Safer Use of Antipsychotics in Youth

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.

Inclusion Criteria:

- 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);

Exclusion Criteria:

- 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