Using Narratives to Align Antipsychotic Prescribing Practices for Youth with Evidence-based Guidelines
Statement of Problem
As we’ve shown through previous research, the growth in the number of publicly insured children in the United States who are using antipsychotics far exceeds that of privately insured youth. In fact, by 2007, 13% of all Medicaid-enrolled children in foster care, and one-quarter of all such youth receiving mental health services, were receiving antipsychotics. This is concerning as it reflects a growing practice of physicians prescribing these medications for off-label reasons, such as responding to disruptive behaviors among youth, and disproportionately to youth with child welfare system involvement. This misuse of psychotropic medications could have significant long-term impacts on a child’s health, which are unknown at this time. It’s for this reason that the off-label use of antipsychotics has raised alarms throughout the medical community.
Spurred from our research, the Pennsylvania Department of Human Services announced several new initiatives in 2016 to further reduce the use of psychotropic medications among Medicaid-enrolled youth in the state, including the release of new prescribing guidelines for physicians. While engaging clinicians is one important component to shifting towards more appropriate prescribing practices, the methods by which we can change prescribing behavior remain unknown.
This project seeks to develop and evaluate communications strategies intended to educate providers who care for Medicaid-enrolled youth on concerns about the misuse of antipsychotics and, ultimately, change their prescribing practices. We plan to conduct a statewide mixed-methods randomized control trial in Pennsylvania to test an innovative dissemination strategy using narratives. Narratives have long been recognized as a persuasive tool to promote health behavior change among patients, but their use for communicating and translating clinical evidence to providers is novel.
Developed from in-depth interviews and focus groups with a diverse set of clinicians, the narratives will take the form of short videos—shared through a newsletter and a website—by which clinicians will explain evidence-based prescribing guidelines for antipsychotic prescribing to their peers. We’ll compare the use of these narratives to written recommendations alone to see which method has the greatest impact on the adoption of evidence-based prescribing practices. We also wish to understand if the effectiveness of this narrative-based intervention differs across clinician specialties and if clinicians receive more than one narrative within a six-month time period.
We have strong partners in the development and execution of this project, including the Pennsylvania chapter of the American Academy of Pediatrics, Pennsylvania’s Office of Medical Assistance Programs, the Pennsylvania Psychiatric Society and the Pennsylvania Society of Family Medical Physicians.
It’s our hope and hypothesis that this narrative intervention will impact provider prescribing practices of antipsychotics to publicly insured youth. With the results, we plan to work with our Medicaid partners in the Commonwealth to refine or further develop this intervention.
The Children's Hospital of Philadelphia, PolicyLab. Using Narratives to Align Antipsychotic Prescribing Practices for Youth with Evidence-based Guidelines [online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here].