Selective Serotonin Reuptake Inhibitor Prescribing Within An Integrated Pediatric Primary Care Behavioral Health Program.

IF 3 3区 医学 Q1 PEDIATRICS
Louis Vernacchio, Jonas Bromberg, Emily T Correa, Margaret Fry, Heather J Walter
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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.

儿科初级保健行为健康综合项目中的选择性羟色胺再摄取抑制剂处方。
目的:选择性 5-羟色胺再摄取抑制剂(SSRI)处方越来越多地被纳入初级保健中,但关于儿科初级保健临床医生(PCC)在实施综合行为健康(BH)保健后的处方模式的数据却很少:我们利用行政报销数据,对综合 BH 计划启动后 10 年间全州儿科初级保健网络内的 SSRI 处方情况进行了横断面分析,计算了初级保健中心和专科医生的 SSRI 处方率。通过使用电子健康记录数据,我们分析了一套拟议的 SSRI 启动质量指标:10年间,PCC开具的SSRI处方从56份/千名患者-年增加到446份/千名患者-年;同期,专科医生为网络内患者开具的处方从233份/千名患者-年增加到380份/千名患者-年。2013 年,儿科专科医生开出的处方占所有 SSRIs 的 19%,而到 2022 年,他们开出的处方占总数的 54%(PConclusions:在儿科综合 BH 计划实施的前 10 年中,初级保健中心开具的 SSRI 处方增加了七倍多,超过了专科医生为患者开具的处方。PCC 在选择药物和起始剂量时非常恰当,但在使用有效症状评分量表和持续随访方面还有待改进。
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来源期刊
Academic Pediatrics
Academic Pediatrics PEDIATRICS-
CiteScore
4.60
自引率
12.90%
发文量
300
审稿时长
60 days
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.
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