Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder.
OBJECTIVE
(1) To describe temporal patterns of office visits for attention-deficit/hyperactivity disorder (ADHD) and stimulant treatment for 5- to 14-year-old US youths; (2) to compare youth visits for ADHD with and without melication according to patient demographics, physician specialty, reimbursement source, and comorbid diagnoses; and (3) to compare office visits for youths with ADHD in relation to common medication patterns (stimulants alone, stimulants with other psychotherapeutic medication, and nonstimulant psychotherapeutic medications alone).


METHODS
Survey based on a national probability sample of office-based physicians in the United States.


METHODS
Physician offices.


METHODS
A systematically sampled group of office-based physicians.


METHODS
National estimates of office visits for ADHD and psychotherapeutic drug visits for ADHD for each year and for a combined 8-year period.


RESULTS
Youth visits for ADHD as a percentage of total physician visits had a 90% increase, from 1.9% in 1989 to 3.6% in 1996. Stimulant therapy within ADHD youth visits rose from 62.6% in 1989 to 76.6% in 1996. While the majority of non-ADHD youth visits were conducted by primary care physicians, one third of ADHD youth visits were managed by psychiatry and neurology specialists. Health maintenance organization insurance was the reimbursement source for 17.9% of non-ADHD youth visits but only 11.7% of ADHD youth visits. Complex medication therapy was more likely to be prescribed by psychiatrists and less likely to be related to visits with health maintenance organization reimbursement.


CONCLUSIONS
National survey estimates in the 1990s confirm the substantial increase in visits for youths diagnosed as having ADHD, with more than three quarters of these visits associated with psychotherapeutic medication treatment. Physician specialty and reimbursement source variables identify distinct patient populations with a gradient in psychotherapeutic medication patterns from single-drug standard (stimulant) therapy to complex multidrug treatment regimens for which evidence-based scientific information is lacking.
Zito
J M
JM
Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, USA. jzito@rx.umaryland.edu
Safer
D J
DJ
dosReis
S
S
Magder
L S
LS
Gardner
J F
JF
Zarin
D A
DA
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008511:Medicine; D009819:Office Visits / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D013038:Specialization; D013997:Time Factors; D014481:United States
D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs