PSYCHOTROPIC PRESCRIBING TRENDS FOR TREATMENT OF YOUTH

青少年治疗的精神治疗处方趋势

• 批准号: 2416153
• 负责人: JULIE M ZITO
• 金额: $ 37.54万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-05-01 至 1999-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2416153
• 关键词: Medicare /Medicaid; adolescence (12-20); antidepressants; behavioral /social science research tag; central nervous system stimulants; child (0-11); child mental disorders; clinical research; combination chemotherapy; dosage; epidemiology; health care cost /financing; health care personnel; health care professional practice; health care service evaluation; health insurance; human data; human therapy evaluation; longitudinal human study; managed care; medical records; mental disorder chemotherapy; pediatric pharmacology; psychopharmacology; psychotropic drugs; serotonin inhibitor

This study addresses the need for knowledge of prescribing trends in psychotropic treatments for the young. This topic has received little attention in either epidemiology or health services research. The lack of reliable information on usual prescribing practice patterns for children makes it difficult to know whether important changes are occurring over time. Yet, rates of drug prescription have increased dramatically in recent years according to regional studies and proprietary data; further, the possible failure of first-line treatments, e.g. methylphenidate for attention deficit hyperactivity disorder (ADHD), has led to recommendations for alternatives e.g., antidepressants. The extent of use of entirely new antidepressants, e.g. selective serotonin reuptake inhibitors (SSRIs), for this age group is largely unknown. Consequently, this study proposes to examine practice variations in psychotropic prescribing for those less than 20-years-old by assembling datasets for samples from Medicaid enrollee data from 4 states (Maryland, Ohio, Michigan and Nebraska) and from a staff model HMO (Kaiser Permanente Northwest region). In addition, survey data from several national sources, including physician-based office visits (NAMCS) and outpatient clinic- based visits (NHAMCS), will be examined. Major outcome measures reflect 3 specific aims. Aim 1: Psychotropic prevalence (total, drug class and specific agents) will be examined by practice setting (private practice, HMO, clinic, other), physician specialty [psychiatrists, neurologists, primary care (pediatricians and family practice] and payment source (commercial insurance, HMO, Medicaid); and stratified by age, gender, and geographic region. Aim 2: Trends in drug prevalence will be examined by observing yearly changes in treatments during the decade from 1987 through 1996. Aim 3: From the more detailed datasets (Maryland Medicaid and HMO) of continuously enrolled 5-14-year-olds, new versus continuing treatment prescriptions will be examined to determine if treatment duration is lengthening, and provide switching patterns, and dosage trends i.e., average daily dosage and combined (concomitant) psychotropic agents. Characteristics which differentiate psychiatrist from primary care visits will be another emphasis of the study. The study findings will provide reliable information on clinical patterns of usage--with implications for long-term effectiveness and satisfaction with treatment--as well as lay the methodologic groundwork for sampling plans and effect sizes to guide the development of future prospective (experimental) efficacy and (quasi- experimental) effectiveness studies. Psychopharmacology experts in government agencies (FDA and NIH), the pharmaceutical industry, child advocates and consumers each have drug information needs which the study proposes to fulfill.

这项研究解决了对开处方趋势知识的需求 年轻人的精神治疗。这个话题几乎没有收到 在流行病学或卫生服务研究中注意。缺乏 有关儿童常规处方实践模式的可靠信息 很难知道重要的改变是否正在发生 时间。然而，药物处方率在 近年来根据区域研究和专有数据；更远， 一线治疗的可能失败，例如哌醋甲酯 注意缺陷多动障碍（ADHD）已导致 替代品的建议，例如抗抑郁药。使用程度 全新的抗抑郁药，例如选择性5-羟色胺再摄取 抑制剂（SSRI），对于这个年龄段的人群很大程度上是未知的。最后， 这项研究提议检查精神上的实践变化 通过组装数据集的数据集为那些不到20岁的人开处方 来自来自4个州的医疗补助注册数据的样本（俄亥俄州马里兰州， 密歇根州和内布拉斯加州）以及员工模特HMO（Kaiser Permanente 西北地区）。此外，来自几个国家来源的调查数据， 包括基于医师的办公访问（NAMC）和门诊诊所 - 将检查基于访问（NHAMC）。重大结果指标反映3 具体目标。目标1：精神病患病率（总体，药物类和 特定代理人将通过练习设置（私人执业， HMO，诊所，其他），医师专业[精神科医生，神经科医生， 初级保健（儿科医生和家庭实践）和付款来源 （商业保险，HMO，医疗补助）；并按年龄，性别和 地理区域。 AIM 2：药物患病率的趋势将由 观察1987年至1987年至今的每年治疗变化 1996年。目标3：从更详细的数据集（马里兰州医疗补助和HMO） 连续入学的5-14岁，新的与持续治疗 将检查处方以确定治疗时间是否为 延长并提供开关模式和剂量趋势，即 平均每日剂量和联合（随之而来的）精神药物。 将精神科医生与初级保健访问区分开的特征 将是该研究的另一个重点。研究结果将提供 有关使用临床模式的可靠信息 - 对 长期有效性和对治疗的满意度 - 以及 采样计划和效果大小的方法论基础，以指导 未来的前瞻性（实验）功效的发展（Quasi- 实验）有效性研究。心理药理学专家 政府机构（FDA和NIH），制药行业，儿童 拥护者和消费者每个人都有研究的需求 建议实现。