In response to a request from Senator Grassley, the Government Accountability Office did a survey [12/01/2011] of the medication of Medicaid covered children with psychotropic drugs in five States [Florida, Texas, Oregon, Michigan, and Massachusetts], separating Foster Children and non-Foster Children:
Medicaid – Foster Children | |||||
Age | FL | TX | OR | MI | MA |
|
|||||
0-5 | 5.3% | 9.1% | 2.5% | 4.4% | 4.9% |
6-12 | 31.2% | 45.8% | 23.4% | 26.7% | 44.8% |
13-17 | 36.8% | 58.2% | 43.3% | 35.0% | 53.4% |
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1-17 | 22.0% | 32.2% | 19.7% | 21.0% | 39.1% |
Medicaid – non–Foster Children | |||||
Age | FL | TX | OR | MI | MA |
|
|||||
0-5 | 3.3% | 3.1% | 0.5% | 1.1% | 2.2% |
6-12 | 12.3% | 10.6% | 6.2% | 11.5% | 12.1% |
13-17 | 11.9% | 11.4% | 12.0% | 13.1% | 14.7% |
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1-17 | 8.2% | 7.1% | 4.8% | 7.9% | 10.2% |
They also looked at some parameters that would be indicators of irrational medication:
Medicaid – Foster Children | |||||
Age | FL | TX | OR | MI | MA |
|
|||||
>5 meds |
0.11% | 1.05% | 0.13% | 0.29% | 1.33% |
> max dose | 1.50% | 3.27% | 1.12% | 1.67% | 2.21% |
<1 year old |
2.10% | 1.20% | 0.30% | 1.50% | 0.70% |
Medicaid – non–Foster Children | |||||
Age | FL | TX | OR | MI | MA |
|
|||||
>5 meds |
0.03% | 0.02% | 0.01% | 0.02% | 1.33% |
>max dose |
0.44% | 0.37% | 0.16% | 0.49% | 0.56% |
<1 year old |
1.20% | 1.00% | 0.10% | 0.30% | 0.70% |
In our draft report, we recommended that the Secretary of HHS evaluate our findings and consider endorsing guidance to state Medicaid and child welfare agencies on best practices for monitoring psychotropic drug prescriptions for foster children, including guidance that addresses, at minimum, informed consent, oversight, consultation, and information sharing. We have received written comments on our draft report from HHS and relevant agencies in 6 states. In written comments, HHS agreed with our recommendation and provided technical comments, which we incorporated as appropriate. In written comments and exit conferences, staff from state Medicaid and foster care agencies provided comments on key facts from the report. Agency comments will be incorporated and addressed in a written report that will be issued in December 2011.
But it’s the APA response that bugs me [below]. This statement, "New research on alleged overuse of psychotropic medications in both nursing-home and foster-care settings signals a need for better training of nonpsychiatric physicians and increased funding to bolster the mental health workforce" puts the blame on others. I expect that there’s plenty of blame to go around but that we psychiatrists and child psychiatrists own a significant share in our own right. And I didn’t care much for this one either, "While APA acknowledged in its statement in conjunction with the Senate hearing that children in foster-care systems experience high rates of mental illness, it voiced support for the GAO’s recommendation that HHS issue formal guidance to state Medicaid and child-welfare agencies on best practices for monitoring the prescription of psychotropic medications for foster children." Medicine has been traditionally self regulating. I don’t hear the APA’s response as having any acknowledgement of that function. It’s a politically correct response with all the forcefulness of a feather.
APA Responds to Reports on Antipsychotic Prescribing
APA cites a need to use practice guidelines when prescribing antipsychotics in nursing homes and foster-care facilities.
Psychiatric News
by Jonathan Wolfe
January 6, 2012
New research on alleged overuse of psychotropic medications in both nursing-home and foster-care settings signals a need for better training of nonpsychiatric physicians and increased funding to bolster the mental health workforce, stated APA in recently submitted congressional testimony. On November 30, 2011, the Senate Special Committee on Aging held a hearing exploring an audit issued earlier in the year by the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG). The report found that 14 percent of nursing-home residents were prescribed an atypical antipsychotic during the first six months of 2007. One day later, the Senate Homeland Security and Government Affairs’ Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security heard testimony from the Government Accountability Office (GAO) that foster children are prescribed psychotropic drugs at a significantly higher rate than children not in foster care.Conducted at the request of Sen. Charles Grassley (R-Iowa), the OIG’s report evaluated the extent to which nursing-home residents over age 65 receive atypical antipsychotics, as well as the cost to Medicare associated with these prescribing practices. Grassley had voiced concern about prescription of these drugs for off-label conditions and/or in the presence of dementia…
Are Foster Children Overmedicated?
On another issue related to concerns about use of antipsychotics, the GAO in recent congressional testimony compared the number of foster children being prescribed psychotropic medications in 2008 with the rate of prescriptions for nonfoster children and examined state oversight of psychotropic prescriptions for foster children through October 2011. While APA acknowledged in its statement in conjunction with the Senate hearing that children in foster-care systems experience high rates of mental illness, it voiced support for the GAO’s recommendation that HHS issue formal guidance to state Medicaid and child-welfare agencies on best practices for monitoring the prescription of psychotropic medications for foster children.“APA strongly believes psychotropic medications must be prescribed only when appropriately deemed necessary, and must form part of a larger customized treatment plan that includes both psychopharmacologic and psychosocial interventions,” Scully said in his testimony.
Texas and MA really stand out for their through the roof rates. Do you think there is any relationship to the KOLs beyond TMAP influence? What other forces might likely be at work? Pharma knowing where its best markets lie?
When it comes to misuse of psychiatric drugs, the APA is always pointing the finger at non-psychiatrist physicians. It’s those darn GPs! But hundreds of thousands of patient anecdotes all over the Web describe nonsensical prescribing by psychiatrists, too. While there may be a few standout psychiatrists, it really seems the majority are not much better than non-psychiatrists in the use of psychiatric medications.
The APA has nothing to be proud of.