CARE-PROVIDING AND PRESCRIBING PRACTICES OF PHYSICIANS TREATING CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

OBJECTIVES: To compare the care-providing and prescribing practices of physicians treating children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: A retrospective cohort study was conducted using the GE-EMR data from 1995-2010. The cohort consisted of individuals ≤18 years of age, diagnosed with ADHD (ICD-9 CM: 314.xx) and received a prescription of stimulants or atomoxetine. The NCQA-HEDIS measure for ADHD was used to study the follow-up care. The prescribing physicians were compared on the basis of time-to-treatment, follow-up care, and use of polypharmacy. Multivariate logistic regression was conducted to determine the association of physician specialty with these outcome measures. RESULTS: After applying the inclusion and exclusion criteria the cohort consisted of 66,719 children and adolescents diagnosed and treated for ADHD. 76% (N=50,582) of these cases were identified by PCPs, 2.6% (N=1,724) by child-psychiatrists and the rest by unknown specialty. 59% (N=39,343) of the patients were prescribed ADHD medication on the day of diagnosis and the rest received delayed treatment, with a median time-to-treatment of 57 days (IQR: 22-190). 34% (N=22,476) of the treated cases had follow-up visits in accordance with the HEDIS criteria. Patients identified by PCPs had a mean of 6.56 (SD=3.67) follow-up visits while those identified by child-psychiatrists had a mean of 7.26 (SD=4.10) visits during the 10-month period. Compared to PCPs, child-psychiatrists were 47% less likely to initiate the treatment on same day of diagnosis (OR: 0.53; 95% CI: 0.48-0.59) and identified more comorbid mental disorders (OR: 1.20; 95% CI: 1.02-1.41). Even after controlling for comorbid conditions, child-psychiatrists were 52% more likely to use psychotropic polypharmacy than PCPs (OR: 1.52; 95% CI: 1.35-1.71). CONCLUSIONS: Disparities exist in the care-providing behavior of physicians treating children with ADHD. Additional studies are needed to understand the clinical consequences of these disparities and the implication of care coordination across different provider specialties.