1. Background Objectives Results Methods Within State Geographic Variation in Antipsychotic Medication Treatment for Medicaid-insured Children and Adolescents in a U.S. Pacific State Dinci Pennap, MPH, 1 Mehmet Burcu MS 1, Julie M. Zito PhD, 1,2 Since the late 1990s, the use of atypical antipsychotics for behavioral conditions in children and adolescents has been on the increase. Despite the widespread increase atypical antipsychotic medication use in this vulnerable population, little is known about regional variation and its relationship to quality and best practices across the U.S. Conflict of Interest None Conflict of Interest None 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD; 2 Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD Study Design & Population A cross-sectional study design was applied to state Medicaid Analytic Extract (MAX) files for 2009 (Personal Summary File, Prescription Drug File, and Other Therapy File) Continuously enrolled beneficiaries were characterized based on total AATP use, and stratified by age categories (2-9, 10 -12, 13 – 15, 16 – 18), race (White, Hispanic, African American and others), region of child’s residence (Region I - VI) and eligibility group (Foster care, Disabled or Income eligible (TANF & CHIP)). Outcomes of Interest Percent prevalence of AATP use stratified by patient characteristics and eligibility groups in 2009 Statistical Analyses Bivariate analysis and multivariable logistic regression models. Unadjusted and adjusted odds ratios of AATP use were generated for each region compared with region I. This cross-sectional study does not follow beneficiaries over time. Medication data are dispensed medications. Actual medication use was not ascertained Major findings Conclusions Intrastate region of residence is a significant factor in accounting for the variation in antipsychotic treatment of Medicaid-insured youth in this Pacific state. Minority youth were prominently less likely to receive AATP dispensings across all six regions. Across the 6 regions of the state, variations in the annual utilization of AATP were pronounced, ranging from 1.1% to 3.1% across regions Among 2 to 9 year olds, AATP percent prevalence ranged from 0.4% to 1.8% while regional racial/ethnic variations in AATP use were substantial regardless of race/ethnicity group. The odds of African American use was 10%-40% lower regionally compared with the reference group (White youth). Among Hispanic youth, the odds were substantially lower (50%-80%) than the reference youth. Compared to region 1, each of the remaining 5 regions had greater odds of receiving AATPs. After adjusting for age group, gender, race/ethnicity and Medicaid eligibility status, the remaining 5 regions had significantly greater odds of receiving AATP, i.e., from 22% to 84% increased AATP dispensings This is an FDA funded project under the Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI) Minority Health Award 2012/2013 For more information Dr. Julie Zito - jzito@rx.umaryland.edujzito@rx.umaryland.edu Limitations Funding Source References To characterize atypical antipsychotic (AATP) medication use in a U.S Pacific State, measured as percentage prevalence of use (having one or more dispensings for an AATP) among 2 – 18 year old Medicaid beneficiaries continuously enrolled in 2009 To assess the impact of region of residence on the use of atypical antipsychotics (AATP) among continuously enrolled youth in a U.S. Pacific state Medicaid program Figure. Percent AATP Use in 2009 By Region Table. Unadjusted and adjusted* odds ratios (OR) and 95% confidence intervals of receiving any AATP in 2009 Burcu, M., Zito, J. M., Ibe, A., & Safer, D. J. (2014). Atypical antipsychotic use among Medicaid-insured children and adolescents: Duration, safety, and monitoring implications. Journal of Child and Adolescent Psychopharmacology, 24, 112-119. Lorberg B, Robb A, Pavuluri M, Chen DT, Wilens T. (2014). Pediatric Psychopharmacology: Food and Drug Administration Approval Through the Evidence Lens. J Am Acad Child Adolesc Psychiatry, 53, 716-719 Olfson, M., Blanco, C., Liu, L., Moreno, C., & Laje, G. (2006). National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Archives of General Psychiatry, 63, 679-685.