Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines.
BACKGROUND
Antipsychotic prescribing for youth has increased rapidly, is linked with serious health concerns, and lacks clear measures of quality for pediatric care. We reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics: 1) use in very young children, 2) multiple concurrent antipsychotics, 3) higher-than-recommended doses, 4) use without a primary indication, 5) access to psychosocial interventions, 6) metabolic screening, and 7) follow-up visits with a prescriber.


METHODS
We searched for clinical practice guidelines meeting the following criteria: developed or endorsed by a national body, published after 2000, and specific treatment recommendations made related to 1 or more of the 7 quality concepts. Sources included electronic databases, the American Academy of Child and Adolescent Psychiatry Web site, and stakeholder and expert advisory committee recommendations. Two raters reviewed the 11 guidelines identified, extracting treatment recommendations, including details that could support measure definitions, and ratings of strength of recommendation and evidence.


RESULTS
All 7 quality concepts were strongly endorsed by 1 or more guidelines, and 2 or more guidelines assigned their highest strength of recommendation ratings to 6 of the 7 concepts. Two guidelines rated evidence, providing high strength of evidence for 2 quality concepts: psychosocial interventions and metabolic monitoring.


CONCLUSIONS
Guidelines provide support for 7 quality concepts addressing antipsychotic prescribing for youth. However, guideline support is often based on strong clinical consensus rather than a robust evidence base.
['Kealey|Edith|E|', 'Scholle|Sarah Hudson|SH|', 'Byron|Sepheen C|SC|', 'Hoagwood|Kimberly|K|', 'Leckman-Westin|Emily|E|', 'Kelleher|Kelly|K|', 'Finnerty|Molly|M|']
D000293:Adolescent D014150:Antipsychotic Agents D002648:Child D002675:Child, Preschool D006801:Humans D007223:Infant D017410:Practice Guidelines as Topic D011618:Psychotic Disorders D011785:Quality Assurance, Health Care D014481:United States
children adolescents antipsychotic agents practice guidelines as topic quality indicators