Loading ...

Fewer than half of the adolescents prescribed a selective serotonin reuptake inhibitor (SSRI) at two large Chicago pediatric primary care clinics had a follow-up visit within the recommended 6 weeks, according to a poster presented at the Pediatric Academic Societies (PAS) 2025 Meeting.

1 in 5 patients who started an SSRI were completely lost to follow-up, reported Katherine Martin, MD, of the Ann & Robert H. Lurie Children’s Hospital of Chicago and McGaw Medical Center of Northwestern University, Chicago, and her colleagues.

“This delay may limit timely assessment of side effects, potentially impacting treatment safety and effectiveness,” the researchers concluded. “Importantly, follow-up timing did not differ based on patient or PCP [primary care provider] demographics, suggesting that barriers may pervasively affect all patients and PCPs at both clinic sites.”

The American Academy of Child and Adolescent Psychiatry recommended that physicians follow up with adolescents within 4-6 weeks after first being prescribed a new SSRI so that they can monitor side effects and adjust the dose as needed.

“This is an important finding for dissemination, as pediatric medical homes are critical players for proactively addressing mental health concerns, and yet pediatricians often lack sufficient experience in management of depression and anxiety in adolescents,” Martine Lamy, MD, PhD, an associate professor of psychiatry at the University of Cincinnati College of Medicine and the associate chief of Staff for Mental Health at Cincinnati Children’s Hospital Medical Center, Cincinnati, told Medscape Medical News.

“Understanding what barriers that pediatric practices face in successfully treating depression and anxiety in the medical home is critical for improving evidence-based care delivery,” said Lamy, who was not involved in this study. “These findings are not unexpected and are likely to be representative of many pediatric outpatient practices around the country facing similar challenges in effectively treating mental health conditions.”

The researchers analyzed electronic health record data from patients aged 6-18 years who were prescribed an SSRI between December 2022 and December 2023 at either of Lurie Children’s large, urban pediatric primary care clinics. The 98 patients identified were predominantly female (62%); one was nonbinary, and they were an average of 15 years old. Most (88%) spoke English, while most of the others spoke Spanish (11%). They were a racially and ethnically diverse group: 23% non-Hispanic Black, 15% non-Hispanic White, 10% non-Hispanic Asian, and 7% Hispanic, with the others declining to identify their race/ethnicity or classified as “other.”

Most of the patients lived within Chicago city limits (81%), but 17% were from the suburbs and 2% from out of state. Most were also on public insurance (80%). The diagnoses were primarily both anxiety and depression (40%); 35% had only anxiety, 18% had only depression, and 7% had another diagnosis. Over half were prescribed fluoxetine (58%), 19% were prescribed escitalopram, and 22% were prescribed sertraline. The prescribing physicians were split between residents (58%) and faculty (51%).

Of the 98 patients, 78 had a follow-up, and 20 were lost to follow-up. Just under half (48%) of the patients overall had a follow-up appointment within 6 weeks of starting their SSRI. Another 31.6% had a follow-up, but it was more than 6 weeks after their prescription. The average follow-up time was 51 days (7.3 weeks). The median follow-up time was 37 days, with a range of 7 to 343 days.

About a quarter of the follow-ups (26%) were via a phone call or the MyChart patient portal rather than an in-person or telemedicine visit. Although the follow-up time was not associated with any patient demographics or clinical factors, having any follow-up at all was marginally significantly associated with the involvement of the collaborative care psychiatry team. In cases where the team was involved, patients had nearly three times greater odds of a follow-up visit (odds ratio, 2.95; P = .045), but there was no association with follow-up within 6 weeks (odds ratio, 1.04; P = .92).

“These findings would be moderately generalizable across different types of pediatric practices who face similar barriers including PCP knowledge and comfort level related to SSRI treatment of depression and anxiety,” Lamy told Medscape Medical News. “The hospital-based, urban clinic setting may have higher rates of patients lost to follow-up than other types of clinic settings, such as suburban private practice, but other barriers to effectively meeting guidelines likely exist across clinic settings.”

She noted that collaborative care mental health teams within the pediatric medical home are not yet widespread, but evidence suggested that they improve pediatric health outcomes, “so there is a growing trend of including these teams in both hospital-based, community, and private practice pediatric clinics,” she said.

Among the likely barriers to timelier follow-up are “PCP knowledge of the pediatric SSRI prescribing guidelines for follow-up and clinic structures that may make it difficult to effectively schedule follow-up appointments within the recommended 6-week timeframe,” Lamy said. “The authors call out the need for increased knowledge for both pediatricians and families on guidelines, as well as quality improvement efforts to improve scheduling and other workflows to improve access to timely follow-up visits.”

No external funding or author disclosures were reported. Lamy does not currently receive any industry or clinical trial funding but had previously received funding from Ovid Therapeutics, Impel Pharmaceuticals, Roche, and Genentech.

Tara Haelle is a science/health journalist based in Dallas.