Lessons Learned from Psychotropic Medication Monitoring for Texas Foster Children

1. Lessons Learned from Psychotropic Medication Monitoringfor Texas Foster Children A joint project of Texas Department of Family and Protective Services (DFPS) Texas Health and Human Services Commission (HHSC) Texas Department of State Health Services (DSHS) All opinions are the authors and do not represent an official position or policy

2. BACKGROUND • Concerns were raised about psychotropic prescriptions given to fostercare children around 2004. • In February 2005, DFPS, DSHS and HHSC released the Psychotropic Medication Utilization Parameters for Foster Children, which were updated in June 2007 and most recently in December 2010. The current version can be found at: http://www.dfps.state.tx.us/Child_Protection/Medical_Services/guide-psychotropic.asp • These Parameters use eight criteria to indicate a need for further review of the child’s medication regimen. Including such things as: • Multiple drugs in the same class • Five or more drugs • Lack of appropriate diagnoses • Dosage outside of recommendations • A system was needed to assess the degree to which these parameters were being met. I was involved in initially setting this system up and continue to work relatively closely with it. • We were very fortunate to have cross agency support and cooperation at all levels to get this project done.

3. RESOURCES YOU WILL NEED

4. IMPORTANT QUESTIONS

5. MAJOR DRUG DECISIONS

6. BASIC STEPS 1. Merge the Medicaid data files with their references. 2. Then more merges and roll ups: Roll up patients and flag services and diagnoses, Roll up scripts by chemical names by patients (calculate lengths of scripts), Roll the chemical names up by class by patients (calculate length and polypharmacy), Summarize patients with flags for drug class and chemical name and length of scripts. 3. Retain merged and labeled files to run further analyses and reports. CHALLENGES • Prescriptions and diagnoses are not connected with one another. • You have to pull the diagnostic information from the claims/encounters. • Diagnoses and Drugs have to be matched based on the person id. • Individual drug prescriptions have to be built up into larger groups to cover periods of time. • There will probably be a time lag in your data probably a minimum of 30 days and probably more like 90 days plus.

7. USEFUL REPORTS AND DATA

9. CLOSING THOUGHTS Our results indicate that both the parameters (~ 05-07) and managed care (~ 08-11) have had relatively large effects. • The parameters and provider outreach decreased a baseline (~ 02-04) of either multi-drug or class polypharmacy of slightly over 5% to well below 4%. • The parameters and provider outreach alone decreased either multi-drug or class polypharmacy from below 4% to slightly over 2%. • Overall both interventions have resulted in well over a 50% reduction in either type of polypharmacy. • We are hoping for further improvements with our participation in MEDNET and further refinements of our monitoring system. Setting up a monitoring system and looking at your data can help you stay on top of the drugs and diagnoses in your system of care and help improve quality of care for your patients.