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Deprescribing psychotropic medications in children: results of a national qualitative study
  1. Erin R Barnett1,2,3,4,
  2. Alissa Z Trepman3,
  3. Hannah A Fuson3,5,
  4. Stephanie C Acquilano3,
  5. Jennifer L McLaren1,2,3,
  6. Steven Woloshin3,6,
  7. Joanna K Leyenaar2,3,7
  1. 1 Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
  2. 2 Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  3. 3 Vulnerable Children Research Group, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
  4. 4 Dartmouth Trauma Interventions Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
  5. 5 Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
  6. 6 Center for Medicine and Media at The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
  7. 7 Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, US
  1. Correspondence to Dr Erin R Barnett, Department of Psychiatry, Dartmouth College Geisel School of Medicine, Lebanon, NH 03755, USA; erin.r.barnett{at}dartmouth.edu

Abstract

Background and Objective Prescriptions for psychotropic medications to children have risen dramatically in recent years despite few regulatory approvals and growing concerns about side effects. Government policy and numerous programmes are attempting to curb this problem. However, the perspectives of practising clinicians have not been explored. To characterise the perspectives and experiences of paediatric primary care clinicians and mental health specialists regarding overprescribing and deprescribing psychotropic medications in children.

Methods We conducted 24 semistructured interviews with clinicians representing diverse geographic regions and practice settings in the USA. Interview questions focused on clinician perspectives surrounding overprescribing and experiences with deprescribing. We transcribed audio files verbatim and verified them for accuracy. We analysed transcripts using a grounded theory approach, identifying emergent themes and developing a conceptual model using axial coding.

Results Analysis yielded themes within four domains: social and clinical contextual factors contributing to overprescribing, opportunities for deprescribing, and facilitators and barriers to deprescribing in paediatric outpatient settings. Most participants recognised the problem of overprescribing, and they described complex clinical and social contextual factors, as well as internal and external pressures, that contribute to overprescribing. Opportunities for deprescribing included identification of high-risk medications, routine reassessment of medication needs and recognition of the broader social needs of vulnerable children. Facilitators and barriers to deprescribing were both internal (eg, providing psychoeducation to families) and external (eg, parent and child preferences) to clinicians.

Conclusion Our findings highlight a discrepancy between clinicians’ concerns about overprescribing and a lack of resources to support deprescribing in outpatient paediatric settings. To successfully initiate deprescribing, clinicians will need practical tools and organisational supports, as well as social resources for vulnerable families.

  • evidence-based medicine
  • mental health
  • paediatrics
  • qualitative research
  • health policy
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available by contacting the first author.

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