Patient, Treatment, and Health Care Utilization Variables Associated with Adherence to Metabolic Monitoring Practices in Children and Adolescents Taking Second-Generation Antipsychotics

Objective: Children and adolescents with a range of psychiatric disorders are increasingly being prescribed atypical or second-generation antipsychotics (SGAs). While SGAs are effective at treating conduct and behavioural symptoms, they infer significant cardiometabolic risk. This study aims to explore what patient, treatment, and health care utilization variables are associated with adherence to Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) metabolic monitoring guidelines. Method: A retrospective chart review of 294 children and adolescents accessing a large outpatient psychiatry setting within a 2-year study period (2014-2016) was conducted. Baseline and follow-up metabolic monitoring, demographic, treatment, and health care utilization variables were then assessed over a 1-year period of interest. Results: Metabolic monitoring practices did not adhere to CAMESA guidelines and were very poor over the 1-year observation period. There were significant differences between children (ages 4-12 years, n = 99) and adolescents (ages 13-18 years, n = 195). In adolescents, factors associated with any baseline metabolic monitoring were a higher number of psychiatry visits (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.10 to 1.41), longer duration of contact (OR, 14; 95% CI, 2.31 to 82.4), and use of other non-SGA medications (OR, 3.2; 95% CI, 1.17 to 8.94). Among children, having an emergency room visit (OR, 3.4; 95% CI, 1.01 to 11.71) and taking aripiprazole (OR, 7.4; 95% CI, 2.02 to 27.45) increased the odds of receiving baseline metabolic monitoring. Conclusion: Findings from this study highlight the need for better metabolic monitoring for children and adolescents taking SGAs. Enhanced focus on opportunities for multidisciplinary collaboration is needed to improve the quality of care offered to this population.

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Inpatient and Outpatient Health Care Utilization of Children and Adolescents with Type 1 Diabetes before and after Introduction of DRGs

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0030-1249673 ◽

2010 ◽

Vol 118 (09) ◽

pp. 644-648 ◽

Cited By ~ 5

Author(s):

C. Bächle ◽

B. Haastert ◽

R. W. Holl ◽

P. Beyer ◽

M. Grabert ◽

...

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Health Care Utilization ◽

Children And Adolescents ◽

Care Utilization ◽

Before And After

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The impact of switching gastroesophageal reflux disease (GERD) patients from omeprazole to lansoprazole on health care utilization and patient treatment outcomes

Gastroenterology ◽

10.1016/s0016-5085(00)80172-9 ◽

2000 ◽

Vol 118 (4) ◽

pp. A1093

Author(s):

Dennis W. Raisch ◽

Lauren M. Klaurens ◽

Craig W. Hayden ◽

Isaac Malagon ◽

Gloria Pulliam ◽

...

Keyword(s):

Health Care ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Health Care Utilization ◽

Treatment Outcomes ◽

Reflux Disease ◽

Patient Treatment ◽

Care Utilization ◽

The Impact

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PMH23 A COMPARISION OF HEALTH CARE UTILIZATION AND COST OF CHILDREN AND ADOLESCENTS WITH BIPOLAR DISORDER TREATED WITH ATYPICAL ANTIPSYCHOTIC MONOTHERAPYVERSUS MOOD STABILIZER MONOTHERAPY

Value in Health ◽

10.1016/s1098-3015(10)70372-7 ◽

2008 ◽

Vol 11 (3) ◽

pp. A116

Author(s):

Y Jing ◽

JJ Guo ◽

NC Patel ◽

PC Heaton ◽

H Li ◽

...

Keyword(s):

Health Care ◽

Bipolar Disorder ◽

Health Care Utilization ◽

Children And Adolescents ◽

Atypical Antipsychotic ◽

Mood Stabilizer ◽

Care Utilization ◽

Cost Of Children

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Trends in Incidence of ACL Reconstruction and Concomitant Procedures Among Commercially Insured Individuals in the United States, 2002-2014

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118803616 ◽

2018 ◽

Vol 10 (6) ◽

pp. 523-531 ◽

Cited By ~ 32

Author(s):

Mackenzie M. Herzog ◽

Stephen W. Marshall ◽

Jennifer L. Lund ◽

Virginia Pate ◽

Christina D. Mack ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Children And Adolescents ◽

Acl Reconstruction ◽

Clinical Epidemiology ◽

Cruciate Ligament ◽

Meniscal Repair ◽

The United States ◽

Care Utilization ◽

Meniscal Surgery

Background: Few population-based descriptive studies on the incidence of anterior cruciate ligament (ACL) reconstruction and concomitant pathology exist. Hypothesis: Incidence of ACL reconstruction has increased from 2002 to 2014. Study Design: Descriptive clinical epidemiology study. Level of Evidence: Level 3. Methods: The Truven Health Analytics MarketScan Commercial Claims and Encounters database, which contains insurance enrollment and health care utilization data for approximately 158 million privately insured individuals younger than 65 years, was used to obtain records of ACL reconstructions performed between 2002 and 2014 and any concomitant pathology using Current Procedures Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) codes. The denominator population was defined as the total number of person-years (PYs) for all individuals in the database. Annual rates were computed overall and stratified by age, sex, and concomitant procedure. Results: There were 283,810 ACL reconstructions and 385,384,623 PYs from 2002 to 2014. The overall rate of ACL reconstruction increased 22%, from 61.4 per 100,000 PYs in 2002 to 74.6 per 100,000 PYs in 2014. Rates of isolated ACL reconstruction were relatively stable over the study period. However, among children and adolescents, rates of both isolated ACL reconstruction and ACL reconstruction with concomitant meniscal surgery increased substantially. Adolescents aged 13 to 17 years had the highest absolute rates of ACL reconstruction, and their rates increased dramatically over the 13-year study period (isolated, +37%; ACL + meniscal repair, +107%; ACL + meniscectomy, +63%). Rates of isolated ACL reconstruction were similar for males and females (26.1 vs 25.6 per 100,000 PYs, respectively, in 2014), but males had higher rates of ACL reconstruction with concomitant meniscal surgery than females. Conclusion: Incidence rates of isolated ACL reconstruction and rates of concomitant meniscal surgery have increased, particularly among children and adolescents. Clinical Relevance: A renewed focus on adoption of injury prevention programs is needed to mitigate these trends. In addition, more research is needed on long-term patient outcomes and postoperative health care utilization after ACL reconstruction, with a focus on understanding the sex-based disparity in concomitant meniscal surgery.

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