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Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients.
Ann Pharmacother. 2009 Dec; 43(12):1939-47.AP

Abstract

BACKGROUND

Adolescents with acute suicidal ideation and attempts are frequently treated with psychotropic medications in psychiatric hospitals. However, little is known about whether pharmacologic interventions used to stabilize suicidal adolescents within inpatient settings are effective in reducing early readmission.

OBJECTIVE

To examine whether psychotropic medication changes and polypharmacy are associated with 30-day readmission rates for suicidal adolescents.

METHODS

We conducted a retrospective cohort study of 318 Medicaid-enrolled adolescents admitted for suicidal behaviors to 3 major inpatient psychiatric hospitals in Maryland. Comprehensive data on patient demographics, clinical factors, service history, and inpatient treatment practices were collected from hospital medical records. Medications prescribed prior to admission and during the hospital stay were matched and compared with regard to drug, dosage, and frequency of administration to identify the different types of medication changes. Multivariate Cox proportional hazard analysis was used to examine the association of medication changes and polypharmacy with readmission.

RESULTS

At least one medication change was made in 78% of suicidal adolescent inpatients, typically the addition of an antidepressant, mood stabilizer, or antipsychotic. At discharge, nearly one quarter (23%) of youths were prescribed 3 or more medications from different drug classes. Controlling for demographic and clinical factors, the addition of an antidepressant was associated with an 85% lower risk of readmission (HR 0.15; 95% CI 0.03 to 0.68). However, the use of 3 or more medications from different drug classes was associated with a 2.6 times higher risk of readmission (95% CI 1.03 to 6.52).

CONCLUSIONS

In this sample of suicidal adolescents, antidepressant treatment was associated with a lower risk of readmission and polypharmacy was associated with a higher risk of readmission. Study findings highlight the need for quality improvement efforts that optimize pharmacologic treatment and physician decision making.

Authors+Show Affiliations

College of Social Work, The Ohio State University, Columbus, OH 43210, USA. fontanella.4@osu.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19934394

Citation

Fontanella, Cynthia A., et al. "Psychotropic Medication Changes, Polypharmacy, and the Risk of Early Readmission in Suicidal Adolescent Inpatients." The Annals of Pharmacotherapy, vol. 43, no. 12, 2009, pp. 1939-47.
Fontanella CA, Bridge JA, Campo JV. Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients. Ann Pharmacother. 2009;43(12):1939-47.
Fontanella, C. A., Bridge, J. A., & Campo, J. V. (2009). Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients. The Annals of Pharmacotherapy, 43(12), 1939-47. https://doi.org/10.1345/aph.1M326
Fontanella CA, Bridge JA, Campo JV. Psychotropic Medication Changes, Polypharmacy, and the Risk of Early Readmission in Suicidal Adolescent Inpatients. Ann Pharmacother. 2009;43(12):1939-47. PubMed PMID: 19934394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients. AU - Fontanella,Cynthia A, AU - Bridge,Jeffrey A, AU - Campo,John V, Y1 - 2009/11/24/ PY - 2009/11/26/entrez PY - 2009/11/26/pubmed PY - 2010/2/4/medline SP - 1939 EP - 47 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 43 IS - 12 N2 - BACKGROUND: Adolescents with acute suicidal ideation and attempts are frequently treated with psychotropic medications in psychiatric hospitals. However, little is known about whether pharmacologic interventions used to stabilize suicidal adolescents within inpatient settings are effective in reducing early readmission. OBJECTIVE: To examine whether psychotropic medication changes and polypharmacy are associated with 30-day readmission rates for suicidal adolescents. METHODS: We conducted a retrospective cohort study of 318 Medicaid-enrolled adolescents admitted for suicidal behaviors to 3 major inpatient psychiatric hospitals in Maryland. Comprehensive data on patient demographics, clinical factors, service history, and inpatient treatment practices were collected from hospital medical records. Medications prescribed prior to admission and during the hospital stay were matched and compared with regard to drug, dosage, and frequency of administration to identify the different types of medication changes. Multivariate Cox proportional hazard analysis was used to examine the association of medication changes and polypharmacy with readmission. RESULTS: At least one medication change was made in 78% of suicidal adolescent inpatients, typically the addition of an antidepressant, mood stabilizer, or antipsychotic. At discharge, nearly one quarter (23%) of youths were prescribed 3 or more medications from different drug classes. Controlling for demographic and clinical factors, the addition of an antidepressant was associated with an 85% lower risk of readmission (HR 0.15; 95% CI 0.03 to 0.68). However, the use of 3 or more medications from different drug classes was associated with a 2.6 times higher risk of readmission (95% CI 1.03 to 6.52). CONCLUSIONS: In this sample of suicidal adolescents, antidepressant treatment was associated with a lower risk of readmission and polypharmacy was associated with a higher risk of readmission. Study findings highlight the need for quality improvement efforts that optimize pharmacologic treatment and physician decision making. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/19934394/Psychotropic_medication_changes_polypharmacy_and_the_risk_of_early_readmission_in_suicidal_adolescent_inpatients_ DB - PRIME DP - Unbound Medicine ER -