Concerned by a sharp rise in the use of powerful psychiatric drugs for adolescents, Minnesota will start requiring doctors in many cases to begin using a state-funded consulting service before prescribing such medications for children.
The state Department of Human Services on Monday awarded a two-year contract to Mayo Clinic to run the service, which will advise pediatricians and family doctors on whether antipsychotic and stimulant medications are appropriate for their young patients.
The system was created to address an alarming increase in psychotropic drug prescriptions among Minnesota's foster children and disabled and poor children in the state's Medicaid fee-for-service program.
A Star Tribune report last summer found that the program's spending on antipsychotics for children surged from $402,000 in 2000 to $6.8 million in 2006 -- and matched a questionable increase in the diagnosis of bipolar disorder as a childhood disease.
Research has found that many such prescriptions are inappropriate -- often given by desperate primary care doctors who lack specialized training and don't know what else to do for agitated children.
"We know there is overprescribing. We know there are some harmful drug combinations," said Dr. Peter Jensen, a Mayo psychiatrist. "How do we help identify those kids and come up with better procedures and practices? We know that some of our attempts to help children are backfiring on us, and that's the problem."
Program begins in August
Mayo is collaborating with regional medical providers such as Sanford Health, Essentia Health and PrairieCare to create a network of psychiatrists capable of providing advice. Roughly $1.7 million in state and federal funding will cover the two-year program, which will start in August. State officials believe the cost will be offset by reduced hospitalizations of children whose psychotropic prescriptions either don't help or make them worse.
Doctors who prescribe against the advice of consulting psychiatrists won't get paid by the state for doing so.
In a letter to the Minnesota Medical Association, state Human Services Commissioner Lucinda Jesson encouraged doctors to use the service even for patients with private insurance. The state is encouraging insurers to pay for the service as well.
Jesson said she was particularly troubled by the fact that children in foster care are five times more likely to receive psychotropic medications than other children.
"While it is certainly the case that children known to the child welfare system are more likely to be diagnosed with mental health disorders than either the general population or other children receiving Medicaid, the magnitude of the medication disparity is alarming."
Doctors calling the service will receive guidance about prescriptions, along with recommendations for treatment options.
Jensen said the threat of withholding payment is controversial and unique compared to voluntary consulting services in other states.
The goal is for doctors to call before crises emerge, he said. "We're trying to intervene with children who are not necessarily in the ER now, but for whom things are really getting worse and worse."
Jeremy Olson • 612-673-7744