Top

Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-01-2018 | Original Article

Impact of Coordinated Behavioral Health Management on Quality Measures of Antipsychotic Use

Authors: Ming-Hui Tai, Bethany Lee, Eberechukwu Onukwugha, Julie M. Zito, Gloria M. Reeves, Susan dosReis

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 1/2018

Abstract

A state Care Management Entity (CME) using the wraparound practice model provided intensive care coordination for youth with severe mental illness, those most likely to receive antipsychotics. The model has led to improved clinical/functional outcomes, but little is known about the impact on antipsychotic prescribing and safety monitoring. A pre-post study was conducted to evaluate antipsychotic dosing, concomitant antipsychotic use, and metabolic monitoring among CME-enrolled and non-CME-enrolled comparison groups. CME-enrolled youth had greater decrease in concomitant antipsychotic use than non-CME-enrolled youth, but no difference in dosing or metabolic monitoring. More education of prescribing antipsychotics and team-based engagement in care coordination are needed.

Available only for authorised users

The Hilltop Institute identified the non-CME youth during December 2009 through December 2013 and had with similar distribution of characteristics (listed below) as the CME youth. The characteristics included age, gender, race, a hierarchy of diagnoses (psychotic disorder, bipolar disorder, depressive disorder, ADHD/disruptive behavior disorders, Anxiety disorders, and others), a hierarchy of Medicaid coverage group (SSI/disabled, Foster care/Adoption, and TANF/low income).

The peer-review prior-authorization program was mainly to address concerns of (1) the increase of youth who received antipsychotics and (2) there was lack of metabolic monitoring for youth receiving antipsychotics. In the PA review process, antipsychotic prescriptions need to be reviewed and approved by psychiatrists/clinical pharmacists.

American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, American Association of Clinical Endocrinologists, & North American Association for the Study of Obesity (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes care, 27(2), 596–601.CrossRef

Anglin, G., Swinburn, A., Foster, L., Brach, C., Bergofsky, L. (2014). The national evaluation of the CHIPRA quality demonstration grant program. Implementation guide number 2: Designing care management entities for youth with complex behavioral health need. Retrieved from http://www.ahrq.gov/sites/default/files/publications/files/impguide2.pdf.

APA Working Group on Psychoactive Medications for Children and Adolescents. (2006). Report of the working group on psychoactive medications for children and adolescents. Psychopharmacological, psychosocial, and combined interventions for childhood disorders: Evidence base, contextual factors, and future directions. Washington, DC: American Psychological Association.

Bobo, W. V., Cooper, W. O., Stein, C. M., Olfson, M., Graham, D., Daugherty, J., Ray, W. A. (2013). Antipsychotics and the risk of type 2 diabetes mellitus in children and youth. JAMA Psychiatry, 70(10), 1067–1075. doi:10.1001/jamapsychiatry.2013.2053.CrossRefPubMed

Bruns, E. J., Rast, J., Peterson, C., Walker, J., & Bosworth, J. (2006). Spreadsheets, service providers, and the statehouse: Using data and the wraparound process to reform systems for children and families. American Journal of Community Psychology, 38(3–4), 201–212. doi:10.1007/s10464-006-9074-z..PubMed

Burcu, M., Zito, J. M., Ibe, A., & Safer, D. J. (2014). Atypical antipsychotic use among Medicaid-insured children and adolescents: Duration, safety, and monitoring implications. Journal of Child and Adolescent Psychopharmacology, 24(3), 112–119. doi:10.1089/cap.2013.0094.CrossRefPubMed

Centers for Medicare and Medicaid Services. (2010). CHIPRA quality demonstration grants summary. Retrieved from http://www.medicaid.gov/chip/chipra-quality-demonstration-grants-summary.html#mar

Cheng, A. M. (2006). Duration calculation from a clinical programmer’s perspective paper presented at the SAS users group international (SUGI), San Francisco, California

CHIPRA Quality Demonstration Grant Program Webinar Series. (2013). Improving behavioral health care quality for children and adolescents: Section of Maryland/Georgia/Wyoming—using care management entities. Retrieved from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/childrens-health-insurance-program-chip/downloads/chipra-quality-demos-webinar-4.pdf

Correll, C. U., Manu, P., Olshanskiy, V., Napolitano, B., Kane, J. M., & Malhotra, A. K. (2009). Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. The Journal of the American Medical Association, 302(16), 1765–1773. doi:10.1001/jama.2009.1549.CrossRefPubMed

Crystal, S., Olfson, M., Huang, C., Pincus, H., & Gerhard, T. (2009). Broadened use of atypical antipsychotics: Safety, effectiveness, and policy challenges. Health Affairs, 28(5), w770–w781. doi:10.1377/hlthaff.28.5.w770.CrossRefPubMedPubMedCentral

Currie, J., & Reichman, N. (2015). Policies to Promote Child Health. Retrieved from https://www.princeton.edu/futureofchildren/publications/docs/FOC-spring-2015.pdf.

Curtis, L. H., Masselink, L. E., Ostbye, T., Hutchison, S., Dans, P. E., Wright, A., & Schulman, K. A. (2005). Prevalence of atypical antipsychotic drug use among commercially insured youths in the united states. Archives of Pediatrics & Adolescent Medicine, 159(4), 362–366.CrossRef

dosReis, S., Yoon, Y., Rubin, D. M., Riddle, M. A., Noll, E., & Rothbard, A. (2011). Antipsychotic treatment among youth in foster care. Pediatrics, 128(6), e1459–e1466. doi:10.1542/peds.2010-2970.CrossRefPubMedPubMedCentral

Hammerman, A., Dreiher, J., Klang, S. H., Munitz, H., Cohen, A. D., & Goldfracht, M. (2008). Antipsychotics and diabetes: An age-related association. The Annals of Pharmacotherapy, 42(9), 1316–1322. doi:10.1345/aph.1L015.CrossRefPubMed

Harrison, J. N., Cluxton-Keller, F., & Gross, D. (2012). Antipsychotic medication prescribing trends in children and adolescents. Journal of Pediatric Health Care, 26(2), 139–145. doi:10.1016/j.pedhc.2011.10.009.CrossRefPubMedPubMedCentral

Hoagwood, K., Burns, B. J., Kiser, L., Ringeisen, H., & Schoenwald, S. K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52(9), 1179–1189.CrossRefPubMed

Kealey, E., Scholle, S. H., Byron, S. C., Hoagwood, K., Leckman-Westin, E., Kelleher, K., & Finnerty, M. (2014). Quality concerns in antipsychotic prescribing for youth: A review of treatment guidelines. Academic Pediatrics, 14(5), S68–S75. doi:10.1016/j.acap.2014.05.009.CrossRefPubMedPubMedCentral

Kreider, A. R., Matone, M., Bellonci, C., dosReis, S., Feudtner, C., Huang, Y. S., & Rubin, D. M. (2014). Growth in the concurrent use of antipsychotics with other psychotropic medications in Medicaid-enrolled children. Journal of the American Academy of Child and Adolescent Psychiatry, 53(9), 960–970. doi:10.1016/j.jaac.2014.05.010.CrossRefPubMed

Louisiana Behavioral Health Partnership. (2013). Coordinated system of care (CSoC)-transforming the system. Retrieved from http://www.magellanoflouisiana.com/formembers-la-en/accessing-services/louisiana's-coordinated-system-of-care.aspx

Maryland Child and Adolescent Innovations Institute and Mental Health Institute, University of Maryland, Baltimore. (2008). The Maryland care management model: Care coordination using high-fidelity wraparound to support the strengths and needs of youth with complex needs and their families. Retrieved from http://theinstitute.umaryland.edu/topics/soc/caremanagement.cfm

Maryland Department of Health and Mental Hygiene.(2015) Medicaid pharmacy program: The peer review program. Retrieved from https://mmcp.dhmh.maryland.gov/pap/SitePages/paphome.aspx

Morrato, E. H., Druss, B., Hartung, D. M., Valuck, R. J., Allen, R., Campagna, E., & Newcomer, J. W. (2010a). Metabolic testing rates in 3 state medicaid programs after FDA warnings and ADA/APA recommendations for second-generation antipsychotic drugs. Archives of General Psychiatry, 67(1), 17.CrossRefPubMed

Morrato, E. H., Newcomer, J. W., Allen, R. R., & Valuck, R. J. (2008). Prevalence of baseline serum glucose and lipid testing in users of second-generation antipsychotic drugs: A retrospective, population-based study of Medicaid claims data. The Journal of Clinical Psychiatry, 69(2), 316–322.CrossRefPubMed

Morrato, E. H., Nicol, G. E., Maahs, D., Druss, B. G., Hartung, D. M., Valuck, R. J., Newcomer, J. W. (2010b). Metabolic screening in children receiving antipsychotic drug treatment. Archives of Pediatrics & Adolescent Medicine, 164(4), 344–351. doi:10.1001/archpediatrics.2010.48.CrossRef

National Committee for Quality Assurance. (2014). Proposed new measures for HEDIS^®1 2015: Safe and judicious antipsychotic use in children and adolescents. Retrieved from http://www.ncqa.org/Portals/0/HomePage/Antipsychotics.pdf

National Wraparound Initiative. (2014). Wraparound basics. Retrieved from http://www.nwi.pdx.edu/wraparoundbasics.shtml

Olfson, M., King, M., & Schoenbaum, M. (2015). Treatment of young people with antipsychotic medications in the united states. JAMA Psychiatry, 72(9), 867–874. doi:10.1001/jamapsychiatry.2015.0500.CrossRefPubMed

Onukwugha, E., Bergtold, J., & Jain, R. (2015a). A primer on marginal effects—Part I: Theory and formulae. PharmacoEconomics, 33(1), 25–30. doi:10.1007/s40273-014-0210-6.CrossRefPubMed

Onukwugha, E., Bergtold, J., & Jain, R. (2015b). A primer on marginal effects-part II: Health services research applications. PharmacoEconomics, 33(2), 97–103. doi:10.1007/s40273-014-0224-0.CrossRefPubMed

Penfold, R. B., Stewart, C., Hunkeler, E. M., Madden, J. M., Cummings, J. R., Owen-Smith, A. A., & Simon, G. E. (2013). Use of antipsychotic medications in pediatric populations: What do the data say? Current Psychiatry Reports, 15(12), 426. doi:10.1007/s11920-013-0426-8.CrossRefPubMedPubMedCentral

Pirracchio, R., Resche-Rigon, M., & Chevret, S. (2012). Evaluation of the propensity score methods for estimating marginal odds ratios in case of small sample size. BMC Medical Research Methodology, 12, 70-2288-12-70. doi:10.1186/1471-2288-12-70.CrossRef

Raghavan, R., Lama, G., Kohl, P., & Hamilton, B. (2010). Interstate variations in psychotropic medication use among a national sample of children in the child welfare system. Child Maltreatment, 15(2), 121–131. doi:10.1177/1077559509360916.CrossRefPubMed

Steyerberg, E. W. (2008). A practical approach to development, validation, and updating. Rotterdam, The Netherlands. New York, NY: Springer.

Stürmer, T., Rothman, K. J., Avorn, J., & Glynn, R. J. (2010). Treatment effects in the presence of unmeasured confounding: Dealing with observations in the tails of the propensity score distribution—A simulation study. American Journal of Epidemiology, 172(7), 843–854.CrossRefPubMedPubMedCentral

The Institute for Innovation and Implementation, CHIPRA evaluation. Retrieved from http://theinstitute.umaryland.edu/centers/researcheval/eval_chipra.cfm

U.S. Department of Health and Human Services, Office of Inspector General. (2015). Second-generation antipsychotics drug use among medicaid-enrolled children: Quality-of-care concerns.

United States Government Accountability Office. (2015). Mental health: HHS leadership needed to coordinate federal efforts related to serious mental illness.

Walker, J. S., Bruns, E. J., & Penn, M. (Eds.). (2008). Individualized services in systems of care: The wraparound process. The system of care handbook: Transforming mental health services for children, youth, and families. Baltimore: Paul H. Brookes.

Wraparound Milwaukee (2012) The year end report for the Wraparound Milwaukee. Retrieved from http://wraparoundmke.com/wp-content/uploads/2013/11/WMAnnualReport_2012.pdf

Zhou, Z., Rahme, E., Abrahamowicz, M., & Pilote, L. (2005). Survival bias associated with time-to-treatment initiation in drug effectiveness evaluation: A comparison of methods. American Journal of Epidemiology, 162(10), 1016–1023. doi:10.1093/aje/kwi307.CrossRefPubMed

Zima, B. T., & Mangione-Smith, R. (2011). Gaps in quality measures for child mental health care: An opportunity for a collaborative agenda. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 735–737. doi:10.1016/j.jaac.2011.05.006.CrossRefPubMed

Zito, J. M., Burcu, M., Ibe, A., Safer, D. J., & Magder, L. S. (2013). Antipsychotic use by medicaid-insured youths: Impact of eligibility and psychiatric diagnosis across a decade. Psychiatric Services, 64(3), 223–229. doi:10.1176/appi.ps.201200081.CrossRefPubMed

Zito, J. M., Safer, D. J., Sai, D., Gardner, J. F., Thomas, D., Coombes, P., & Mendez-Lewis, M. (2008). Psychotropic medication patterns among youth in foster care. Pediatrics, 121(1), e157–e163. doi:10.1542/peds.2007-0212.CrossRefPubMed

Zou, G. (2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159(7), 702–706. doi:10.1093/aje/kwh090.CrossRefPubMed

Title: Impact of Coordinated Behavioral Health Management on Quality Measures of Antipsychotic Use
Authors: Ming-Hui Tai
Bethany Lee
Eberechukwu Onukwugha
Julie M. Zito
Gloria M. Reeves
Susan dosReis
Publication date: 01-01-2018
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 1/2018
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-017-0807-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of Coordinated Behavioral Health Management on Quality Measures of Antipsychotic Use

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2018

A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation

Association Between Mental Health Staffing Level and Primary Care-Mental Health Integration Level on Provision of Depression Care in Veteran’s Affairs Medical Facilities

Explication and Definition of Mental Health Recovery: A Systematic Review

The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care

Correction to: Understanding the Therapist Contribution to Psychotherapy Outcome: A Meta-Analytic Approach

Mental Health Service Use Among Young Adults: A Communication Framework for Program Development