Louis Vernacchio, Jonas Bromberg, Emily T Correa, Margaret Fry, Heather J Walter
{"title":"Selective Serotonin Reuptake Inhibitor Prescribing Within An Integrated Pediatric Primary Care Behavioral Health Program.","authors":"Louis Vernacchio, Jonas Bromberg, Emily T Correa, Margaret Fry, Heather J Walter","doi":"10.1016/j.acap.2024.10.008","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Selective serotonin reuptake inhibitor (SSRI) prescribing is increasingly being integrated into primary care but few data are available about prescribing patterns by pediatric primary care clinicians (PCCs) following implementation of integrated behavioral health (BH) care.</p><p><strong>Methods: </strong>Using administrative claims data, we performed a cross-sectional analysis of SSRI prescribing within a statewide pediatric primary care network over 10 years after initiation of an integrated BH program, calculating the rate of PCC and specialist SSRI prescribing. Using electronic health record data, we analyzed a proposed set of quality metrics for SSRI initiation.</p><p><strong>Results: </strong>Over 10 years, SSRI prescribing by PCCs increased from 56 fills/1000 patient-years to 446; over the same time period, prescribing by specialists for the network's patients rose from 233 fills/1000 patient-years to 380. In 2013, PCCs prescribed 19% of all SSRIs while by 2022 they prescribed 54% of the total (P<0.001 for change for PCCs compared to specialists). Among 16272 initial SSRI prescribing events by PCCs, 99.6% prescribed a recommended SSRI; 97.5% used an appropriate starting dose; 55.2% documented a validated symptom rating scale at initiation; 53.4% had a contact within 14 days; 67.8% had a follow-up visit within 60 days; and 37.4% documented a symptom rating scale within 60 days.</p><p><strong>Conclusions: </strong>In the first 10 years of a pediatric integrated BH program, SSRI prescribing by PCCs increased over seven-fold and surpassed specialist prescribing for the patient population. PCCs chose medications and starting doses appropriately but could improve their use of validated symptom rating scales and consistent follow-up.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acap.2024.10.008","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Selective serotonin reuptake inhibitor (SSRI) prescribing is increasingly being integrated into primary care but few data are available about prescribing patterns by pediatric primary care clinicians (PCCs) following implementation of integrated behavioral health (BH) care.
Methods: Using administrative claims data, we performed a cross-sectional analysis of SSRI prescribing within a statewide pediatric primary care network over 10 years after initiation of an integrated BH program, calculating the rate of PCC and specialist SSRI prescribing. Using electronic health record data, we analyzed a proposed set of quality metrics for SSRI initiation.
Results: Over 10 years, SSRI prescribing by PCCs increased from 56 fills/1000 patient-years to 446; over the same time period, prescribing by specialists for the network's patients rose from 233 fills/1000 patient-years to 380. In 2013, PCCs prescribed 19% of all SSRIs while by 2022 they prescribed 54% of the total (P<0.001 for change for PCCs compared to specialists). Among 16272 initial SSRI prescribing events by PCCs, 99.6% prescribed a recommended SSRI; 97.5% used an appropriate starting dose; 55.2% documented a validated symptom rating scale at initiation; 53.4% had a contact within 14 days; 67.8% had a follow-up visit within 60 days; and 37.4% documented a symptom rating scale within 60 days.
Conclusions: In the first 10 years of a pediatric integrated BH program, SSRI prescribing by PCCs increased over seven-fold and surpassed specialist prescribing for the patient population. PCCs chose medications and starting doses appropriately but could improve their use of validated symptom rating scales and consistent follow-up.
期刊介绍:
Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.