Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study

Frontiers in Pediatrics

article

Talia R. Lester¹  Yair Bannett¹  Rebecca M. Gardner²  Heidi M. Feldman¹  Lynne C. Huffman¹ 

[1] Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine;Quantitative Science Unit, Department of Medicine, Stanford School of Medicine

关键词: pediatric mental health;    pediatric anxiety;    pediatric depression;    primary care pediatrics;    electronic health records;    health services research;    developmental and behavioral pediatrics;   

DOI  :  10.3389/fped.2022.794722

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Objectives To describe medication management of children diagnosed with anxiety and/or depression by primary care providers within a primary care network. Study Design/Methods We performed a retrospective cross-sectional analysis of electronic health record (EHR) structured data from all children seen at least twice in a 4-year observation period within a network of primary care clinics in Northern California. For children who had visit diagnoses of anxiety, depression, anxiety+depression or symptoms characteristic of these conditions, we analyzed the rates and types of medications prescribed. A logistic regression model considered patient variables for the combined sample. Results Of all patients 6–18 years old ( N = 59,484), 4.4% ( n = 2,635) had a diagnosis of anxiety only, 2.4% ( n = 1,433) depression only, and 1.2% ( n = 737) both anxiety and depression (anxiety + depression); 18% of children with anxiety and/or depression had comorbid ADHD. A total of 15.0% with anxiety only ( n = 357), 20.5% with depression only ( n = 285), and 47.4% with anxiety+depression (n=343) were prescribed a psychoactive non-stimulant medication. For anxiety and depression only, the top three medications prescribed were sertraline, fluoxetine, and citalopram. For anxiety + depression, the top three medications prescribed were citalopram, sertraline, and escitalopram. Frequently prescribed medications also included benzodiazepines. Logistic regression modeling showed that the depression only and anxety + depression categories had increased likelihood of medication prescription. Older age and mental health comorbidities were independently associated with increased likelihood of medication prescription. Conclusions In this network, ~8% of children carried a diagnosis of anxiety and/or depression. Medication choices generally aligned with current recommendations with the exception of use of benzodiazepines.

【 授权许可】

CC BY