Racial/Ethnic Patterns Of Psychotropic Medication Use In Medicaid-Insured Youth

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Public Health and Policy


Doctor of Public Health

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In 2003, the Institute of Medicine reported that racial/ethnic disparities in mental and behavioral problems hinder the nation's effort to improve overall health, mostly because of the risk of poorer health status and lower levels of access to healthcare in non-whites compared with white Americans. Earlier studies have shown that African American and Hispanic youth are significantly less likely to be prescribed psychotropic medications than white youth with Medicaid insurance. Aim 1 of this study updates previous studies on racial/ethnic disparities for Medicaid-insured youth across a ten-year period (1997-2006); aim 2 linkes outpatient diagnosis to prescription drug records so as to inform psychotropic practice patterns in relation to clinician-reported diagnosis; aim 3 assesses combination psychotropic pharmacotherapy in terms of the extent of this practice and the types of drug combinations. The major study findings show that in 2006: 1) African American youth enrolled in a state Medicaid program were 57% less likely to be dispensed a psychotropic medication compared to Caucasian youth. Similarly, Hispanic youth were 60% less likely to be dispensed a psychotropic medication compared to Caucasian youth. 2) Substantially increased use occurred for ADHD drugs and antipsychotics across racial/ethnic groups but Caucasian/non-Caucasian disparities remained. 3) Across the decade clinician-reported diagnoses of pediatric bipolar disorder and autism increased 5-fold and 2.7-fold, respectively, but non-Caucasians showed relative decrements of 61%-65% and 39%-47%, respectively, regarding these diagnoses. 4) The likelihood of Medicaid youth enrollees receiving concomitant psychotropic medications increased 3-fold across the decade. 5) Racial/ethnic disparities in clinician-reported diagnosis and concomitant use were not as dramatic in treated-population data as in population-based psychotropic medication prevalence of use data. The study findings are relevant to the mission of state Medicaid programs with respect to developing interventions to reduce disparities in medications used to treat psychiatric and behavioral conditions in relation to access, outcome and satisfaction.