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The utilization of psychopharmacological treatment and medication adherence among Medicaid enrolled children and adolescents with bipolar depression.

Abstract：

BACKGROUND:To examine the psychotropic medication utilization and compare adherence to treatment regimens in pediatric bipolar depression patients. METHODS:2003-2007 MAX data from four geographically diverse states were used. According to the regimen received by the patients (6-18 years) in the first month after the index bipolar depression diagnosis, patients were categorized into six mutually exclusive groups. The month to month change of treatment regimen in each group was then assessed during the 6 month post-index bipolar depression diagnosis. Adherence to each regimen was measured as continuation of the initial regimen, switch to a new regimen, augmentation with medication from a different therapeutic category, and discontinuation of all pharmacotherapies. Repeated measure analysis was conducted to compare the trend of each adherence measure across the study groups. RESULTS:Of the 5,460 subjects identified, 15.39% received antipsychotic monotherapy, 9.43% received mood stabilizer monotherapy, 5.77% received antidepressant monotherapy, 26.48% received mood stabilizer-antipsychotic polytherapy, 22.51% received antidepressant polytherapy, and 19.89% received antipsychotic-mood stabilizer-antidepressant polytherapy. At the end of the follow-up period, over 50% of the 1st month polytherapy users and less than 50% of the monotherapy users were continuing their initial regimen. Repeated measure analysis using antipsychotic monotherapy as the reference group suggested differences in trend slopes (p<0.05). LIMITATIONS:In absence of structured clinical evaluation, bipolar disorder diagnoses cannot be ascertained in this study. CONCLUSIONS:Bipolar depression patients were predominantly treated with combinations of psychotropic drugs. Potentially questionable practice, such as antidepressant monotherapy was used only in a small fraction of patients. Combination regimens had better adherence as compared to monotherapies.

journal_name

J Affect Disord

journal_title

Journal of affective disorders

authors

Bhowmik D,Aparasu RR,Rajan SS,Sherer JT,Ochoa-Perez M,Chen H

doi

10.1016/j.jad.2013.04.034

subject

Has Abstract

pub_date

2013-09-05 00:00:00

pages

424-9

issue

eissn

0165-0327

issn

1573-2517

pii

S0165-0327(13)00335-2

journal_volume

150

pub_type

杂志文章

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The utilization of psychopharmacological treatment and medication adherence among Medicaid enrolled children and adolescents with bipolar depression.