Evidence map›Paper›PMID 39472075›Full record

Trial reportJournal of child psychology and psychiatry, and allied disciplines2025

Safer and targeted use of antipsychotics in youth: an embedded, pragmatic randomized trial.

Robert B Penfold, Abisola E Idu, R Yates Coley, Kara L Cushing-Haugen, Deborah King, Ashley Glass, Rebecca C Phillips, Anne D Renz, Chester J Pabiniak, Vina F Graham and 22 more

Abstract readPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of child psychology and psychiatry, and allied disciplines, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Robert B PenfoldKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.ORCID 0000-0003-4795-7902
Abisola E IduKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
R Yates ColeyKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Kara L Cushing-HaugenKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Deborah KingKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Ashley GlassKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Rebecca C PhillipsKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Anne D RenzKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Chester J PabiniakKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Vina F GrahamKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Ella E ThompsonKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
James D RalstonKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Gregory E SimonKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Erin S GonzalezSeattle Children's Hospital, Seattle, WA, USA.
Kathleen M MyersSeattle Children's Hospital, Seattle, WA, USA.
Arne BeckKaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
LeeAnn M QuintanaKaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
Arthur J RunkleKaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
Megan RogersKaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
Deirdre M FosterKaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
Gregory N ClarkeKaiser Permanente Center for Health Research, Portland, OR, USA.
Stefan MassiminoKaiser Permanente Center for Health Research, Portland, OR, USA.
Phillip M CrawfordKaiser Permanente Center for Health Research, Portland, OR, USA.
Julie A CaveseKaiser Permanente Center for Health Research, Portland, OR, USA.
Anthony R CordaroKaiser Permanente Center for Health Research, Portland, OR, USA.
Laura I ChavezThe Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Kelly J KelleherThe Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Nadine SchwartzThe Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Kristina R JinerThe Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Swan Bee LiuThe Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Sara CondracThe Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Robert J HiltSeattle Children's Hospital, Seattle, WA, USA.

Funding

NIDA NIH HHS HHSN271201600002CNIMH NIH HHS HHSN271201600002C
6 · The paper itself

Abstract

backgroundAntipsychotic medications (AP) are inappropriately prescribed to young people. The goal of this pragmatic trial was to test a four-component approach to improved targeting of antipsychotic prescribing to people aged ≥3 and <18 years.

methodsClinicians in four health systems were cluster randomized by the number of previous AP orders and service line - specialty mental health and all others. Intervention arm clinicians received a best practice alert and child psychiatrist consultation and feedback. Families received system navigation and expedited access to psychotherapy. Primary outcomes were total days' supply of AP medication and proportion of youth with any AP supply at 6 months. We estimated the log-odds of AP use at 6 months and the relative rate of AP over 6 months. The Safer and Targeted Use of Antipsychotics in Youth (SUAY) trial took place between 3/2018 and 12/2020.

resultsThe trial enrolled 733 patients. The odds ratio (OR) comparing use at 6 months was 0.75 (95% CI: 0.52, 1.09). The mean number of days using AP was 118.5 for intervention patients and 128.2 for control patients (relative risk [RR] = 0.92; 95% CI: 0.81-1.04). Exploratory heterogeneity of treatment effects (HTE) was not detected in groups defined by age, gender, provider specialty, and insurance type. HTE by race/ethnicity was present: among youth of color, mean days' supply was 103.2 for intervention arm and 131.2 for the control arm (RR 0.79, 95% CI: 0.67-0.93). Among secondary outcomes, only new psychotherapy referrals differed with 44.3% (n = 154) of intervention participants having a new order for psychotherapy compared to 33.5% (n = 129) in the control arm (OR 1.47: 95% CI: 1.01-2.14).

conclusionsThis intervention did not result in less AP use at 6 months or a reduction in the days' supply of AP medication, although psychotherapy orders increased. The intervention may be effective for some subgroups.

Indexed as

Antipsychotic AgentsPractice Patterns, Physicians'AdolescentChildChild, PreschoolFemaleHumansMaleAntipsychotic AgentsaccessibilityAntipsychoticconsultingguidelines

Identifiers

PMID39472075
PMCPMC11815570

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.