Abstract
Background and Objectives: It is important that children prescribed attention-deficit/hyperactivity disorder (ADHD) medication get timely follow-up care. In 2018, only 44% of US Medicaid recipients attended a follow-up visit within 30 days of their first ADHD prescription. The objective of this study was to identify the member and practitioner-related predictors that were associated with children who were diagnosed with ADHD and had a follow-up visit within 30 days (initiation phase) of their first prescription of ADHD medication (Index Prescription Start Date, or IPSD).
Methods: A cross-sectional study was conducted to identify the independent predictors of a follow-up visit within 30 days and 2 follow-up visits within 270 days after the initiation phase (continuation and maintenance phase, or C&M phase) for Medicaid recipients. Predictive factors examined included race, school age group, gender, geography of residence, Medicaid service region, newly diagnosed ADHD, hospital admission, emergency department (ED) visit, types of ADHD medication, other psychosocial or behavioral diagnoses, psychosocial or behavioral therapy, prescriber specialty, and school season.
Results: There were 2369 members eligible for the initiation phase measure, of whom 330 members were eligible for the C&M phase measure. Multiple regression analysis found that unmet 30-day follow-up was significantly associated with African American children with an existing diagnosis of ADHD (adjusted odds ratio [AOR] = 2.13; 95% confidence interval [CI], 1.64-2.76), middle school-aged children (AOR = 1.49; 95% CI, 1.23-1.80), rural residence (AOR = 1.27; 95% CI, 1.05-1.55), no ED visit (AOR = 1.57; 95% CI, 1.16-2.12), no psychosocial or behavioral therapy prior to the IPSD (AOR = 2.30; 95% CI, 1.65-3.21), and primary care practitioners (AOR = 1.88; 95% CI, 1.45-2.44).
Conclusion: Pediatrics was the most common specialty prescribing ADHD medications. Managed care organizations can focus intervention efforts to improve compliance with 30-day follow-up among Medicaid children by targeting the high-risk categories identified above. They can also focus on facilitating communication between behavioral health practitioners and pediatricians about several key points: (1) the importance of using behavioral health therapy prior to prescribing medication; (2) the importance of timely follow-up care; and (3) the importance of medication management in combination with behavioral health therapy.