Antipsychotic prescriptions for children enrolled in Washington state’s Medicaid program decreased by nearly half following the implementation of an innovative psychiatric consultation program affiliated with Seattle Children’s, according to a study published in the March 2017 issue of the journal Health Services Research.

The 49% reduction in prescriptions from July 2006 to 2013 is a reversal from the steady statewide growth in the use of antipsychotics to treat children prior to the introduction of the Partnership Access Line (PAL). The number of children on Medicaid treated with antipsychotics in Washington decreased by 940 despite an increase of 186,855 enrollees in the joint Federal/state program during the study. According to the study, this counters a national trend of increased antipsychotic use with children from 2002 to 2015.

Other key findings in the study include:

• High–dose antipsychotic use fell by 57.8% in children 6 to 12 years old; and by 52.1% in teens
• 1,458 providers received a direct patient consult through PAL
• 759 providers attended at least one of PAL’s 31 general psychopharmacology education conferences

PAL, the first program of its kind in the state and only the second in the country, is a telephone–based child mental health consultation system that allows primary care providers (PCPs) to consult directly with child psychiatrists affiliated with Seattle Children’s and the University of Washington School of Medicine. PAL also consults with community psychiatric specialists through the delivery of Medicaid second opinion services.

“Given the limited access to mental and behavioral healthcare across the state, the PAL program arms community providers with the support they need to deliver the best care, and one aspect of that is partnering with them in clinical decisions, such as when to use medications like antipsychotics,” said Dr. Rebecca Barclay, a Seattle Children’s psychiatrist and lead author of the study. “This study shows that the reduction in antipsychotic use has come as a result of PAL interventions.”

Significant decreases in antipsychotic use followed the implementation of each stage of PAL’s three sub–programs: elective consults available to PCPs in 2008; mandatory medication reviews based on young age or high dosage in 2009; and mandatory medication reviews for those treated with an antipsychotic combined with other psychotropics in July 2012.

“We have known for quite some time that PAL is making a difference in promoting best practice evidence based care, helping both providers and patients overcome obstacles like access to care, cost and limited insurance coverage,” said Dr. Robert Hilt, who led the design of the program and is the director of PAL and Community Leadership at Seattle Children’s. “The hope is that studies like this facilitate growth and continued support of programs like PAL, which ultimately help children to receive the appropriate level of care.”