Antipsychotic Treatment Patterns and Dosing in Pediatric Foster Care
Wednesday, May 14, 2014
10:00 a.m.-11:00 a.m.
FDA-White Oak Bldg. 2, Room 2047
Antipsychotic Treatment Patterns and Dosing in Pediatric Foster Care: Does Outpatient Treatment Conform with the Evidence-Base?
Susan dosReis, PhD
University of Maryland School of Pharmacy
Although much of the rise in second generation antipsychotic use in the last decade among youth in foster care has been primarily ‘off-label’ for the management of aggression and irritability, there has been little attention on whether antipsychotic dosing falls within approved ranges for pediatric patients. The study objectives were to a) estimate antipsychotic dosing by therapeutic agent, and b) determine if antipsychotic dosing differs by treatment continuity. A retrospective study using administrative databases from two child-serving agencies was conducted to examine 24-month (2010-2011) patterns of antipsychotic among 2,476 youth aged 19 and younger who were involved in foster care. Pharmacy claims data were used to create four mutually exclusive antipsychotic patterns over the 24-month period: persistent use, treatment initiation, treatment discontinuation, and intermittent use. Average daily dose was estimated for each antipsychotic agent and stratified by antipsychotic pattern, age and gender. Descriptive and bivariate analyses were conducted to assess significant differences in dosing across antipsychotic pattern and by demographics. Antipsychotic average daily doses were compared with FDA-approved dosing to assess concordance with evidence-based practice. Of the 500 (20%) youth who received an antipsychotic at any time during 2010-2011, 40% had persistent use, 30% discontinued use, 19% initiated use, and 10% had intermittent use. Most youth received FDA approved doses, but haloperidol had the highest proportion with doses above the FDA-approved range. Doses below the range were common for quetiapine. The findings carry important implications for antipsychotic monitoring for youth in foster care. This potentially could result in better dosing that is aligned with FDA recommendations and practice guidelines.
Dr. dosReis is an Associate Professor in the Department of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy. She received a bachelor of science in pharmacy from the University of Rhode Island School of Pharmacy and a doctorate in pharmacoepidemiology from the University of Maryland Graduate School. She completed a postdoctoral fellowship in child mental health services from the Johns Hopkins Bloomberg School of Public Health. Prior to this current faculty appointment, she was on the faculty of the Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry. She works closely with the state Mental Hygiene Administration on policies and programs that impact child mental health services. She is a core faculty of the Maryland Child Mental Health Advisory group within the Center for Child Mental Health Innovations at the University of Maryland School of Medicine. In this role, she advises the state on child psychopharmacologic treatment of youth in the public mental health system, with a specific focus on psychotropic medication use among youth in the child welfare system. She has received developed a program of research on psychotropic medication use among children and adolescents. Her work has included examining disparities in psychotropic use by age, race, and foster care involvement, characterizing psychotropic treatment by combined use with psychotherapy for ADHD, and investigating the use of multiple psychotropic medications. This research has been sponsored by several federal grants from the National Institute of Mental Health (NIMH), the Agency for Healthcare Research and Quality (AHRQ), and the Center for Medicare and Medicaid Services (CMS).