OBJECTIVES: The rise in prescriptions for antipsychotic medications in children and adolescents has generated public and professional concern. Antipsychotic adverse effects may increase a child’s risk for developing serious metabolic health complications in adulthood. This clinical need for metabolic monitoring to ensure proper management of children and adolescents on antipsychotic medications is recommended by relevant medical associations. The Healthcare Effectiveness Data and Information Set (HEDIS) quality measure Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) has received considerable attention from Medicaid programs in recent years. The objective of this study was to evaluate adherence to metabolic monitoring for children and adolescents.

METHODS: A retrospective cohort study was conducted using Mississippi Medicaid claims data from 2017- 2018. Children and adolescents aged 1 to 17 years who were dispensed antipsychotic medications during the measurement year were included. Continuous eligibility for the 12-month measurement year and a six month look-back period was required.

RESULTS: A total of 7,397 individuals met the inclusion criteria. Among these, 1,704 (23%) had documentation of glucose monitoring, 813 (11%) had documentation of lipid monitoring and 741(10%) had documentation of both glucose and lipid monitoring within 12 months prior to receiving antipsychotic medication. Children ages 12-17 years were most likely to receive monitoring (27% for glucose, 12% for lipids, 11% for both). Younger children were significantly less likely to receive monitoring. Disparities also exist between Caucasians and African American for monitoring glucose (25% vs 21%) and lipids (12% vs. 10%).

CONCLUSIONS: Few clinicians currently perform metabolic monitoring for children and adolescents before prescribing antipsychotics. Provider education is needed to address this issue and to identify barriers. Mississippi Medicaid is currently initiating an educational intervention program to address this issue and evaluating the impact of academic detailing in addition to educational mailings on improving metabolic monitoring.