Title

Identifying clinically questionable psychotropic prescribing practices for medicaid recipients in New York state

UMMS Affiliation

Department of Psychiatry

Date

12-3-2009

Document Type

Article

Medical Subject Headings

Adult; Aged; Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Child; Drug Administration Schedule; Drug Therapy, Combination; Drug Utilization; Female; Humans; Insurance Claim Review; Male; Medicaid; New York; Physician's Practice Patterns; Psychotropic Drugs; *Quality Assurance, Health Care; United States

Disciplines

Psychiatry

Abstract

OBJECTIVE: This study sought to identify and characterize rates of clinically questionable prescribing in New York State.

METHODS: As part of a quality improvement initiative, 34 national psychopharmacology experts identified a set of questionable prescribing practices recognizable from pharmacy claims data. Indicators of such practices were applied to Medicaid claims data for 217,216 beneficiaries in New York State who had an active psychotropic prescription on April 1, 2008.

RESULTS: A total of 156,103 (72%) of these beneficiaries had one or more continuing (>90 days) prescriptions for a psychotropic. About 10% of adults were prescribed four or more psychotropics concurrently, and 13% of children and 2% of older adults were prescribed three or more concurrently. Prescribing an antipsychotic with a moderate-to-high risk of causing metabolic abnormalities approached 50% (46%) among individuals who had existing cardiometabolic conditions. Among beneficiaries prescribed second-generation antipsychotics with a moderate-to-high risk of causing metabolic abnormalities, over half (60%) had not received a metabolic screening test in the past year. Among women of reproductive age prescribed mood stabilizers, over one-quarter (30%) were prescribed a valproic acid-based formulation despite its potential for teratogenicity. Only 2% of youths under age 18 were prescribed benzodiazepines; however, about half (48%) had trials over 90 days' duration.

CONCLUSIONS: Examination of pharmacy claims from Medicaid beneficiaries in New York State indicated that prescribing practices deemed clinically questionable by pharmacology experts are common. Aggregated pharmacy claims data can identify such practices, and reviews of these data can be a core component of efforts to improve prescribing practices.

Rights and Permissions

Citation: Psychiatr Serv. 2009 Dec;60(12):1595-602. Link to article on publisher's site

Comments

Dr. Jean A. Frazier is a member of the New York State Office of Mental Health Scientific Advisory Committee, who served as coauthors.

Related Resources

Link to Article in PubMed