔>15天。统计2002年7月至2007年6月期间儿童和青少年抗精神病药物联合用药的发生率、治疗持续时间、开始抗精神病药物单药治疗后的抗精神病药物联合用药时间以及抗精神病药物联合用药率。在儿童中，男性患者的比例（73%和63%）和种族被表示为“其他”的患者的比例（31%和14%）分别显著高于青少年患者（均为P < 0.001）。7%的儿童和8%的青少年接受抗精神病药物治疗（P = 0.001）。儿童和青少年中多种用药发作的平均（SD）持续时间分别为170.0（139.0）天和185.5（175.9）天（P = 0.010）。儿童和青少年开始多种药物治疗的时间分别为505.8（440.5）天和384.9（424.3）天（P < 0.001）。青少年（比值比[OR] = 1.16; 95%CI，1.04-1.29）比儿童更容易成为多种药物接受者，精神障碍患者（OR = 1.47; 95%CI，1.20-1.81）比双相I型障碍患者更容易成为多种药物接受者。种族为“其他”的患者比白色种族的患者更可能接受多种药物治疗（OR = 1.18; 95% CI，1.04-1.34; P < 0.001）;其他种族/种族组无显著差异。在儿童和青少年中最常见的特定抗精神病药复方制剂是阿立哌唑/奎替利（分别为23%和17%），利培酮/奎替卡松（18%和15%），阿立哌唑/利培酮（17%和11%），利培酮/奥氮平（5%和6%）和奎替鲁/奥氮平结论：在医疗补助按服务收费的人群中，抗精神病药物接受者中抗精神病药物多种用药的患病率和持续时间值得注意。需要研究儿科人群中实践的风险和益处。(Clin Ther. 2010;32：949-959）（C）2010 Excerpta Medica Inc.
Objectives: The aims of this study were to quantify and describe antipsychotic polypharmacy use among patients aged 6 to 12 years (children) and 13 to 17 years (adolescents) and to identify the characteristics of polypharmacy recipients.Methods: Data from patients enrolled in Florida's Medicaid fee-for-service program and receiving treatment with an antipsychotic were included. Antipsychotic polypharmacy was defined as the receipt of antipsychotic medications concurrently for >60 days, with no gaps >15 days in polypharmacy treatment. The prevalence of antipsychotic polypharmacy, durations of treatment episodes, times to antipsychotic polypharmacy after initiation of antipsychotic monotherapy, and rates of antipsychotic combination use were calculated for the period between July 2002 and June 2007.Results: During the 5-year period, 12,764 children and 10,419 adolescents received antipsychotic treatment. The proportions of patients who were male (73% and 63%) and whose race was indicated as "other" (31% and 14%) were significantly greater in children than in adolescents, respectively (both, P < 0.001). Seven percent of the children and 8% of the adolescents were prescribed antipsychotic polypharmacy (P = 0.001). Mean (SD) durations of polypharmacy episodes were 170.0 (139.0) days in children and 185.5 (175.9) days in adolescents (P = 0.010). Times to initiation of polypharmacy were 505.8 (440.5) days in children and 384.9 (424.3) days in adolescents (P < 0.001). Adolescents (odds ratio [OR] = 1.16; 95% CI, 1.04-1.29) were more likely than children to be polypharmacy recipients, as were those with psychotic disorders (OR = 1.47; 95% CI, 1.20-1.81) compared with those with bipolar I disorder. Patients whose race was indicated as "other" were more likely than patients of white race to receive polypharmacy (OR = 1.18; 95% CI, 1.04-1.34; P < 0.001); other ethnic/racial groups did not differ significantly. The most common specific antipsychotic combinations prescribed in children and adolescents were aripiprazole/quetiapine (23% and 17%, respectively), risperidone/quetiapine (18% and 15%), aripiprazole/risperidone (17% and 11%), risperidone/olanzapine (5% and 6%), and quetiapine/olanzapine (4% and 7%).Conclusions: The prevalence and duration of antipsychotic polypharmacy among anti psychotic recipients in this Medicaid fee-for-service population were noteworthy. Research on the risks and benefits of the practice in the pediatric population is needed. (Clin Ther. 2010;32:949-959) (C) 2010 Excerpta Medica Inc.