Risk factors of psychotropic polypharmacy in the treatment of children and adolescents with psychiatric disorders

Objective To examine patient and provider characteristics associated with the use of pediatric psychotropic polypharmacy. Methods A retrospective study was conducted on children with psychiatric disorder diagnosis and treatment using the 2013–2015 claims data from a Pediatric Medicaid Managed Care Plan. Psychotropic polypharmacy was defined as the receipt of ≥2 psychotropic medications from different drug classes concurrently for ≥60 days. Stratified logistic regression analyses based on the number of prescribers involved in the treatment, i.e. single prescriber (SP) and multiple prescribers (MP) were conducted to determine the risk factors associated with multiclass psychotropic polypharmacy. The Fairlie decomposition method was used to test the difference in receipt of psychotropic polypharmacy between patients with and without a psychiatrist visit. Results A total of 24,147 children and adolescents met the inclusion criteria. The prevalence of psychotropic polypharmacy was 20.09%. In addition to patients' demographics, diagnoses, number of comorbid psychiatric disorders (MP only), and the number of prescribers involved in the treatment (MP only), patients with a psychiatrist involved in the treatment had 5.3 times and 3.6 times higher odds of receiving psychotropic polypharmacy in SP and MP groups respectively (SP: OR = 5.32; 95% CI 4.62–6.14 & MP: OR = 3.57; 95% CI 3.20–3.99). Only a quarter of the prescribing practice variation between psychiatrists and PCPs was explained by the observed need factors. Conclusions Pediatric psychotropic polypharmacy may be necessary and justified as it is mainly prescribed by the best-trained providers.