Racial and Ethnic Differences in ADHD Treatment Quality Among Medicaid-Enrolled Youth

Cummings, Janet R.; Ji, Xu; Allen, Lindsay; Lally, Cathy; Druss, Benjamin G.

doi:10.1542/peds.2016-2444

Cited by 67 publications

(38 citation statements)

References 45 publications

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“…In contrast to North American studies,10 12 we did not find ADHD symptom severity or age of commencement of medication to be predictive of medication coverage. Racial and ethnic variables have been found to be associated with differences in medication persistence in the USA,29 however these variables were not able to be assessed in this data set.…”

Section: Discussionmentioning

confidence: 86%

Patterns of long-term ADHD medication use in Australian children

et al. 2020

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ObjectiveAdherence to attention-deficit/hyperactivity disorder (ADHD) medication treatment is often suboptimal. This can compromise patient outcomes. We aimed to describe the patterns of ADHD medication use in Australian children, and characteristics associated with patterns of use.DesignDispensing data were analysed for all redeemed prescriptions of methylphenidate, dexamphetamine and atomoxetine between May 2002 and March 2015 from waves 1 to 6 of the Longitudinal Study of Australian Children (n=4634, age 4–5 years at wave 1). Medication coverage was defined as the proportion of time between the first and the last redeemed prescriptions in which the child was taking medication. Associations between predictor variables (child sex, ADHD symptom severity, age at first prescription, family socioeconomic status (SES), single parent status, parent education and parent mental health) and medication coverage were examined using regression analyses.Results166 (3.6%) children had ever redeemed a prescription for an ADHD medication. Boys had higher odds of having taken ADHD medication than girls (OR=3.9; 95% CI 2.7 to 5.7). The mean medication coverage was 59.8%. Medication coverage was lower in children from families of lower SES (β=4.0; 95% CI 0.2 to 7.8, p=0.04). Medication coverage was relatively high in the first year of prescription, then decreased progressively, only increasing again after 5 or 6 years of treatment.ConclusionsChildren with ADHD from socially disadvantaged families were less likely to receive medication consistently. Prescribers need to continue to support families over many years to ensure medication is used consistently for children with ADHD.

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Section: Discussionmentioning

confidence: 86%

Patterns of long-term ADHD medication use in Australian children

et al. 2020

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“…We also created 2 indicators to assess physical health problems, including asthma and other chronic conditions. 21 Each indicator was created for those who had at least 2 inpatient and/or outpatient claims with the respective ICD-9 diagnosis codes (in any position) during the study timeframe, including the exclusion period and 144-day treatment period combined (details are presented in Table S3, available online).…”

Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Differences in Minimally Adequate Depression Care Among Medicaid-Enrolled Youth

Cummings

Lally

et al. 2019

Journal of the American Academy of Child & Adolescent Psych

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Objective: To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth.Method: Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5-17 years old) who were diagnosed with a new episode of major depression (N ¼ 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (!4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors. Results: Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p < .001) and Hispanic (48.2%; p < .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p < .001) and Hispanic (15.0%; p < .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%). Conclusion: The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.

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“…African Americans and Latinos are less likely to receive a referral by a school professional, are more likely to report limited ability to pay for healthcare, and in some racial/ethnic subcultures, may hold negative attitudes toward identification of a mental health diagnosis [48]. African Americans and Hispanic children are more likely to discontinue medication and are more likely to disengage from treatment altogether, despite having greater overall mental healthcare needs [49]. Children living in higher-income households (> $70,000 a year, p < .001) are more likely to receive a diagnosis of ADHD [19], while children with Medicaid and public insurance are five times more likely (6.5% vs. 1.3%, p < .001) to have a diagnosis of conduct or behavioral problems compared to children who were privately insured when controlling for other demographic variables [50].…”

Section: Systemic Factorsmentioning

confidence: 99%