BackgroundAntipsychotic medications (AP) are inappropriately prescribed to young people. The goal of this pragmatic trial was to test a four‐component approach to improved targeting of antipsychotic prescribing to people aged ≥3 and <18 years.MethodsClinicians in four health systems were cluster randomized by the number of previous AP orders and service line – specialty mental health and all others. Intervention arm clinicians received a best practice alert and child psychiatrist consultation and feedback. Families received system navigation and expedited access to psychotherapy. Primary outcomes were total days' supply of AP medication and proportion of youth with any AP supply at 6 months. We estimated the log‐odds of AP use at 6 months and the relative rate of AP over 6 months. The Safer and Targeted Use of Antipsychotics in Youth (SUAY) trial took place between 3/2018 and 12/2020.ResultsThe trial enrolled 733 patients. The odds ratio (OR) comparing use at 6 months was 0.75 (95% CI: 0.52, 1.09). The mean number of days using AP was 118.5 for intervention patients and 128.2 for control patients (relative risk [RR] = 0.92; 95% CI: 0.81–1.04). Exploratory heterogeneity of treatment effects (HTE) was not detected in groups defined by age, gender, provider specialty, and insurance type. HTE by race/ethnicity was present: among youth of color, mean days' supply was 103.2 for intervention arm and 131.2 for the control arm (RR 0.79, 95% CI: 0.67–0.93). Among secondary outcomes, only new psychotherapy referrals differed with 44.3% (n = 154) of intervention participants having a new order for psychotherapy compared to 33.5% (n = 129) in the control arm (OR 1.47: 95% CI: 1.01–2.14).ConclusionsThis intervention did not result in less AP use at 6 months or a reduction in the days' supply of AP medication, although psychotherapy orders increased. The intervention may be effective for some subgroups.

中文翻译：

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在青少年中更安全、有针对性地使用抗精神病药物：一项嵌入式、务实的随机试验


背景抗精神病药物 （AP） 不恰当地开给年轻人。这项实用试验的目标是测试一种四组分方法，以改善抗精神病药物处方对 ≥3 岁和 <18 岁人群的针对性。方法四个卫生系统的临床医生按先前 AP 订单和服务线的数量进行整群随机分配 - 专业心理健康和所有其他。干预组临床医生收到了最佳实践警报和儿童精神科医生咨询和反馈。家庭接受了系统导航并加快了心理治疗。主要结局是 AP 药物的总供应天数和 6 个月时有任何 AP 供应的青年比例。我们估计了 6 个月时 AP 使用的对数几率和 6 个月内 AP 的相对发生率。青少年更安全和有针对性地使用抗精神病药物 （SUAY） 试验于 2018 年 3 月至 2020 年 12 月进行。比较 6 个月使用量的比值比 （OR） 为 0.75 （95% CI： 0.52， 1.09）。干预患者使用 AP 的平均天数为 118.5 天，对照组患者为 128.2 天（相对风险 [RR] = 0.92;95% CI：0.81-1.04）。在按年龄、性别、提供者专业和保险类型定义的组中未检测到治疗效果的探索性异质性 （HTE）。存在按种族/民族划分的 HTE：在有色人种青年中，干预组的平均供应天数为 103.2 天，对照组为 131.2 天（RR 0.79,95% CI：0.67-0.93）。在次要结局中，只有新的心理治疗转诊不同，44.3% （n = 154） 的干预参与者有新的心理治疗顺序，而对照组为 33.5% （n = 129） （OR 1.47： 95% CI： 1.01-2.14）。结论尽管心理治疗订单增加，但这种干预并未导致 6 个月时 AP 使用减少或 AP 药物供应天数减少。干预可能对某些亚组有效。