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Background/objective: The use of antipsychotics in children and adolescents in the Texas Medicaid program has increased with the introduction of newer atypical antipsychotics. The purpose of this study was to examine physician specialty associated with antipsychotic prescribing from 1996 to 2001.Methods: All antipsychotic prescription claims records for children and adolescents younger than the age of 20 years from 1996 to 2001 were extracted from the Texas Medicaid Drug Vendor prescription database. Physician specialty associated with youths receiving all, atypical, and conventional antipsychotic prescriptions was examined for time trends. Physician specialty categories included psychiatry, primary care, neurology, other, and unspecified.Results: Psychiatrists accounted for more than 80% of youths receiving antipsychotic prescriptions from 1996 to 2001. The proportion of youths receiving antipsychotic prescriptions from primary care physicians remained fairly steady over the course of time (1996: 19%; 2001: 16%). The number of youths prescribed conventional antipsychotics decreased in all specialty groups, whereas the number prescribed atypical antipsychotic prescriptions increased dramatically.Conclusions: Although the majority of children and adolescents in the Texas Medicaid program were prescribed antipsychotics by psychiatrists and child and adolescent psychiatrists, youths may often receive treatment within the primary care setting. Future research is necessary to evaluate patient outcomes associated with antipsychotic treatment across different treatment settings. [ABSTRACT FROM AUTHOR]

This article presents a case study from a primary care practice that achieves blood pressure control (ie, less than 130/85 mm Hg) in a majority of patients with diabetes. Fifty-three percent of the last blood pressures measured in 2001 were controlled and 38% of patients achieved blood pressure control without medications or with a single agent. Blood pressure control is achieved in a majority of patients in this practice secondary to their focus on guidelines, involvement of nursing staff in case management, and medication use consistent with recommendations. Copyright © 2003 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]