include increased the risk of obesity in children, Type 2 diabetes, cardiovascular conditions, neurologic effects including tardive dyskinesia, and extrapyramidal symptoms, and cognitive impairment. 14. Mood stabilizer % or children 18 years of age or Numerator: Those members in the Polypharmacy is common in the Medicaid Claims & Encounter C polypharmacy younger who are on three (3) or denominator who were prescribed treatment of refractory bipolar Data (> 3 mood stabilizers) more concomitant mood three (3) or more medications disorder. There have been few stabilizing agents for ≥ 60 days concomitantly for 60 days or more controlled studies of the use of Pharmacy file (All diagnoses) combinations of mood stabilizers. Eligibility file Denominator: The number of children Combination therapy increases the (≤18 years) who were prescribed at risk for drug interactions and creates least one mood stabilizer for 60 days more side effect burden.. Common or longer during the measurement side effects of mood stabilizers in year pediatric populations include: weight gain, cognitive blunting, enuresis, GI See Appendix F for listing of distress, acne, sedation, and psychotropic medications lethargy. The interactions of combinations of mood stabilizers are complex and can be potentially dangerous, particularly because children have higher metabolism. Combination therapy may also decrease compliance. Treatment guidelines recommend caution in administration of multiple classes of anticonvulsants together because of the associated risks. 15. Stimulant polypharmacy % of enrollees 18 years of age Numerator: Those member in the Treatment of behavioral symptoms Medicaid Claims & Encounter C (> 2 stimulants) or younger who are on two (2) or denominator who were prescribed associated with ADHD, disruptive Data more concomitant amphetamine two (2) or more amphetamine and disorders, and autism is a major Pharmacy file (All diagnoses) and methylphenidate-based methylphenidate-based stimulants driver of polypharmacy in children Eligibility file stimulants for ≥ 60 days during concurrently for 60 days or more and adolescents. Research
include increased the risk of obesity in children, Type 2 diabetes, cardiovascular conditions, neurologic effects including tardive dyskinesia, and extrapyramidal symptoms, and cognitive impairment. 14. Mood stabilizer polypharmacy (> 3 mood stabilizers) (All diagnoses) % or children 18 years of age or younger who are on three (3) or more concomitant mood stabilizing agents for ≥ 60 days Numerator: Those members in the denominator who were prescribed three (3) or more medications concomitantly for 60 days or more Denominator: The number of children (≤18 years) who were prescribed at least one mood stabilizer for 60 days or longer during the measurement year See Appendix F for listing of psychotropic medications Polypharmacy is common in the treatment of refractory bipolar disorder. There have been few controlled studies of the use of combinations of mood stabilizers. Combination therapy increases the risk for drug interactions and creates more side effect burden.. Common side effects of mood stabilizers in pediatric populations include: weight gain, cognitive blunting, enuresis, GI distress, acne, sedation, and lethargy. The interactions of combinations of mood stabilizers are complex and can be potentially dangerous, particularly because children have higher metabolism. Combination therapy may also decrease compliance. Treatment guidelines recommend caution in administration of multiple classes of anticonvulsants together because of the associated risks. Medicaid Claims & Encounter Data Pharmacy file Eligibility file C 15. Stimulant polypharmacy (> 2 stimulants) (All diagnoses) % of enrollees 18 years of age or younger who are on two (2) or more concomitant amphetamine and methylphenidate-based stimulants for ≥ 60 days during Numerator: Those member in the denominator who were prescribed two (2) or more amphetamine and methylphenidate-based stimulants concurrently for 60 days or more Treatment of behavioral symptoms associated with ADHD, disruptive disorders, and autism is a major driver of polypharmacy in children and adolescents. Research Medicaid Claims & Encounter Data Pharmacy file Eligibility file C
QualityMeasures.docx