PHS84 - Racial Disparity in the Use of First-Line Psychosocial Care For Children and Adolescents Initiating Therapy on Antipsychotics

Abstract

The use of antipsychotics (AP) among children and adolescents has increased in recent years, predominantly in disorders for which effective psychosocial interventions exist. This study examined performance on the measure proposed for Healthcare Effectiveness Data and Information Set (HEDIS) by NCQA of first-line psychosocial services for children initiating therapy with antipsychotics and disparities related to performance on the measure. This was a retrospective study using Mississippi Medicaid Claims Data for the period Jan 1- Dec 31, 2016. The earliest AP prescription dispensing date with a negative medication history for 120 days prior was identified as the index prescription start date (IPSD). Beneficiaries aged 1-17 years initiating AP therapy and continuously enrolled for 120 days pre and 30 days post IPSD were included. Beneficiaries with medical claims for psychosocial services within 90 days prior and 30 days after IPSD met the measure criteria. Logistic regression was used to examine the relationship between receiving first-line psychosocial therapy and beneficiary age, race, gender, and region in the state. A cohort of 3,584 beneficiaries met the inclusion criteria. Among them 1,908 (53%) received first-line psychosocial therapy. The odds ratios for receiving first-line psychosocial services were significantly higher for African American children than Caucasians (0R: 1.63, 95% CI: 1.41,1.89), lower for other children (OR: 0.64; 95% CI: 0.44,0.91), higher for children ages 6-11 compared to children <6 (OR: 1.99, 95% CI: 1.37, 2.91) and higher for ages 12-17 (OR: 1.64, 95% CI: 1.13,2.39). Benchmark data are not available but performance on the measure was not as good as desired. The presence of disparities on race and age indicate that both patient and system factors may be responsible for the lack of first-line psychosocial services. Further research is needed to better understand these disparities in order to plan effective quality improvement programs.