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Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning

INTRODUCTION: After the 2004 FDA box warning raised concerns about increased suicidal ideation among youth taking antidepressants, antidepressant use decreased for White youth but slightly increased for Black and Latino youth. Better understanding of patient and provider factors contributing to thes...

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Autores principales: Cook, Benjamin L., Wang, Ye, Sonik, Rajan, Busch, Susan, Carson, Nicholas, Progovac, Ana M., Zaslavsky, Alan M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341210/
https://www.ncbi.nlm.nih.gov/pubmed/30666633
http://dx.doi.org/10.1111/1475-6773.13104
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author Cook, Benjamin L.
Wang, Ye
Sonik, Rajan
Busch, Susan
Carson, Nicholas
Progovac, Ana M.
Zaslavsky, Alan M.
author_facet Cook, Benjamin L.
Wang, Ye
Sonik, Rajan
Busch, Susan
Carson, Nicholas
Progovac, Ana M.
Zaslavsky, Alan M.
author_sort Cook, Benjamin L.
collection PubMed
description INTRODUCTION: After the 2004 FDA box warning raised concerns about increased suicidal ideation among youth taking antidepressants, antidepressant use decreased for White youth but slightly increased for Black and Latino youth. Better understanding of patient and provider factors contributing to these differences is needed to improve future risk warning dissemination. METHODS: We analyzed antidepressant prescriptions for youth aged 5‐17 in 2002‐2006 Medicaid claims data from four states (CA, FL, NC, and NY). In multilevel models, we assessed provider‐ and patient‐level contributions to changes in antidepressant use by race/ethnicity and compared responses to the box warning between providers with large (>2/3) and small (<1/3) proportions of minority patients. RESULTS: A significant amount of variance in overall prescribing patterns (calculated by the ICC) was explained at the provider level. Significant provider‐level variation was also identified in the differential effect of the box warning by racial/ethnic group. In a test of the influence of provider panel mix, we found that providers with large proportions of minority patients reduced antidepressant prescribing more slowly after the box warning than other providers. DISCUSSION: This study is the first to assess provider‐ and patient‐level variation in the impact of a health care policy change on treatment disparities. Black and Latino youth Medicaid beneficiaries were seen by largely different providers than their White counterparts, and these distinct providers were influential in driving antidepressant prescription patterns following the box warning. Concerted outreach to providers of minority beneficiaries is needed to ensure that risk warnings and clinical innovations diffuse swiftly across racial/ethnic minority groups.
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spelling pubmed-63412102020-02-01 Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning Cook, Benjamin L. Wang, Ye Sonik, Rajan Busch, Susan Carson, Nicholas Progovac, Ana M. Zaslavsky, Alan M. Health Serv Res Health Equity INTRODUCTION: After the 2004 FDA box warning raised concerns about increased suicidal ideation among youth taking antidepressants, antidepressant use decreased for White youth but slightly increased for Black and Latino youth. Better understanding of patient and provider factors contributing to these differences is needed to improve future risk warning dissemination. METHODS: We analyzed antidepressant prescriptions for youth aged 5‐17 in 2002‐2006 Medicaid claims data from four states (CA, FL, NC, and NY). In multilevel models, we assessed provider‐ and patient‐level contributions to changes in antidepressant use by race/ethnicity and compared responses to the box warning between providers with large (>2/3) and small (<1/3) proportions of minority patients. RESULTS: A significant amount of variance in overall prescribing patterns (calculated by the ICC) was explained at the provider level. Significant provider‐level variation was also identified in the differential effect of the box warning by racial/ethnic group. In a test of the influence of provider panel mix, we found that providers with large proportions of minority patients reduced antidepressant prescribing more slowly after the box warning than other providers. DISCUSSION: This study is the first to assess provider‐ and patient‐level variation in the impact of a health care policy change on treatment disparities. Black and Latino youth Medicaid beneficiaries were seen by largely different providers than their White counterparts, and these distinct providers were influential in driving antidepressant prescription patterns following the box warning. Concerted outreach to providers of minority beneficiaries is needed to ensure that risk warnings and clinical innovations diffuse swiftly across racial/ethnic minority groups. John Wiley and Sons Inc. 2019-01-21 2019-02 /pmc/articles/PMC6341210/ /pubmed/30666633 http://dx.doi.org/10.1111/1475-6773.13104 Text en © 2019 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Health Equity
Cook, Benjamin L.
Wang, Ye
Sonik, Rajan
Busch, Susan
Carson, Nicholas
Progovac, Ana M.
Zaslavsky, Alan M.
Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning
title Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning
title_full Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning
title_fullStr Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning
title_full_unstemmed Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning
title_short Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning
title_sort assessing provider and racial/ethnic variation in response to the fda antidepressant box warning
topic Health Equity
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341210/
https://www.ncbi.nlm.nih.gov/pubmed/30666633
http://dx.doi.org/10.1111/1475-6773.13104
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