title: 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 long-acting 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.
authors: Robert Wood Johnson Health and Society Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. bsaloner@gmail.com
authors: Brendan
authors: B
authors: Saloner
authors: Catherine
authors: C
authors: Fullerton
authors: Thomas
authors: T
authors: McGuire
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000208:ethnology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003692:Delayed-Action Preparations; D005260:Female; D005431:Florida; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D008484:Medicaid; D055118:Medication Adherence / Q000208:ethnology*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations
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