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Vermont Medicaid/CHIP (CCS-19)

APC: Use of Multiple Concurrent Antipsychotic Medications in Children & Adolescents* (CCS-19)

Current Value

3.9%

2019

Definition

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Notes on Methodology

  • The annual reported rate captures activity during the previous calendar year. 
  • This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
  • As of 2014, DVHA’s rates only include only Medicaid Primary beneficiaries in HEDIS administrative measures.
  • The target trend line is the 50th percentile national benchmark for Medicaid programs. 

Story Behind the Curve

Percentage of children & adolescents ages 1 to 17 who were on two or more concurrent antipsychotic medications.  For this measure, a lower rate indicates better performance.

Antipsychotic prescribing for children has increased rapidly in recent decades, driven by new prescriptions and by longer duration of use.  The frequency of prescribing antipsychotics among youth increased almost fivefold from 1996-2002, from 8.6 per 1,000 children to 39.4 per 1,000.  Although some evidence supports the efficacy of antipsychotics in youth for certain narrowly defined conditions, less is known about the safety and effectiveness of antipsychotic prescribing  patterns in community use (e.g. combinations of medications, off-label prescribing, dosing outside of recommended ranges).

Both the efficacy and side effects of antipsychotic medications vary by age.  Children and adolescents prescribed antipsychotics are more at risk for serious health concerns, including weight gain, extrapyramidal side effects, hyperprolactinemia and some metabolic effects.  This suggests that use of multiple concurrent antipsychotics may pose differing risks for children and adolescents compared with adults.  While there is no research on long-term effects of multiple concurrent antipsychotics on children's health, the increased side effect burden of certain antipsychotic medications for youth has implications for future physical health concerns including obesity and diabetes.  Girls treated with certain antipsychotics may also be at increased risk for gynecological problems and osteoporosis.  Risks of multiple concurrent antipsychotics, compared with monotherapy, have not been systematically investigated; existing evidence appears largely in case reports.  In general, the field also lacks high quality studies of side effects associated with the use of multiple concurrent antipsychotic medications in adults.

The American Academy of Child and Adolescent Psychiatry recommends that clinicians avoid the simultaneous use of multiple concurrent antipsychotic medication for children & adolescents.

Last updated:  February 2020

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