Safer Use of Antipsychotics in Youth
Condition: Child Behavior Disorders
MeSH terms: Mental Disorders; Child Behavior Disorders
Study type: Interventional

Summary: 
      This study tests the effectiveness of an intervention treatment algorithm vs. usual care
      control in a practical clinical trial. Control arm providers will receive a standard
      medication alert in the electronic medical record (EMR) when initiating an antipsychotic
      prescription for an eligible patient. Intervention arm prescribers will receive an
      interactive medication alert in the EMR when prescribing for eligible patients and the
      patient and provider will enter the treatment algorithm (provider - medication alert plus
      clinical review by a child psychiatrist; patient - offer of personalized behavioral health
      navigation plus bridging therapy when appropriate). The study aims to recruit 800 eligible
      patients in 4 health systems.
    

Detailed description: 
      SUAY is a practical clinical trial designed to test the effectiveness of an intervention
      aiming to improve the targeted and safer use of antipsychotic medications by guiding
      clinician-prescribing behavior of antipsychotics for children aged ≥ 3 and < 18 years and
      encouraging psychosocial therapy for eligible youth. The intervention includes a medication
      best practice alert in Epic, consultation with a child and adolescent psychiatrist, and extra
      support for patients and families to improve behavioral health service access. The trial will
      be conducted in 4 non-academic health systems. Each health system will randomize prescribers
      to one of two study arms, intervention and control. During patient encounters, entering an
      antipsychotic for a potentially eligible patient will cause either the control or
      intervention medication alert to fire in the electronic medical record. The control arm
      medication alert will point prescribing clinicians to relevant Choosing Wisely®
      recommendations. The intervention arm medication alert will inform prescribers that:

        1. Antipsychotics are not recommended 1st line treatment for non-psychotic disorders;

        2. A child and adolescent psychiatrist (CAP) will review antipsychotic usage by youth;

        3. Expedited access to bridging therapy, behavior health navigation, and/or a proactive
           consultation with a CAP may be ordered.

      The intervention medication alert will point prescribing clinicians to both Choosing Wisely®
      recommendations and to SUAY clinical prescribing guidelines. SUAY guidelines were developed
      by a national expert consensus panel in a prior phase of the study.

      Analytic data will be collected from automated data sources at the health systems. The
      primary outcomes are percent of children ordered an antipsychotic medication at 6 months of
      follow up, and total person-months of antipsychotic orders placed for participants during the
      study period.
    

Intervention name(s): Control - Provider Medication Alert Only; Intervention - Alert + CAP Review AND Enhanced BH Access
Intervention type(s): Other; Other
Intervention description(s): Simple text medication alert referencing Choosing Wisely guidelines.; Interactive medication alert referencing SUAY Clinical Guidelines and offering options to keep/remove orders for the antipsychotic, virtual CAP consult, BH navigation for the patient, and access to bridging therapy for the patient.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Providers are preassigned to one of two study arms: usual care control or intervention arm. Patients are assigned to the same arm as the provider triggering the best practice alert and study algorithm.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Other
Keywords: Youth; Mental Health; Psychotropic; Medication Safety; Quality Improvement