Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity

Abstract Objective To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use. Method Retrospective cohort from random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started...

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Veröffentlicht in:Journal of the American Academy of Child and Adolescent Psychiatry 2016-04, Vol.55 (4), p.289-294
Hauptverfasser: Brinkman, William B., M.D., M.Ed., M.Sc, Baum, Rebecca, MD, Kelleher, Kelly J., MD, MPH, Peugh, James, PhD, Gardner, William, PhD, Lichtenstein, Phil, MD, Langberg, Joshua, PhD, Epstein, Jeffery N., Ph.D
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Sprache:eng
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Zusammenfassung:Abstract Objective To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use. Method Retrospective cohort from random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started ADHD medication. Independent variables included physician behaviors related to medication titration and monitoring of treatment response. Primary outcomes were number of days covered with ADHD medication during the first year of treatment and time from starting medicine to the first 30-day gap in medication supply. Multilevel modeling and Cox proportional hazards regression models were conducted. Results Children had an average medication supply of 217 days in the first year. Half experienced a 30-day gap in medication supply in the first 3 months. Nearly three-quarters had a medication adjustment in the first year with the first adjustment usually being a dosage change. The average time to the first medication adjustment was over 3 months. Physician’s first contact with parents occurred in the first month of treatment for fewer than half with the average time being over 2 months. Little variation related to ADHD care quality was accounted for at the physician level. Early titration and early contact were related to greater medication supply and continuity of treatment. Conclusion Earlier physician-delivered ADHD care (e.g. contact with parent after starting medication and medication adjustment) is related to greater medication supply and continuity. It remains to be determined whether interventions that improve the quality of titration and monitoring practices for children with ADHD would also improve medication continuity.
ISSN:0890-8567
1527-5418
DOI:10.1016/j.jaac.2016.02.001