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Under the direction of Professor Stephen Crystal the Institute for Health received a major award from the Agency for Healthcare Research and Quality (AHRQ) to establish a Center for Education and Research on Therapeutics (CERTs). This award along with three others expand the CERT network to eleven AHRQ-funded research centers and one coordinating center. The CERTs program that AHRQ administers in partnership with the Food and Drug Administration was authorized by Congress in 1997 to examine the benefits and risks and cost-effectiveness of therapeutic products, educate clients, consumers, physicians, nurses, pharmacists and other clinical personnel and improve the safety and quality of care while reducing costs by increasing appropriate use of therapeutics and preventing adverse effects and their consequences.
Researchers at the Institute will work on improving the safety and effective use of antidepressant and antipsychotic medicines among children and adolescents including balancing the risks and benefits of childhood antipsychotic use; psychotropic drug use among adults and the frail elderly; and improve the quality and outcomes of pharmaceutical care under the Medicare Prescription Drug Improvement and Modernization Act for beneficiaries with mental illnesses. A multidisciplinary faculty will be involved in this new initiative including those from the Ernest Mario School of Pharmacy, the Graduate School of Applied and Professional Psychology, the School of Social Work, the Department of Statistics, the UMDNJ’s medical schools and School of Public Health, and Columbia University.
The CERTs program at the Institute for Health developed from earlier activities at Rutgers that revealed a need for this center. Several central themes for the CERTs emerged from Dr. Crystal’s previously funded AHRQ Building Research Infrastructure Center grant including a focus on research partnerships and those facilitating the translation of research results into practice and enlarging the infrastructure for managing and using large and complex multistate datasets to support studies of pharmaceutical use and outcomes for individuals with mental health problems. With funding from the Rutgers’ Academic Excellence Fund, a Center for Health Services Research on Pharmacotherapy, Chronic Disease Management and Outcomes became a forerunner to the CERTs and facilitated early work into a more robust activity with the great potential for positive impact on the use and management of mental health therapeutics in usual care especially in publicly-funded programs.
The CERTs investigators have focused particularly on the therapeutic challenges with high population health impact; the apparent mismatch between evidenced-based recommendations and widespread practices; emerging safety concerns; the disparities and high variability in practices without apparent clinical rationale; off-label use of psychotropic medications; critical weaknesses in the knowledge base of psychotropic medications; the potential for significant impact in improving practices and outcomes; and the potential to leverage CERTs resources into outcomes improvement and sustainable studies and interventions. Through the CERTs consortium, Rutgers investigators have discussed therapeutic challenges with an outstanding group of experts, stakeholders, and federal and state agencies that have helped the CERTs evolve to meet the ever-changing challenges of the field. For education and translation it has been important to develop a sustained, multi-year effort to leverage CERTs funds to affect policies, practices and ultimately outcomes and to function as a resource that is trusted for its independence as well as its expertise.
Some examples of current research in our CERTs include:
1. Database Development
A data use agreement was completed that supports merging Medicaid, Medicare and nursing home Minimum Data Set data for eight states. Analyses will be conducted on the use, management and outcomes associated with psychotropic medications across various population groups.
2. Use and Monitoring of Psychotropic Therapy among Youths
Analyses with 1999-2000 Medicaid Analytic Extract data and private insurance data will be conducted on the use and monitoring of psychotropic therapy among Medicaid eligible youth.
3. Guideline Development and Prescriber Training to Improve Practices for Antidepressants and Atypical Antipsychotic Medications in Children
The CERTs convened a national consensus conference and conducted an expert survey on the treatment of aggression in youth. Treatment guidelines and toolkits for the management of aggression in youth in outpatient settings will be developed based on these consensus activities.
4. Atypical Antipsychotic Drugs in Nursing Homes: Implementing Treatment Recommendations for Frail Elders
Exploratory work was conducted on antipsychotic drug use in nursing homes providing pilot data for the development of a multistate study of patterns of antipsychotic prescription use and management in nursing homes typically for the control of behavioral symptoms of dementia.