The cornerstone of the program is the Florida Best Practice Psychotherapeutic Medication Guidelines for major mental health conditions affecting children, adolescents, and adults. The guidelines are updated on a rotating basis every other year. In fiscal year 2016-17, the Program updated the following guidelines:
In collaboration with AHCA, the program has implemented the Second Medical Review Program (formerly known as the Prior Authorization Program) for the prescribing of antipsychotics and antidepressants in children. Specifically, the SMR Program reviews applications for: 1) Children who are prescribed an antipsychotic medication under the age of 6 years old; 2) Children over the age of 6 who receive antipsychotic polypharmacy prescriptions or antipsychotic prescriptions above maximum dosing recommendations; and 3) Children under the age of 6 years who receive an antidepressant prescription. More recently, a Second Medical Review was introduced for children under the age of 6 who receive a stimulant medication prescription. The SMR Program was created out of concern for the prescribing of antipsychotics and/or antidepressants to very young children for whom very few randomized control trials exist to demonstrate safety and efficacy. Since the SMR Program began in the second quarter of 2008, over 8,500 requests have been received and reviewed by child psychiatrists at the University of South Florida, Department of Psychiatry and Neurosciences. The SMR Program is intended to reduce the number of young children receiving inappropriate antipsychotic, antidepressant, and stimulant treatment, and children and adolescents receiving high dose medications and/or polypharmacy.
An important responsibility of the program is to track the use of antipsychotic medications for children and adults whose prescriptions hit a series of quality indicators designed to flag practices that are not well supported by evidence, may produce marginal benefit and/or increase clinical risk and can be applied to analysis of claims. We have been tracking trends of antipsychotic prescribing for the last eight years. We generate several types of analyses to identify practices which warrant greater review and scrutiny. These analyses also help us design the types of intervention used to communicate with prescribers. As a result of our analyses we found that a small number of high volume adult and child clinicians provide the greatest potential for impact. In addition there are many primary care physicians writing small numbers of antipsychotic medications. Our quality initiatives have targeted both groups. We report that the use of antipsychotic polypharmacy in both children and adults has substantially reduced.
From the information obtained through the prior authorization process we have created a database/registry of children who began antipsychotic treatment before the age of six years. The goals of this initiative are to provide an opportunity to generate data on the long-term outcomes of antipsychotic medications, report actual medical practice, track a broad variety of outcomes, monitor trends over time to understand the long- term effects of antipsychotic use in young children, identify analytic opportunities and ultimately make the registry available to the research community. To date we have 4,929 children in the registry for which we have collected demographic information, medical and behavioral diagnoses, and psychotherapeutic drug information.
The Program hosts two hotlines for Florida Providers:
The Substance Abuse and Mental Health Services Administration (SAMSHA) defines an integrated approach to care as “the systematic coordination” of mental health, substance abuse, and primary care services. Integrated care bridges the gap that often occurs between the medical and behavioral health care systems, and produces the best health outcomes for individuals with serious mental illness.
Every two years, the Program produces a set of guidelines for clinicians who treat patients with SMI to take an integrated approach to monitoring: 1) The physical health of their patients who are at increased risk of developing chronic medical conditions such as cardiovascular disease and diabetes; and 2) The side effects that often arise from patients taking psychotherapeutic medication. These guidelines were most recently updated in February 2016 and are available here.
During the year, the program conducts various evaluation studies on priority areas for the Agency. In fiscal year 2015-16, the Program reviewed: