Safer and targeted use of antipsychotics in youth: an embedded, pragmatic randomized trial

• DOI: 10.1111/jcpp.14059
• Publication Date: 2024-10-30T01:28:24Z
• Authors: Robert B. Penfold; Abisola E. Idu; R. Yates Coley; Kara L. Cushing‐H...; Deborah King; Ashley Glass; Rebecca C. Phillips; Anne D. Renz; Chester J. Pabiniak; Vina F. Graham; Ella E. Thompson; James D. Ralston; Gregory E. Simon; Erin S. Gonzalez; Kathleen M. Myers; Arne Beck; LeeAnn M. Quintana; Arthur J. Runkle; Megan Rogers; Deirdre M. Foster; Gregory N. Clarke; Stefan Massimino; Phillip M. Crawford; Julie A. Cavese; Anthony R. Cordaro; Laura I. Chavez; Kelly J. Kelleher; Nadine Schwartz; Kristina R. Jiner; Swan Bee Liu; Sara Condrac; Robert J. Hilt
• Keywords: Specialty

Background Antipsychotic medications (AP) are inappropriately prescribed to young people. The goal of this pragmatic trial was test a four‐component approach improved targeting antipsychotic prescribing people aged ≥3 and <18 years. Methods Clinicians in four health systems were cluster randomized by the number previous AP orders service line – specialty mental all others. Intervention arm clinicians received best practice alert child psychiatrist consultation feedback. Families system navigation expedited access psychotherapy. Primary outcomes total days' supply medication proportion youth with any at 6 months. We estimated log‐odds use months relative rate over Safer Targeted Use Antipsychotics Youth (SUAY) took place between 3/2018 12/2020. Results enrolled 733 patients. odds ratio (OR) comparing 0.75 (95% CI: 0.52, 1.09). mean days using 118.5 for intervention patients 128.2 control (relative risk [RR] = 0.92; 95% 0.81–1.04). Exploratory heterogeneity treatment effects (HTE) not detected groups defined age, gender, provider specialty, insurance type. HTE race/ethnicity present: among color, 103.2 131.2 (RR 0.79, 0.67–0.93). Among secondary outcomes, only new psychotherapy referrals differed 44.3% ( n 154) participants having order compared 33.5% 129) (OR 1.47: 1.01–2.14). Conclusions This did result less or reduction medication, although increased. may be effective some subgroups.