Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers

Bannett, Yair; Feldman, Heidi M.; Bentley, Jason; Ansel, David; Wang, C. Jason; Huffman, Lynne C.

doi:10.1016/j.acap.2019.11.016

Cited by 8 publications

(6 citation statements)

References 29 publications

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“…As Figure 1 illustrates, in 2020, only two QMs were achieved in most records. This evidence for poor quality care is consistent with prior reports that many PCPs are not well equipped to diagnose and manage the disorder (Adler et al, 2009; Bannett et al, 2020; Faraone et al, 2004; Huang et al, 2020).…”

Section: Discussionsupporting

confidence: 89%

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Progress and Pitfalls in the Provision of Quality Care for Adults With Attention Deficit Hyperactivity Disorder in Primary Care

et al. 2023

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Objective: Quality care for attention deficit hyperactivity disorder (ADHD) in adults has lagged behind other psychiatric disorders. We sought to assess how the achievement of quality measures (QMs) for diagnosing and treating ADHD in adults has changed over time. Method: We assessed 10 QMs in electronic health records (EHRs) from primary care and behavioral health clinics from 2010 to 2020 for 71,310 patients diagnosed with ADHD. Results: The achievement of QMs increased over time ( p < .001). Some showed increases to high levels; others remained low throughout the observation period. No patients achieved more than six of 10 QMs in any year. Small but significant effects for sex, race, ethnicity, practice ownership, practice type, and age. Conclusion: Increase in quality care from 2010 to 2020 along with clear evidence that more efforts are needed to improve quality of care for adults with ADHD seen in primary care.

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Section: Discussionsupporting

confidence: 89%

“…Huang et al (2020) reported many healthcare providers feel ill equipped to diagnose and manage adults presenting with inattention and impulsivity. Another study reported wide variability in PCP approaches to ADHD with some clinicians never diagnosing ADHD and others diagnosing ADHD in up to 8.3% of patients (Bannett et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Progress and Pitfalls in the Provision of Quality Care for Adults With Attention Deficit Hyperactivity Disorder in Primary Care

et al. 2023

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“…We retrospectively analyzed electronic health record (EHR) data from Packard Children's Health Alliance (PCHA), a community-based pediatric health care network in the San Francisco Bay Area, affiliated with Stanford Children's Health and Lucile Packard Children's Hospital, serving ∼100,000 children annually, as previously described. 8 Structured EHR data were extracted through the STAnford Medicine Research data Repository Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) [STARR-OMOP]. 9 The Stanford University School of Medicine institutional review board approved this study.…”

Section: Methodsmentioning

confidence: 99%

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic

Bannett

Dahlen

Huffman

et al. 2022

J Dev Behav Pediatr

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The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care. Method: We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n 5 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020-March 15, 2021) compared with prepandemic years (January 1, 2016-March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared. Results: ADHD-related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%-43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years. Conclusion: Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHDrelated care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

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“…We retrospectively analyzed electronic health record (EHR) data from Packard Children’s Health Alliance (PCHA), a community-based pediatric healthcare network in the San Francisco Bay Area, affiliated with Stanford Children’s Health and Lucile Packard Children’s Hospital, serving ∼100,000 children annually, previously described. 5 Structured EHR data were extracted through the STAnford Medicine Research data Repository Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) [STARR-OMOP]. 6 The Stanford University School of Medicine institutional review board approved the study.…”

Section: Methodsmentioning

confidence: 99%

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-aged Children: Trends and Disparities During the COVID-19 Pandemic

Bannett¹,

Dahlen

Huffman³

et al. 2021

Preprint

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ImportanceLittle is known about changes in health care in the first year of the pandemic for the large population of school-aged children with attention-deficit/hyperactivity disorder (ADHD), who were especially impacted by lockdowns, school closures, and remote learning.ObjectiveTo assess temporal trends in rates of primary care provider (PCP) diagnosis and treatment of school-aged children with ADHD in the first year of the COVID-19 pandemic as compared to pre-pandemic years, and to investigate disparities in care.MethodWe retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children ages 6-17 years seen between 01/2016 and 03/2021 in a community-based primary healthcare network in California (n=77,298 patients). Study Outcomes: (1) # of primary care visits, (2) # of visits with ADHD diagnosis (ADHD-related visits), (3) # of first ADHD diagnoses, (4) # of PCP prescriptions for ADHD medications (stimulants, alpha-2 agonists, atomoxetine), (5) # of first PCP prescriptions of ADHD medications. Interrupted time-series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (3/15/2020-3/15/2021) compared to pre-pandemic years. Patient demographic characteristics were compared pre-pandemic to pandemic year.ResultsIn the first quarter (Q1) of the pandemic year, all primary care visits dropped by 62% (CI 54.9-67.2%); ADHD-related visits dropped by 33% (95% CI 22.2-43.6%). In Q2-4, while all primary care visits remained significantly below pre-pandemic rates, ADHD-related visits returned to pre-pandemic rates. Conversely, rates of first ADHD diagnoses remained at half of pre-pandemic rates throughout the year (Q1-4). ADHD medication prescription rates remained stable throughout the pandemic year. The proportion of patients living in low-income neighborhoods who received ADHD-related care (ADHD-related visits and first ADHD diagnoses) were lower during the pandemic year compared to pre-pandemic years. Females comprised a higher proportion of first ADHD diagnoses compared to pre-pandemic years (34% vs. 28%, absolute standardized difference=0.13, p=0.03).ConclusionOngoing treatment for school-aged children with ADHD was maintained during the pandemic, especially in children from high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

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Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers

Cited by 8 publications

References 29 publications

Progress and Pitfalls in the Provision of Quality Care for Adults With Attention Deficit Hyperactivity Disorder in Primary Care

Progress and Pitfalls in the Provision of Quality Care for Adults With Attention Deficit Hyperactivity Disorder in Primary Care

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-aged Children: Trends and Disparities During the COVID-19 Pandemic

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