By: Jeni Cook
Originally published to the UNC Eshelman School of Pharmacy Site.
A new paper in Psychiatric Services by Kathleen C. Thomas, PhD, in the Division of Pharmaceutical Outcomes and Policy (DPOP), raises concerns about disparities in care in children with high needs. The paper describes psychotropic polypharmacy, the use of multiple psychotropic drugs to treat a patient, and its association with neighborhood context in a cohort of children with psychiatric conditions, intellectual and developmental disability, and complex medical conditions living in North Carolina.
“This paper highlights our concern that, even after accounting for clinical conditions, neighborhood context is associated with children’s experience of psychotropic polypharmacy,” Thomas said. “The findings underscore concerns about structural disparities and systemic racism and raise questions about access to appropriate levels of care. Findings from this work motivate cross division collaboration in our School to understand and improve psychotropic medication treatment for these high need children.”
After examining electronic health records of high need children, this study indicates that neighborhood Child Opportunity Index, race, and ethnicity are significant drivers of interclass psychotropic polypharmacy and psychotherapy.
The motivation behind this study came from UNC Health physicians noticing that families of children with psychiatric conditions, intellectual and developmental disability, and complex medical conditions often travel to Chapel Hill from distant places in North Carolina and those families who come at a time of child crisis often live in low resource areas.
“We know that there are disparities in access to care. We are concerned that children with high needs receive medications in place of low-cost low risk nonmedical supports such as in-home therapy or a personal aid because they are just not available.” Thomas said. “This paper is a step to document what’s happening.”
This paper was completed in partnership with Izabela Annis, MS senior analyst in DPOP, Dr. Neal deJong, associate professor in general pediatrics and adolescent medicine at the UNC School of Medicine, Dr. Robert Christian, assistant professor of psychiatry and pediatrics at the UNC School of Medicine, Scott Davis, PhD, assistant professor in DPOP, Phillip Hughes, PhD, graduate research assistant in DPOP, and parent advisors Beth Prichard, Jason Prichard, Pamela Allen, Josh Gettinger, D’Jenne-Amal Morris, and Kerri Eaker.
“It’s not easy for parents and researchers to collaborate and we’re really proud of this product.” Thomas emphasized.
Thomas was recently promoted to full professor in DPOP at the UNC Eshelman School of Pharmacy where she serves as Vice Chair for Research and Graduate Education. Dr. Thomas has been working at UNC-Chapel Hill for the past 25 years. She began in the Program on Mental Health Services Research at the Cecil G. Sheps Center for Health Services Research where she built her portfolio focusing on access and quality of mental health services among children and adults. In 2018, she moved to the UNC Eshelman School of Pharmacy. “I greatly appreciate pharmacy’s investment in my research and career,” said Thomas.
Being in pharmacy has supported Thomas’ focus on issues of psychotropic medication use and polypharmacy and opens the door to novel collaborations across the School. She hopes to combine findings from mental health services and expertise in drug metabolism to open new paths of scholarship.