Pilot project to identify area-level predictors of the prevalence of psychotropic medication use among North Carolina Medicaid enrollees ages 0-4

Alan R. Ellis, MSW, Principal Investigator

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Psychotropic medications are part of the standard of care for many mental disorders, but their increasing use among preschool children has raised concern because of insufficient clinical guidelines and because of possible racial and economic disparities. Often the medication is a stimulant and is prescribed for Attention Deficit/Hyperactivity Disorder (ADHD) or related symptoms. For example, a study of one state’s Medicaid program found a three-fold increase in stimulant prescriptions for two-to-four-year-olds over a five-year period. This is a cause for concern because there is not a sufficient knowledge base to support the diagnosis of ADHD or the use of psychotropic medication in very young children. Also, medication is sometimes prescribed in the absence of well-child care or psychosocial services. Polypharmacy and the prescribing physician’s level of preparation represent additional areas of concern. Outside North Carolina (NC), some studies have found less use of psychotropic and other medications among African American or Latino youths than among White youths, while other studies have found no such difference.

Using data from the Census and mental health catchment area statistics from the NC Division of Medical Assistance (2001-2006), this pilot study described regional and temporal variation in the prevalence of psychotropic medication prescriptions and used hierarchical linear models to identify area-level predictors of prevalence. This provides a foundation for larger studies that will use multiple years of Medicaid claims, eligibility, and case data; will take both personal characteristics (e.g., diagnosis, race, sex) and area characteristics into account; will be able to investigate racial/ethnic disparities among subgroups such as children in foster care; and will be able to investigate issues such as polypharmacy. This study was funded by the UNC-GlaxoSmithKline Center for Excellence in Pharmacoepidemiology and Public Health.