PDF(Pubmed)
Abstract：
BACKGROUND: Behavioral or mental health disorders are common in children, adolescents, and young adults. Medication use is increasingly common, with few data describing drug-drug combinations in ambulatory settings. The objectives of this study were to describe the pharmaco-epidemiology of behavioral and mental health (BMH) medications among children, adolescents, and young adults in New York Medicaid and assess the prevalence of contraindicated drug pairs within this population.
METHODS: This observational cross-sectional study evaluated New York State Medicaid managed care and fee-for-service enrollees under 21 years of age dispensed BMH medications in 2014. Main outcomes included number of members with prescriptions filled; number filling > 1 medication prescription concurrently for ≥ 30 days (polypharmacy), and number and nature of potentially contraindicated drug pairs.
RESULTS: Of 2,430,434 children, adolescents, and young adults, 422,486 (17.4%) had a visit associated with a BMH diagnosis and 141,363 (5.8%) received one or more BMH medications. With 84 distinct medications evaluated, polypharmacy was common, experienced by 53,388 individuals (37.8% of those with a prescription filled), generating 11,115 distinct drug combinations. 392 individuals filled prescriptions for a contraindicated pair of ≥ 2 BMH medications for 30 days or longer. With ≥ 1 day overlap, 651 were exposed to contraindicated medications. The most common contraindicated pairs increased potential risk for prolonged QT interval and serotonin syndrome (n = 378 and n = 250 patients, respectively). Most combinations involved ziprasidone (3247.1 per 10,000 ziprasidone prescriptions filled).
CONCLUSIONS: With nearly 6% of members dispensed a BMH medication, contraindicated drug pairs were uncommon. However, any of those combinations represent a potential risk. Clinicians should attend to the balance of potential risks and benefits before contraindicated pairs are dispensed. The methodology described could serve as a basis for monitoring such rare instances and might reduce harm.
METHODS: This observational cross-sectional study evaluated New York State Medicaid managed care and fee-for-service enrollees under 21 years of age dispensed BMH medications in 2014. Main outcomes included number of members with prescriptions filled; number filling > 1 medication prescription concurrently for ≥ 30 days (polypharmacy), and number and nature of potentially contraindicated drug pairs.
RESULTS: Of 2,430,434 children, adolescents, and young adults, 422,486 (17.4%) had a visit associated with a BMH diagnosis and 141,363 (5.8%) received one or more BMH medications. With 84 distinct medications evaluated, polypharmacy was common, experienced by 53,388 individuals (37.8% of those with a prescription filled), generating 11,115 distinct drug combinations. 392 individuals filled prescriptions for a contraindicated pair of ≥ 2 BMH medications for 30 days or longer. With ≥ 1 day overlap, 651 were exposed to contraindicated medications. The most common contraindicated pairs increased potential risk for prolonged QT interval and serotonin syndrome (n = 378 and n = 250 patients, respectively). Most combinations involved ziprasidone (3247.1 per 10,000 ziprasidone prescriptions filled).
CONCLUSIONS: With nearly 6% of members dispensed a BMH medication, contraindicated drug pairs were uncommon. However, any of those combinations represent a potential risk. Clinicians should attend to the balance of potential risks and benefits before contraindicated pairs are dispensed. The methodology described could serve as a basis for monitoring such rare instances and might reduce harm.
摘要：
背景：行为或精神健康障碍在儿童中很常见，青少年,和年轻人。药物使用越来越普遍，很少有数据描述门诊环境中的药物-药物组合。这项研究的目的是描述儿童行为和心理健康（BMH）药物的药物流行病学，青少年,和纽约医疗补助的年轻人，并评估该人群中禁忌药物对的患病率。
方法：这项观察性横断面研究评估了2014年纽约州医疗补助管理护理和21岁以下按服务收费的参与者发放了BMH药物。主要结果包括配开处方的成员人数；配开处方的人数>1个药物处方并发≥30天（多重用药），以及潜在禁忌药物对的数量和性质。
结果：在2,430,434名儿童中，青少年,和年轻人，422,486（17.4％）的就诊与BMH诊断相关，141,363（5.8％）接受了一种或多种BMH药物治疗。评估了84种不同的药物，多重用药很常见，53388人(37.8%的人配药)，产生11,115种不同的药物组合。392名患者在30天或更长时间内服用了一对禁忌的≥2种BMH药物。重叠时间≥1天,651人暴露于禁忌药物。最常见的禁忌对增加QT间期延长和5-羟色胺综合征的潜在风险（n=378和n=250例患者，分别)。大多数组合涉及齐拉西酮(3247.1/10,000齐拉西酮处方)。
结论：近6％的成员分配了BMH药物，禁忌药物对并不常见。然而,这些组合中的任何一种都代表着潜在的风险。在分配禁忌对之前，临床医生应注意潜在风险和收益的平衡。所描述的方法可以作为监测这种罕见情况的基础，并可能减少损害。
方法：这项观察性横断面研究评估了2014年纽约州医疗补助管理护理和21岁以下按服务收费的参与者发放了BMH药物。主要结果包括配开处方的成员人数；配开处方的人数>1个药物处方并发≥30天（多重用药），以及潜在禁忌药物对的数量和性质。
结果：在2,430,434名儿童中，青少年,和年轻人，422,486（17.4％）的就诊与BMH诊断相关，141,363（5.8％）接受了一种或多种BMH药物治疗。评估了84种不同的药物，多重用药很常见，53388人(37.8%的人配药)，产生11,115种不同的药物组合。392名患者在30天或更长时间内服用了一对禁忌的≥2种BMH药物。重叠时间≥1天,651人暴露于禁忌药物。最常见的禁忌对增加QT间期延长和5-羟色胺综合征的潜在风险（n=378和n=250例患者，分别)。大多数组合涉及齐拉西酮(3247.1/10,000齐拉西酮处方)。
结论：近6％的成员分配了BMH药物，禁忌药物对并不常见。然而,这些组合中的任何一种都代表着潜在的风险。在分配禁忌对之前，临床医生应注意潜在风险和收益的平衡。所描述的方法可以作为监测这种罕见情况的基础，并可能减少损害。
