Quality Indicators in PSYCKES

Transcription

1 Quality Indicators in PSYCKES Antipsychotic polypharmacy of two or more agents [2AP] Antipsychotic polypharmacy of three or more agents [3AP] Antidepressant polypharmacy of two or more agents in the same subclass [2AD] Antidepressant polypharmacy of three or more agents [3AD] adults (four or more) [4PP(A)] youth (three or more) [3PP(Y)] Polypharmacy summary Polypharmacy Indicators The percentage of consumers of all ages on two or more antipsychotics for longer than 90 days, among those on at least 1 antipsychotic for longer than 90 days The percentage of consumers of all ages on three or more antipsychotics for longer than 90 days, among those on at least 1 antipsychotic for longer than 90 days The percentage of consumers of all ages on two or more antidepressants in the same subclass for longer than 90 days, among those on at least 1 antidepressant for longer than 90 days The percentage of consumers of all ages on three or more antidepressants for longer than 90 days, among those on at least 1 antidepressant for longer than 90 days The percentage of consumers eighteen years and older on four or more psychotropics for longer than 90 days, among those on at least 1 psychotropic for longer than 90 days (in adults) The percentage of consumers younger than eighteen years old on three or more psychotropics for longer than 90 days, among those on at least 1 psychotropic for longer than 90 days polypharmacy indicators, among those on at least 1 psychotropic for longer than 90 days

2 Hypertension [HTN] Cardiovascular Disease [CVD] Hyperlipidemia [HL] Diabetes/Pre-diabetes [DM] Obesity [Obes] Cardiometabolic summary Cardiometabolic Indicators antipsychotic AND who have been diagnosed with hypertension in the previous five years antipsychotic AND who have been diagnosed with acute myocardial infarction, stroke, or any ischemic vascular disease, or who have undergone a coronary artery bypass graft or percutaneous transluminal coronary angioplasty during the previous in the previous five years antipsychotic AND who have been diagnosed with hyperlipidemia/hypercholesterolemia, or were prescribed medications to treat those conditions in the previous five years antipsychotic AND who have been diagnosed with diabetes or have had elevated blood glucose (pre-diabetes) or received medication for diabetes or pre-diabetes in the previous five years antipsychotic AND who have been diagnosed with obesity or received medication for obesity in the previous five years cardiometabolic indicators, among those on an antipsychotic AND who have one of the specified cardiometabolic conditions Antipsychotic medications with a moderate- to high-risk for cardiometabolic disorders for adults (ages 18 and older): chlorpromazine (Thorazine), thioridazine (Mellaril), olanzapine (Zyprexa), quetiapine (Seroquel) Antipsychotic medications with a moderate- to high-risk for cardiometabolic disorders for youth (under age 18): ALL antipsychotics with the exception of aripiprazole (Abilify) and ziprasidone (Geodon)

3 Dose Indicators Antipsychotics [DoseAP] The percentage of consumers on antipsychotics in the past 35 Antidepressants [DoseAD] The percentage of consumers on antidepressants in the past 35 Anxiolytic/Hypnotic [DoseANX] The percentage of consumers on anxiolytics/hypnotics in the past 35 Mood Stabilizer [DoseMS] The percentage of consumers on mood stabilizers in the past 35 ADHD Medications [DoseADHD] Dose summary The percentage of consumers on ADHD medications in the past 35 dose indicators, among those on at least 1 psychotropic in the past 35 days In adults, the recommended doses were determined using the PORT guidelines for antipsychotics and the PDR for other drug classes. In youth, the following decision tree was used: 1. When there is an FDA approval for use in a pediatric population, use the associated/extrapolated dose for children under 13 years and those 13 to 18 as the PDR suggests. When there are multiple indications in youth, use the dose for the psychiatric indication. 2. If there is no FDA indication for the pediatric population, use the guidelines proposed by the Texas report regarding the care of Foster Children. 3. In the absence of both the FDA indication and guidance from the Texas report, then used Appendix 1 of Pediatric Psychopharmacology: Principles and Practice (2003) Editors Andres Martin, Lawrence Scahill, Dennis S. Charney, and James F. Leckman Oxford University Press (TEXT; Revised edition expected in 2010 will be used to update the recommendations) 4. In the case that none of the above sources set forth any guidance, then the adult PDR Maximum will be used.

4 Very young children on psychotropics [<6yrs] Youth on higher than recommended dose of psychotropic [Dose(Y)] youth (three or more) [3PP(Y)] Youth summary Youth Indicators Very young children (5 years and younger) on a psychotropic, among all youth on a psychotropic in the past 35 days Youth on any psychotropic in the past 35 days with evidence of a dose higher than the recommended for that psychotropic The percentage of consumers younger than eighteen years old on three or more psychotropics for longer than 90 days, among those on at least 1 psychotropic for longer than 90 days youth indicators, among consumers under 18 on any psychotropic.

5 Quality Indicator Abbreviations Abbreviation 2AP 3AP 2AD 3AD 4PP(A) 3PP(Y) DM HL HTN CVD Obes DoseAP DoseAD DoseMS DoseANX DoseADHD 3PP(Y) <6yrs Dose(Y) Quality Indicator Antipsychotic Polypharmacy of 2 or More Agents Antipsychotic Polypharmacy of 3 or More Agents Antidepressant Polypharmacy of 2 or More Agency in the Same Subclass Antidepressant Polypharmacy of 3 or More Agents Psychtropic Polypharmacy of 4 or More Agents (Adults) Psychotropic Polypharmacy of 3 or More Agents (Youth) Diabetes/Pre-diabetes Hyperlipidemia Hypertension Cardiovascular Disease Obesity Higher than Recommended Dose: Antipsychotic Higher than Recommended Dose: Antidepressant Higher than Recommended Dose: Mood Stabilizer Higher than Recommended Dose: Anxiolytic Higher than Recommended Dose: ADHD Meds Psychotropic Polypharmacy of 3 or More Agents (Youth) Very Young Children on Psychotropics Youth on Higher than Recommended Doses of Psychotropics