The definition and prevalence of pediatric psychotropic polypharmacy
Abstract
OBJECTIVES: Using increasingly stringent criteria, this study evaluated the prevalence of psychotropic polypharmacy among children on the basis of duration of overlap between two or more psychotropic medications.
METHODS: The prevalence of psychotropic polypharmacy was defined as receiving ≥ 14 days, ≥ 30 days, ≥ 60 days, and ≥ 90 days of overlapping psychotropic prescription fills. Descriptive analysis was used to compare the prevalence findings on the basis of multistate Medicaid data involving children six to 18 years of age. A sensitivity analysis was also conducted to explore the extent to which the cross-sectional operational definitions of polypharmacy used in the published literature identified patients who were prescribed psychotropic combinations on a long-term basis.
RESULTS: The analysis revealed that 282,910 children had at least one psychotropic prescription fill in 2005. Of these patients, 28.8% received psychotropic combinations for at least 14 consecutive days. The observed rate of polypharmacy dropped to 27.2% with 30 days of overlap and to 20.9% with 60 days of overlap. Using a 60-day overlap in psychotropic drugs as a cutoff between short-term and long-term polypharmacy, analyses showed that 14%-46% of patients identified by cross-sectional definitions as receiving polypharmacy had likely received combination treatment on a temporary rather than on a long-term basis. In addition, cross-sectional definitions failed to identify 18%-44% of patients…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 282,910 participants or records.
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