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Child Behavior DisordersSUAYNCT03448575

Safer Use of Antipsychotics in Youth

A study testing Intervention - Alert + CAP Review AND Enhanced BH Access in people with Child Behavior Disorders, run by Kaiser Permanente at 4 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study tests the effectiveness of an intervention treatment algorithm vs. usual care control in a practical clinical trial. Control arm providers will receive a standard medication alert in the electronic medical record (EMR) when initiating an antipsychotic prescription for an eligible patient. Read more about this study

Who is it for?
Ages 3 to 17 yearsHealthy volunteers can take part
Conditions the study is for
Child Behavior Disorders
What is being tested?
Intervention - Alert + CAP Review AND Enhanced BH Access
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
733 participants
Where
4 sitesUnited States
Study dates
29 Mar 2018to 24 Dec 2021
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 3 to 17 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Patient is ≥ 3 and < 18 years of age at the time of the encounter at which the study alert fired (index date);
  • Patient is initiating a new episode of outpatient treatment with an antipsychotic medication. (New episodes are defined by no record of an antipsychotic medication being ordered within the health system as part of an outpatient care plan in the prior 180 days);
  • Study service (BH navigation, bridging therapy, CAP consult) ordered in Epic for the patient; (e.g., provider removed antipsychotic order and still ordered study services);

Who cannot join

  • Patient has a diagnosed psychotic disorder, mania, autism spectrum disorder, or intellectual disability;
  • Patient was enrolled in the SUAY pilot study;
  • The antipsychotic entered is prochlorperazine (Comazol®);
  • An outpatient antipsychotic order is entered by a temporary provider in the health system (e.g., "doc of the day"). Orders placed by temporary providers do not count towards the 180 day medication free period for defining a new episode of care.
  • The antipsychotic order was placed within an urgent care, emergency department, or inpatient setting (to avoid intervening during a crisis). Orders placed in these settings do not count towards the 180 day medication free period for defining a new episode of care.
  • Primary language is not English

Trial locations and contacts

4 sites in 1 country.

United States4 sites
  • Kaiser Permanente Colorado Institute for Health Research

    Aurora, Colorado, 80014

  • Nationwide Children's Hospital / Partners for Kids

    Columbus, Ohio, 43205

  • Kaiser Permanente Center for Health Research - Northwest

    Portland, Oregon, 97227

  • Kaiser Permanente Washington Health Research Institute

    Seattle, Washington, 98115

Other trials in United States

About this study

Official title: A Targeted Approach To A Safer Use of Antipsychotics In Youth

This study tests the effectiveness of an intervention treatment algorithm vs. usual care control in a practical clinical trial. Control arm providers will receive a standard medication alert in the electronic medical record (EMR) when initiating an antipsychotic prescription for an eligible patient. Intervention arm prescribers will receive an interactive medication alert in the EMR when prescribing for eligible patients and the patient and provider will enter the treatment algorithm (provider - medication alert plus clinical review by a child psychiatrist; patient - offer of personalized behavioral health navigation plus bridging therapy when appropriate). The study aims to recruit 800 eligible patients in 4 health systems.

Read the detailed description

SUAY is a practical clinical trial designed to test the effectiveness of an intervention aiming to improve the targeted and safer use of antipsychotic medications by guiding clinician-prescribing behavior of antipsychotics for children aged ≥ 3 and < 18 years and encouraging psychosocial therapy for eligible youth. The intervention includes a medication best practice alert in Epic, consultation with a child and adolescent psychiatrist, and extra support for patients and families to improve behavioral health service access. The trial will be conducted in 4 non-academic health systems. Each health system will randomize prescribers to one of two study arms, intervention and control. During patient encounters, entering an antipsychotic for a potentially eligible patient will cause either the control or intervention medication alert to fire in the electronic medical record. The control arm medication alert will point prescribing clinicians to relevant Choosing Wisely® recommendations. The intervention arm medication alert will inform prescribers that:

  1. Antipsychotics are not recommended 1st line treatment for non-psychotic disorders;
  2. A child and adolescent psychiatrist (CAP) will review antipsychotic usage by youth;
  3. Expedited access to bridging therapy, behavior health navigation, and/or a proactive consultation with a CAP may be ordered.

The intervention medication alert will point prescribing clinicians to both Choosing Wisely® recommendations and to SUAY clinical prescribing guidelines. SUAY guidelines were developed by a national expert consensus panel in a prior phase of the study.

Analytic data will be collected from automated data sources at the health systems. The primary outcomes are percent of children ordered an antipsychotic medication at 6 months of follow up, and total person-months of antipsychotic orders placed for participants during the study period.

Being tested
Control - Provider Medication Alert Only, Intervention - Alert + CAP Review AND Enhanced BH Access
Keywords
Youth, Mental Health, Psychotropic, Medication Safety, Quality Improvement
Medical subject headings
Child Behavior Disorders, Psychological Well-Being

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Control - Provider Medication Alert OnlyOther

    Simple text medication alert referencing Choosing Wisely guidelines.

  • Intervention - Alert + CAP Review AND Enhanced BH AccessOther

    Interactive medication alert referencing SUAY Clinical Guidelines and offering options to keep/remove orders for the antipsychotic, virtual CAP consult, BH navigation for the patient, and access to bridging therapy for the patient.

Study groups in NCT03448575
Study groupRoleWhat they receive
Control - Medication Alert OnlySham comparatorThe control arm medication alert is a simple text pop-up in the EMR that will inform the prescriber of Choosing Wisely® recommendations developed the American Psychiatric Association regarding antipsychotic medication use in children and adolescents.
Receives: Other: Control - Provider Medication Alert Only
Intervention - Alert + CAP Review AND Enhanced BH AccessExperimentalThe intervention alert prompts the prescriber to keep/remove the antipsychotic order, and/or order any study services: behavioral health navigation, expedited psychotherapy access, virtual consult with a child and adolescent psychiatrist (CAP). Passive case review by the study CAP will occur for all intervention arm cases. A virtual consult will be scheduled if the prescriber ordered it or the CAP needs to discuss the case. The CAP will provide the prescriber with a written summary of his/her review. Following review by the CAP, a navigator reaches out to the eligible intervention arm patient/family to offer extra support. The navigator's role is to (a) provide extra support to facilitate access and engagement in appropriate psychosocial therapies; (b) coordinate short-duration bridging therapy sessions for teens/families not engaged in psychotherapy, when appropriate; and (c) keep the prescriber informed of any clinically relevant updates.
Receives: Other: Intervention - Alert + CAP Review AND Enhanced BH Access

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percent of Youths With Antipsychotic Orders at 6 Months

    Measured by medication orders placed within the health system

    Measured: 180 day period following index date

  2. Days' Supply of Antipsychotics Ordered for Youth

    Average days' supply of antipsychotic medication (values fell between 1 and 180 days), as measured by the intended days' supply on the medication orders for each participant. Only orders placed within the health system were accounted for.

    Measured: 180 day period following index date

Secondary outcomes (10)
  1. Percent of Youths Using Antipsychotics at 6 Months

    Measured by medication fill data available to the health system

    Measured: 180 day period following index date

  2. Days' Supply of Antipsychotic Use by Youth

    Average days' supply of antipsychotic medication (values fell between 1 and 180 days), as measured by medication fill data available to the health system for each participant. Only pharmacy claims captured by the health system were accounted for.

    Measured: 180 day period following index date

  3. Emergency Department/Urgent Care Visit Frequency

    Measured by utilization data; both for psychiatric crises and for all other reasons

    Measured: 180 day period following index date

  4. Baseline and Follow-up Safety Assessments - BMI

    Percentage of patients with BMI measurements completed at baseline and 3 months

    Measured: index date to 180 days post-index date

  5. Change to Psychotropic Medication Treatment Plan

    Percentage of patients with change to psychotropic medication treatment plan following exposure to study algorithm

    Measured: 180 day period following index date

  6. Behavioral Health (BH) Navigation Acceptance

    Percent of intervention arm patients that agree to BH navigation

    Measured: 180 day period following index date

  7. Use of Usual Care Therapy

    Percentage of patients attending two or more system-provided therapy sessions

    Measured: 180 day period following index date

  8. Use of Bridging Therapy

    Percentage of patients attending two or more study-provided bridging therapy sessions

    Measured: 180 day period following index date

  9. Use of Usual Care Therapy Following Bridging Therapy

    Of patients in study therapy, percentage who subsequently attend two or more system-provided therapy sessions

    Measured: 180 day period following index date

  10. Baseline and Follow-up Safety Assessments - Safety Lab Tests

    Percentage of patients with safety lab tests ordered and completed at baseline and 3 months

    Measured: index date to 180 days post-index date

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Feb 2018
  2. Study start29 Mar 2018
  3. Primary completion30 Jun 2020
  4. Study completion24 Dec 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Providers are preassigned to one of two study arms: usual care control or intervention arm. Patients are assigned to the same arm as the provider triggering the best practice alert and study algorithm.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
733 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03448575
Sponsor's protocol ID
HHSN271201600002C
Acronym
SUAY
Status last verified
Oct 2024
First submitted
21 Feb 2018
Last updated
31 Oct 2024
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The data sharing plan is incorporated by reference into the contract governing the project. Any changes to the plan must be pre-approved by the NIH Contracting Officer. A de-identified database will be delivered to the NIH, along with a statistical report. Any datasets for public distribution (including to the National Database for Clinical Trials Related to Mental Illness) will be de-identified in compliance with HIPAA standard for de-identification.

Publications

  • Chavez LJ, Richards JE, Fishman P, Yeung K, Renz A, Quintana LM, Massimino S, Penfold RB. Cost of Implementing an Evidence-Based Intervention to Support Safer Use of Antipsychotics in Youth. Adm Policy Ment Health. 2023 Sep;50(5):725-733. doi: 10.1007/s10488-023-01273-y. Epub 2023 Jun 1.

    PubMed 37261566
  • Penfold RB, Thompson EE, Hilt RJ, Schwartz N, Robb AS, Correll CU, Newton D, Rogalski K, Earls MF, Kowatch RA, Beck A, Yarborough BJH, Crystal S, Vitiello B, Kelleher KJ, Simon GE. Development of a Symptom-Focused Model to Guide the Prescribing of Antipsychotics in Children and Adolescents: Results of the First Phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial. J Am Acad Child Adolesc Psychiatry. 2022 Jan;61(1):93-102. doi: 10.1016/j.jaac.2021.04.010. Epub 2021 May 4.

    PubMed 34256967
  • Chavez LJ, Kelleher KJ, Beck A, Clarke GN, Penfold RB. Trends Over Time in Antipsychotic Initiation at a Large Children's Health Care System. J Child Adolesc Psychopharmacol. 2021 Jun;31(5):381-386. doi: 10.1089/cap.2020.0190.

    PubMed 34143677
  • Penfold RB, Thompson EE, Hilt RJ, Kelleher KJ, Schwartz N, Beck A, Clarke GN, Ralston JD, Hartzler AL, Coley RY, Akosile M, Vitiello B, Simon GE. Safer use of antipsychotics in youth (SUAY) pragmatic trial protocol. Contemp Clin Trials. 2020 Dec;99:106184. doi: 10.1016/j.cct.2020.106184. Epub 2020 Oct 20.

    PubMed 33091587
  • Schoenfelder Gonzalez E, Myers K, Thompson EE, King DA, Glass AM, Penfold RB. Developing home-based telemental health services for youth: Practices from the SUAY Study. J Telemed Telecare. 2021 Feb;27(2):110-115. doi: 10.1177/1357633X19863208. Epub 2019 Jul 25.

    PubMed 31342851

Questions about this trial

What is this clinical trial studying?

A study testing Intervention - Alert + CAP Review AND Enhanced BH Access in people with Child Behavior Disorders, run by Kaiser Permanente at 4 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 31 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 31 Oct 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percent of Youths With Antipsychotic Orders at 6 Months (time frame: 180 day period following index date). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03448575, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Oct 2024.

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