Five ways to combat growing polypharmacy among children

June 21, 2017

One expert believes managed care executives are key to a necessary paradigm shift in pediatric polypharmacy.

The risk of polypharmacy in children is high, and is a sign that modern healthcare is failing, according to one expert.

Stephani Higashi, DC, chief executive of the integrated healthcare practice HEALTH ATLAST, believes that a multiple-disciplinary approach is key.

Higashi

“If we improve our approach to healthcare on an integrated approach the future will hold great things-healthy, happy productive youth leading the future,” Higashi says.

Polypharmacy-which results from patients receiving treatment from multiple doctors, with no coordination of care-is especially dangerous among children because there’s no research to determine the long-term effects prescription medications will have on their bodies, according to Higashi.

“A multiple-disciplinary approach is the necessary paradigm shift,” she says. “The protection is for the patient, but it extends to protect the physicians, specialty providers and pharmacists.”

Higashi reviewed the literature and found that nearly 25% of all children take at least one prescription medication each month, according to a recent CDC study, including opioids, antidepressants and other psychotropic medications.

In addition to increased rates of opioid abuse among America’s youth, there has been a five-fold increase in the number of children prescribed psychostimulant medications, along with a six-fold increase in the number of antipsychotic medications prescribed, according to a recent National Institute of Mental Health blog.

“Managed care executives are some of the most powerful and influential people regarding care, covered care, adjudication of care and determining guidelines for care,” Higashi says. “They literally have the control to determine much of healthcare delivery and the future of our healthcare of our communities. It means we would love for them to have great interest in what is needed to help improve our healthcare and the guidelines of what should or should not be covered and what tests should or should not be done prior to medicating children.”

According to Higashi, most Americans going to a physician expect to receive a prescription when they are seen and are often not satisfied or feel they have been helped if they do not receive the prescription.

“In addition, physicians do not have time and it is easier to simply write a prescription to treat the symptoms,” she says. “Prescriptions also rise due to the increased labeling of symptoms into disease categories which then create categories of drugs to prescribe. Thus the prescription of change your diet, exercise, improve your posture, and get more sleep, and spend more time outdoors with your family and friends, is not actually ever prescribed. Sometimes the best prescription is no prescription.

Next: Five recommendations for executives

 

Higashi recommends five ways managed care executives can help combat growing polypharmacy rates or child prescription drug use:

  • Have as a covered benefit and guideline to review a three- to seven-day diet journal analysis of the child to see what they are consuming and actually have it evaluated. Educate the child and parents about the benefits of proper nutrition and how food can be medicine.

  • Review the child’s activity, including exercise and social interaction, play and review of lifestyle management of ways to manage stress, and have doctors prescribe analysis and actual activity and stress management.

  • Ensure that if a child is prescribed a medication that drug-gene testing is done using a buccal swab (cheek swab) to see which medications can or cannot be metabolized based on their genetic make up.

“Make sure that blood tests are performed first to ensure there aren’t undiagnosed underlying medical conditions that may be causing the symptoms that a prescriptive drug may otherwise mask causing the condition to be actually untreated,” Higashi says.

Also, make available benefits to children that are available to adults such as massage therapists, acupuncture, physical therapists, nutritionists and the first-line and course of treatment instead of just a prescription, according to Higashi.

  • Insist that children be treated with the most aggressive conservative care first before they are ever allowed to be given a prescription drug for conditions that should be able to be treated naturally.

“Obviously there are exceptions like emergency appendix rupture, car accident and broken bones that may require medication to control pain,” Higashi says. “But for the majority of visits such as neck pain, back pain, attention problems, depression, anxiety etc something conservative should always be tried first.”

  • Hold parents and providers accountable for the health of children.

“If we don’t and we continue to allow kids to constantly be on their phone, eat and drink unhealthy, be inactive and turn to prescriptions to quick fix their problems we will have a future of unhealthy, unproductive, unhappy people that may or may not be able to lead the future well,” Higashi says.