title: Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity.
abstract: OBJECTIVE
  To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use.
  
  
  METHODS
  A retrospective cohort from a random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started ADHD medication, was studied. Independent variables included physician behaviors related to medication titration and monitoring of treatment response. Primary outcomes were number of days covered with ADHD medication during the first year of treatment and time from starting medicine to the first 30-day gap in medication supply. Multilevel modeling and Cox proportional hazards regression models were conducted.
  
  
  RESULTS
  Children had an average medication supply of 217 days in the first year. Half experienced a 30-day gap in medication supply in the first 3 months. Nearly three-fourths had a medication adjustment in the first year with the first adjustment usually being a dosage change. The average time to the first medication adjustment was over 3 months. Physician's first contact with parents occurred in the first month of treatment for less than half, with the average time being over 2 months. Little variation related to ADHD care quality was accounted for at the physician level. Early titration and early contact were related to greater medication supply and continuity of treatment.
  
  
  CONCLUSIONS
  Earlier physician-delivered ADHD care (e.g., contact with parent after starting medication and medication adjustment) is related to greater medication supply and continuity. It remains to be determined whether interventions that improve the quality of titration and monitoring practices for children with ADHD would also improve medication continuity.
authors.affiliation: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine. Electronic address: Bill.Brinkman@cchmc.org.
authors.forename: William B
authors.initials: WB
authors.lastname: Brinkman
authors.affiliation: Nationwide Children's Hospital, Columbus.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Baum
authors.affiliation: Nationwide Children's Hospital, Columbus.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Kelleher
authors.affiliation: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine.
authors.forename: James
authors.initials: J
authors.lastname: Peugh
authors.affiliation: Research Institute at the Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Gardner
authors.affiliation: The Children's Home of Cincinnati.
authors.forename: Phil
authors.initials: P
authors.lastname: Lichtenstein
authors.affiliation: Virginia Commonwealth University, Richmond.
authors.forename: Joshua
authors.initials: J
authors.lastname: Langberg
authors.affiliation: Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine.
authors.forename: Jeffery N
authors.initials: JN
authors.lastname: Epstein
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D010290:Parents; D010372:Pediatrics / Q000379:methods; D012189:Retrospective Studies; D016903:Drug Monitoring
keywords: adherence; attention-deficit/hyperactivity disorder; clinical practice guidelines; pharmacotherapy; quality of care