Trends in Psychotropic Polypharmacy Among Youths Enrolled in Ohio Medicaid, 2002–2008

Abstract

Objective This study examined polypharmacy patterns and rates over time among Medicaid-enrolled youths by comparing three enrollment groups (youths in foster care, with a disability, or from a family with low income). Methods Serial cross-sectional trend analyses of Medicaid claims data were conducted for youths age 17 and younger who were continuously enrolled in Ohio Medicaid for a one-year period and prescribed one or more psychotropic medications during fiscal years 2002 (N=26,252) through 2008 (N=50,311). Outcome measures were any polypharmacy (three or more psychotropic medications from any drug class) and multiclass polypharmacy (three or more psychotropic medications from different drug classes). Results Both types of polypharmacy increased across all three eligibility groups. Any polypharmacy increased from 8.8% to 11.5% for low-income youths (adjusted odds ratio [AOR]=1.12, 99% confidence interval [CI]=1.10–1.13), from 18.0% to 24.9% for youths with a disability (AOR=1.11, CI=1.09–1.13), and from 19.8% to 27.3% for youths in foster care (AOR=1.09, CI=1.07–1.11). Combinations associated with positive increases were two or more antipsychotics, two or more stimulants, and antipsychotics with stimulants. Conclusions Polypharmacy increased across all enrollment groups, with the highest absolute rates for youths in foster care. Both the overall prevalence and increases in prescriptions for drug combinations with limited evidence of safety and efficacy, such as the prescription of two or more antipsychotics, underscore the need for targeted quality improvement efforts. System oversight and monitoring of psychotropic medication use appears to be warranted, especially for higher-risk groups, such as youths in foster care and those from low-income households who were prescribed multiple antipsychotics.

Variation of the prevalence of pediatric polypharmacy: A scoping review

“…Other characteristics of studies that reported a mean number of medications without reporting prevalence included evaluating multiple drugs/classes and being in international settings (Table S3). Table S3 also shows the rest of the studies that reported prevalence or average number of medications.…”

The depth, duration, and degree of outpatient pediatric polypharmacy in Colorado fee-for-service Medicaid patients

“…18 We chose the 12-month cut point to balance between a study duration long enough to capture multiple prescriptions but not so restrictive to severely limit sample size. 20 If a child had interrupted enrollment where ≥2 periods during the study dates met the 12-month eligibility criteria, we used the first eligible period for analysis. CCCs were classified using a recently updated and published taxonomy of ICD-9-CM codes, which includes a new "technology-dependent" variable to identify children who rely on technology such as ventilators, gastrostomy tubes, shunts, and so on.…”

Polypharmacy in the elderly

“…Based on the Ohio Medicaid data report, the rate of psychotropic polypharmacy increased significantly since 2002 in younger adults, however, there are few data available for a general elderly population. [ 7 ] Most previous studies focused on cardiac patients, hospital-based or posthospital patients. [ 8 9 ]…”