Selective Serotonin Reuptake Inhibitor Prescribing Within an Integrated Pediatric Primary Care Behavioral Health Program

Abstract

ObjectiveSelective serotonin reuptake inhibitor (SSRI) prescribing is increasingly being integrated into primary care, but few data are available about prescribing patterns by pediatric primary care clinicians (PCCs) following implementation of integrated behavioral health (BH) care. MethodsUsing administrative claims data, we performed a cross-sectional analysis of SSRI prescribing within a statewide pediatric primary care network over 10 years after the initiation of an integrated BH program, calculating the rate of PCC and specialist SSRI prescribing. Using electronic health record data, we analyzed a proposed set of quality metrics for SSRI initiation. ResultsOver 10 years, SSRI prescribing by PCCs increased from 56 fills/1000 patient-years to 446; over the same time period, prescribing by specialists for the network’s patients rose from 233 fills/1000 patient-years to 380. In 2013, PCCs prescribed 19% of all SSRIs, while by 2022, they prescribed 54% of the total (P < 0.001 for change for PCCs compared to specialists). Among 16,272 initial SSRI prescribing events by PCCs, 99.6% prescribed a recommended SSRI; 97.5% used an appropriate starting dose; 55.2% documented a validated symptom rating scale at initiation; 53.4% had a contact within 14 days; 67.8% had a follow-up visit within 60 days; and 37.4% documented a symptom rating scale within 60 days. ConclusionsIn the first 10 years of a pediatric integrated BH program, SSRI prescribing by PCCs increased over 7-fold and surpassed specialist prescribing for the patient population. PCCs chose medications and starting doses appropriately but could improve their use of validated symptom rating scales and consistent follow-up.