药物专家在多大程度上同意州医疗保险数据库中为儿童和青少年开具的精神药物的诊断?

Q2 Social Sciences Developmental Child Welfare Pub Date : 2021-05-24 DOI:10.1177/25161032211019045
Conor O’Brien, J. Rapp
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引用次数: 3

摘要

本研究评估了精神药物专家对30名患者的精神药物治疗方案得出的精神/行为诊断的一致程度。三位药物专家审查了药物治疗方案,并根据所列药物推断出一种或多种诊断。此后,我们使用kappa统计分析和逐类分析来评估诊断的一致性(a)在每个数据集涵盖的两个时间点(间隔8-14个月),在所有三名评审员之间,(b)在两个时间点将每对评审员之间的一致性,以及(c)在两种时间点上每个评审员内部的一致性。在审查者之间,对第一个和最后一个方案数据的kappa统计分析只产生了5个非常一致的病例和13个不一致的病例。剩下的所有事例都表明存在不同程度的分歧。同样,在专家kappa统计分析中,有两个例子的一致性很好,四个例子的不一致性很差,其余的例子有不同程度的分歧。总体而言,最高的kappa值与低计数方案有关,而大多数分数,无论药物计数如何,都很低,表明存在潜在的分歧。分类分析得出了类似的结果。一项二次条件分析显示,当药物治疗方案包含通常为被诊断为注意力缺陷多动障碍的患者开具的精神药物时,审查人员之间和内部的一致性更高。
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To what extent do medication experts agree on diagnoses derived from psychotropic medication prescribed for children and adolescents in a state Medicare database?
This study evaluated the extent to which psychotropic medication experts agreed on psychiatric/behavior diagnoses derived from 30 individuals’ psychotropic medication regimens. Three medication experts reviewed the medication regimens and inferred one or more diagnoses based on the medication listed. Thereafter, we used kappa statistical analyses and category-by-category analyses to evaluate agreement of diagnoses (a) across all three reviewers for two time points (separated by 8 to 14 months) covered by each data set, (b) across each pairing of reviewers at the two time points, and (c) within each reviewer across both time points. Between-reviewer kappa statistical analyses of first- and last-regimen data yielded only five instances with excellent agreement and 13 instances of poor agreement. All remaining instances indicated various levels of disagreement. Similarly, within-expert kappa statistical analyses showed two instances with excellent agreement, four instances with poor agreement, and the remaining instances with various levels of disagreement. Overall, the highest kappa values were attached to low-count regimens, while most scores, regardless of medication count, were low and indicated potential disagreement. The category-by-category analyses yielded similar results. A secondary, conditional analysis revealed higher agreements between and within reviewers when medication regimens contained psychotropic medications typically prescribed to individuals diagnosed with Attention Deficit Hyperactivity Disorder.
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来源期刊
Developmental Child Welfare
Developmental Child Welfare Medicine-Pediatrics, Perinatology and Child Health
CiteScore
3.90
自引率
0.00%
发文量
17
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