The Impact of Long-Acting Medications on Attention-Deficit/Hyperactivity Disorder Treatment Disparities

Abstract

Objective: Long-acting stimulants have increased medication adherence for many children diagnosed with attention deficit/hyperactivity disorder (ADHD), but it is unknown whether the increase has been similar across racial/ethnic groups. Our objective was to determine whether differences in medication utilization and adherence among white, black, and Hispanic ADHD-diagnosed children and adolescents narrowed following the introduction of long-acting stimulants in the 1990s. Methods: We conducted a retrospective analysis of Florida Medicaid claims data from fiscal years 1996-2005. At each of three cross sections, we identified children and adolescents 3-17 years of age with at least two claims with an ADHD diagnosis. We used linear regression to model disparities over the study period in utilization of any ADHD medications (utilization of long-acting medication specifically) and medication adherence, and identified patient level, treatment setting, and geographic contributors to disparities. Results: Although ADHD medication utilization was lower for ADHD-diagnosed minorities than whites in all years, minorities were as likely as whites to switch to long-acting medications. The increase in prescribed days following longacting medication diffusion was comparable for white and black medication users (40 and 43 days, respectively), but lower for Hispanics (27 days). Geography and provider setting helped to explain disparities in medication utilization overall, but disparities in adherence were not explained by any of the covariates. Conclusions: Despite equivalent switching to long-acting medications in the study period, minorities continued to utilize all ADHD medications less than did whites, and for shorter periods. Provider setting helps explain the ADHD medication utilization gap. High-volume, minority-serving providers are potential targets for future interventions related to improved communication about medication and follow-up after medication initiation.

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

“…Consistent with previous studies, 18,19 there were considerable racial/ ethnic differences in medication discontinuation. Higher rates of medication discontinuation among minority youth could be due to differences in cultural health beliefs and/or concerns about ADHD medication treatment.…”

“…14 Yet, rates of ADHD medication adherence and persistence are low among Medicaidenrolled youth in general, 15 -18 and even lower among African American and Hispanic children than non-Hispanic white children. 18,19 Lower rates of ADHD medication persistence among minority youth compared with whites are most problematic if racial/ethnic minorities are also more likely to disengage from treatment entirely. Randomized trials have revealed that behavioral therapy is also effective at reducing ADHD symptoms.…”

Medication Adherence of Latino Children and Caregivers: An Integrative Review

“…The analysis showed low adherence as the main theme. Latino children were less adherent to medication than other groups (Adeyemi, Rascati, Lawson, & Strassels, 2012; Bhatia et al, 2012; Capo-Ramos, Duran, Simon, Akinbami, & Schoendorf, 2014; Herndon, Mattke, Cuellar, Hong, & Shenkman, 2012; Makhinova, Barner, Richards, & Rascati, 2015; McQuaid et al, 2012; Mosnaim et al, 2014; Palli, Kamble, Chen, & Aparasu, 2012; Saloner, Fullerton, & McGuire, 2013). Adeyemi et al (2012) described adherence to oral diabetic medication and assessed trends in adherence and persistence using medication possession ratio (MPR) and persistence as a proxy for measuring adherence.…”

Differences in Utilization Patterns among Medications in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: a 36-Month Retrospective Study Using the Korean Health Insurance Review and Assessment Claims Database

“…In previous studies, most had observation period up to 1 year ( 22 ). Until the current study, the longest treatment duration was 6 years for treatment discontinuation and 2 years for adherence ( 23 24 ).…”