1
|
McLaren JL, Zito JM, Fegert JM, Barnett ER. Editorial: Psychotropic overprescribing to youth: scope of the problem, causes, and possible solutions. Front Psychiatry 2024; 15:1418600. [PMID: 38774431 PMCID: PMC11107288 DOI: 10.3389/fpsyt.2024.1418600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/24/2024] Open
Affiliation(s)
- Jennifer L. McLaren
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, United States
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Julie M. Zito
- Department of Practice, Sciences and Health Outcomes Research, University of Maryland, Baltimore, Baltimore, MD, United States
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Erin R. Barnett
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| |
Collapse
|
2
|
Hughes PM, Graaf G, Gigli KH, deJong NA, McGrath RE, Thomas KC. Pediatric Mental Health Care and Scope-of-Practice Expansions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:384-392. [PMID: 38349470 PMCID: PMC11076160 DOI: 10.1007/s10488-024-01342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 05/08/2024]
Abstract
To examine the association between psychologist and nurse practitioner scope-of-practice (SoP) regulations and pediatric mental health service access. A nationally representative sample of children with mental health needs was identified using 5 years of National Survey of Children's Health (2016-2020). Utilization was measured in two ways: (1) unmet mental health care needs and (2) receipt of mental health medication. Expanded SoP for psychologists and nurse practitioners was measured based on the child's state of residence and the year of the survey. The associations between both SoP expansion and both outcomes were assessed using logistic regression models adjusted for multiple covariates. The probability of having unmet mental health needs was 5.4 percentage points lower (95% CI - 0.102, - 0.006) for children living in a state with psychologist SoP expansion; however, there was no significant difference in unmet mental health needs between states with and without NP SoP expansion. The probability of receiving a mental health medication was 2.0 percentage points higher (95% CI 0.007, 0.034) for children living in a state with psychologist SoP expansion. Conversely, the probability of receiving a mental health medication was 1.5 percentage points lower (95% CI - 0.023, - 0.007) for children living in a state with NP SoP expansion. Expanded SoP for psychologists is associated with improved access to pediatric mental health care in terms of both unmet need and receiving medication. Expanded SoP for NPs, however, was not associated with unmet need and lower receipt of medication.
Collapse
Affiliation(s)
- Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Lane, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA.
- Division of Research, UNC Health Sciences at MAHEC, Asheville, NC, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.
| | - Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Kristin H Gigli
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert E McGrath
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Lane, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
3
|
Marquez C, Thompson R, Feinstein JA, Orth LE. Identifying opportunities for pediatric medication therapy management in children with medical complexity. J Am Pharm Assoc (2003) 2022; 62:1587-1595.e3. [PMID: 35527209 PMCID: PMC9464681 DOI: 10.1016/j.japh.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/07/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite potential benefits of medication therapy management (MTM) for complex pediatric patients, implementation of pediatric MTM services is rare. OBJECTIVES To describe how a standardized pediatric MTM model identifies potential interventions and their impact on medication regimen complexity index (MRCI) scores in children with medical complexity (CMC) and polypharmacy. METHODS This retrospective proof-of-concept study included pediatric patients receiving primary care in a large outpatient primary care medical home for CMC within a tertiary freestanding children's hospital from August 2020 to July 2021. Medication profiles of established patients aged 0-18 years with at least 5 active medications at the time of the index visit were assessed for medication-related concerns, potential interventions, and potential impact of proposed interventions on MRCI scores. RESULTS Among 100 patients, an average of 3.4 ± 2.6 medication-related concerns was identified using the pediatric MTM model. Common medication-related concerns (>25% of patients) included inappropriate or unnecessary therapy, suboptimal therapy, undertreated symptom, adverse effect, clinically impactful drug-drug interaction, or duplication of therapy. A total of 97% had opportunities for 5.0 ± 2.9 potential interventions. Most common proposed interventions included drug discontinuation trial (69%), patient or caregiver education (55%), dosage form modification (51%), dose modification (49%), and frequency modification (46%). The mean baseline MRCI score was 32.6 (95% CI 29.3-35.8) among all patients. MRCI scores decreased by a mean of 4.9 (95% CI 3.8-5.9) after application of the theoretical interventions (P < 0.001). Mean potential score reduction was not significantly affected by patient age or number of complex chronic conditions. Potential impact of the proposed interventions on MRCI score was significantly greater in patients with higher baseline medication counts (P < 0.001). CONCLUSION Most CMC would likely benefit from a pharmacist-guided pediatric MTM service. A standardized review of active medication regimens identified multiple medication-related concerns and potential interventions for nearly all patients. Proposed medication interventions would significantly reduce medication regimen complexity as measured by MRCI. Further prospective evaluation of a pharmacist-guided pediatric MTM service is warranted.
Collapse
|
4
|
McLaren JL, Barnett ER, Acquilano SC, Concepcion Zayas MT, Drake RE, Leyenaar JK. Psychotropic Polypharmacy and Antipsychotics in Children: A Survey of Caregiver's Perspectives. Community Ment Health J 2022; 58:512-516. [PMID: 34057662 DOI: 10.1007/s10597-021-00845-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We examined caregiver's knowledge, attitudes, and concerns about their child's psychotropic medication regimen and the potential side effects, describe how they seek information regarding treatment, and ascertain their perspectives toward deprescribing. METHODS We surveyed 48 caregivers of children 6-17 years old treated with two or more psychotropic medications or an antipsychotic medication, analyzing outcomes using descriptive statistics. RESULTS Almost all (N = 44, 92%) participants reported feeling very knowledgeable about why medications were prescribed, but only one-third (N = 16, 33%) reported feeling very knowledgeable about potential problems with long-term use or polypharmacy. Half of respondents (N = 24, 50%) reported asking their provider about reducing/stopping medications due to concerns about harmful effects, and nearly half (N = 20, 42%) reported stopping medications earlier than recommended. CONCLUSIONS Interventions to engage caregivers in shared decision-making about complex medication regimens and to support prescribers to safely deprescribe psychotropic medications are needed to address caregivers' concerns regarding psychotropic medication use.
Collapse
Affiliation(s)
- Jennifer L McLaren
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA. .,Vulnerable Children Research Group, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
| | - Erin R Barnett
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA.,Vulnerable Children Research Group, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Trauma Interventions Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Stephanie C Acquilano
- Vulnerable Children Research Group, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Milangel T Concepcion Zayas
- Vulnerable Children Research Group, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Robert E Drake
- Westat, Inc., 85 Mechanic Street, Suite C3-1, Lebanon, NH, USA
| | - JoAnna K Leyenaar
- Vulnerable Children Research Group, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
5
|
Keeshin BR, Monson E. Assessing and Responding to the Trauma of Child Maltreatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:176-183. [PMID: 37153127 PMCID: PMC10153498 DOI: 10.1176/appi.focus.20210033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Child maltreatment is a significant risk factor for severe psychiatric outcomes in childhood and contributes to problematic symptoms that direct parents, teachers, or other invested parties to seek psychiatric intervention. With ongoing workforce shortages, much of the pediatric psychiatric care to this population is delivered by generalists. Child maltreatment and trauma can critically alter a child's development trajectory, affecting potential success in school and other important life pursuits. In addition, child maltreatment and resultant traumatic stress can dramatically disrupt child and adolescent development of healthy emotional regulation, distress tolerance, and the ability to form effective interpersonal relationships. Such disruption can lead to presentations within children and adolescents that mimic other symptoms of psychopathology but that typically respond poorly to traditional psychopharmacology. Ineffective treatment trials can lead to increased risk of polypharmacy and inaccurate expectations for treatment benefits. Such treatment efforts may impede addressing important environmental contributors and delay indicated therapeutic strategies. This article seeks to review child maltreatment-including core features and prevalence, overlap of child maltreatment with adverse childhood experiences, developmental impacts of exposure and resultant traumatic stress, guidance for appropriate assessment, and evidence-based interventions-and provide basic deprescribing guidelines to reduce polypharmacy burden.
Collapse
Affiliation(s)
- Brooks R Keeshin
- Department of Pediatrics (Keeshin) and Department of Psychiatry (Monson), Huntsman Mental Health Institute, University of Utah, Salt Lake City
| | - Eric Monson
- Department of Pediatrics (Keeshin) and Department of Psychiatry (Monson), Huntsman Mental Health Institute, University of Utah, Salt Lake City
| |
Collapse
|
6
|
Preliminary findings on the effects of medication advocacy and daily behavior ratings on prescriber behavior. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
7
|
Batstra L, van Roy AM, Thoutenhoofd ED. Teachers With Special Needs. De-Psychiatrization of Children in Schools. FRONTIERS IN SOCIOLOGY 2021; 6:781057. [PMID: 35224087 PMCID: PMC8867226 DOI: 10.3389/fsoc.2021.781057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
Psychiatrization not only affects adults. Ever more children in Western countries are being diagnosed with a mental disorder of behavior, such as ADHD. Children may often be labelled with the best intentions, for example in order to be able to provide them with suitable care and guidance. However, this labelling can have exclusionary effects and often entails the consequence that important discussion about contextual factors that give rise to (the perception of) unwelcome behavior or academic underperformance rarely, if at all, takes place. In this article we contend that although children are of central concern to schools and the design of pupils' education, it is important not to make pupils the sole owner of problems that arise. It is therefore high time that a far more critical normative stance towards inclusive education is taken, in which the presently widespread biomedical approach is met with a school community response that focuses not on the nature of individual disorders but on the special need for additional capacity that schools and teachers have in meeting (perceived) deviant behaviors and emotions and/or academic underperformance. We argue that teaching should not set out to remedy individual diagnoses, but that teachers should be supported to extend their professional competence to the benefit of all pupils.
Collapse
Affiliation(s)
- Laura Batstra
- Department of Child and Family Welfare, The University of Groningen, Groningen, Netherlands
| | - A.C. Marieke van Roy
- Department of Child and Family Welfare, The University of Groningen, Groningen, Netherlands
| | - Ernst D. Thoutenhoofd
- Department of Education and Special Education, The University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
8
|
Stutzman DL. Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing. Ment Health Clin 2021; 11:320-333. [PMID: 34824957 PMCID: PMC8582767 DOI: 10.9740/mhc.2021.11.320] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
It is estimated that 8% to 12% of youth are prescribed psychotropic medications. Those in foster care, juvenile justice systems, residential treatment facilities, and with developmental or intellectual disabilities are more likely to be prescribed high-risk regimens. The use of psychotropic medications in this age group is often off-label and can be associated with significant risk, warranting critical evaluation of their role. Landmark trials, pediatric-specific guidelines, and state-driven initiatives play critical roles in supporting evidence-based use of psychotropic medications in children. Overall, there is a lack of literature describing the long-term use of psychotropic medications in youth—particularly with regard to neurobiological, physical, and social changes that occur throughout development. Deprescribing is an important practice in child and adolescent psychiatry, given concerns for over-prescribing, inappropriate polytherapy, and the importance of reevaluating the role of psychotropic medications as children develop.
Collapse
|
9
|
Bužančić I, Kummer I, Držaić M, Ortner Hadžiabdić M. Community-based pharmacists' role in deprescribing: A systematic review. Br J Clin Pharmacol 2021; 88:452-463. [PMID: 34155673 DOI: 10.1111/bcp.14947] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/15/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Community-based pharmacists are an important stakeholder in providing continuing care for chronic multi-morbid patients, and their role is steadily expanding. The aim of this study is to examine the literature exploring community-based pharmacist-initiated and/or -led deprescribing and to evaluate the impact on the success of deprescribing and clinical outcomes. METHODS Library and clinical trials databases were searched from inception to March 2020. Studies were included if they explored deprescribing in adults, by community-based pharmacists and were available in English. Two reviewers extracted data independently using a pre-agreed data extraction template. Meta-analysis was not performed due to heterogeneity of study designs, types of intervention and outcomes. RESULTS A total of 24 studies were included in the review. Results were grouped based on intervention method into four categories: educational interventions; interventions involving medication review, consultation or therapy management; pre-defined pharmacist-led deprescribing interventions; and pharmacist-led collaborative interventions. All types of interventions resulted in greater discontinuation of medications in comparison to usual care. Educational interventions reported financial benefits as well. Medication review by community-based pharmacist can lead to successful deprescribing of high-risk medication, but do not affect the risk or rate of falls, rate of hospitalisations, mortality or quality of life. Pharmacist-led medication review, in patients with mental illness, resulting in deprescribing improves anticholinergic side effects, memory and quality of life. Pre-defined pharmacist-led deprescribing did not reduce healthcare resource consumptions but can contribute to financial savings. Short follow-up periods prevent evaluation of long-term sustainability of deprescribing interventions. CONCLUSION This systematic review suggests community-based pharmacists can lead deprescribing interventions and that they are valuable partners in deprescribing collaborations, providing necessary monitoring throughout tapering and post-follow-up to ensure the success of an intervention.
Collapse
Affiliation(s)
- Iva Bužančić
- City Pharmacies Zagreb, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ingrid Kummer
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - Margita Držaić
- City Pharmacies Zagreb, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | | |
Collapse
|
10
|
Edelsohn GA, Eren K, Parthasarathy M, Ryan ND, Herschell A. Inter-class Concomitant Pharmacotherapy in Medicaid-Insured Youth Receiving Psychiatric Residential Treatment. Front Psychiatry 2021; 12:658283. [PMID: 34093273 PMCID: PMC8173180 DOI: 10.3389/fpsyt.2021.658283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Concomitant pharmacotherapy has become increasingly common in the treatment of youth, including in psychiatric residential treatment facilities (PRTF) despite limited efficacy and safety data. Research is reported on the prevalence of any class and interclass concomitant pharmacotherapy, specific class combinations of psychotropics, and changes in number of medications from admission to discharge for Medicaid insured youth treated in PRTFs in one mid-Atlantic state. Methods: Medicaid administrative claims data were examined for youth under age 18 years who were discharged from one of 21 PRTFs during calendar year 2019. Descriptive statistics were calculated to examine patterns of service utilization 90 days prior to admission. The rates of concomitant psychotropic use at admission were compared to the rates at discharge. Logistic regression models were used to examine covariates associated with discharging on 4 or more medications. Results: Fifty-four % of youth were admitted on either two or three psychotropics, while 25% were admitted on four or more psychotropics. The proportion of youth admitting and discharging on 2 or 3 medications was stable. There was a 27% increase in number of youth discharging on 4 medications with a 24% decrease in those on a 5- drug regimen. Only the number of medications prescribed at admission was found to be significant (p < 0.001), with more medications at admission contributing to probability of discharging on 4 or more medications. Conclusions: Concomitant pharmacotherapy is common in PRTFs. These findings support the practice of deprescribing and underscore the need for further research.
Collapse
Affiliation(s)
- Gail A Edelsohn
- Community Care Behavioral Health Organization, University of Pittsburgh Medical Center (UPMC) Insurance Services Division, Pittsburgh, PA, United States
| | - Kemal Eren
- Community Care Behavioral Health Organization, University of Pittsburgh Medical Center (UPMC) Insurance Services Division, Pittsburgh, PA, United States
| | - Meghna Parthasarathy
- Community Care Behavioral Health Organization, University of Pittsburgh Medical Center (UPMC) Insurance Services Division, Pittsburgh, PA, United States
| | - Neal D Ryan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amy Herschell
- Community Care Behavioral Health Organization, University of Pittsburgh Medical Center (UPMC) Insurance Services Division, Pittsburgh, PA, United States
| |
Collapse
|
11
|
Zito JM, Zhu Y, Safer DJ. Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary. Front Psychiatry 2021; 12:644741. [PMID: 34194346 PMCID: PMC8236612 DOI: 10.3389/fpsyt.2021.644741] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Psychotropic concomitant medication use for the treatment of youth with emotional and behavioral disorders has grown significantly in the U.S. over the past 25 years. The use of pharmacy claims to analyze these trends requires the following: age of the selected population, overlapping days of use, and precision of the outcome itself. This review will also address the gaps in reporting of pediatric psychotropic polypharmacy. Methods: An electronic literature search was undertaken for the period 2000 through 2020 using keywords such as "pediatric," "concomitant," "polypharmacy," "multiple medications," and "concurrent psychotropic"; Relevant references in textbooks were also used. Only English language and U.S. studies were included, resulting in 35 inter-class studies. Results: Studies were organized into seven groups according to data sources and clinical topics: (1) population surveys; (2a) multi-state publicly insured populations; (2b) single/two state studies; (3) privately insured populations; (4) diagnosed populations; (5) foster care populations; (6) special settings. Across 20 years it is apparent that pediatric psychotropic polypharmacy affects substantially more children and adolescents today than had been the case. As many as 300,000 youth now receive 3 or more classes concomitantly. The duration of concomitant use is relatively long, e.g., 69-89% of annual medicated days. Finally, more adverse event reports were associated with 3-class compared with 2-class drug regimens. Discussion: Factors that contribute to the growth of pediatric psychotropic polypharmacy include: (1) predominance of the biological model in psychiatric practice; (2) invalid assumptions on efficacy of combinations, (3) limited professional awareness of metabolic and neurological adverse drug events, and (4) infrequent use of appropriate deprescribing. Conclusion: A review of publications documenting U.S. pediatric psychotropic polypharmacy written over the last 20 years supports the need to standardize the methodologies used. The design of population-based studies should maximize information on the number of youth receiving regimens of 3-, 4-, and 5 or more concomitant classes and the duration of such use. Next, far more post-marketing research is needed to address the effectiveness, safety and tolerability of complex drug regimens prescribed for youngsters.
Collapse
Affiliation(s)
- Julie M Zito
- Department of Pharmaceutical Health Services Research, School of Pharmacy, Baltimore, MD, United States.,Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Yue Zhu
- Department of Pharmaceutical Health Services Research, School of Pharmacy, Baltimore, MD, United States.,Department of Epidemiology, School of Public Health, George Washington University, Washington, DC, United States
| | - Daniel J Safer
- Department of Psychiatry, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| |
Collapse
|