Factors that Affect the Adherence to ADHD Medications during a Treatment Continuation Period in Children and Adolescents: A Nationwide Retrospective Cohort Study Using Korean Health Insurance Data from 2007 to 2011.
OBJECTIVE
Several factors, such as male gender, older age, type of insurance, comorbid conditions, and medication type, have been associated with attention-deficit/hyperactivity disorder (ADHD) medication adherence rates, but the results have been inconsistent. We analyzed data to answer several questions: 1) How old were patients who first refilled their treatment medications used primarily for ADHD, regardless of the medication type? 2) What socio-demographic factors are associated with medication adherence? 3) What medical conditions, such as medication type and comorbid diagnosis, influence adherence?


METHODS
We analyzed National Health Insurance data, which comprised continuously enrolled Korean National Medical Insurance children (6-18 years) with at least 2 ADHD prescription claims (January 2008-December 2011). The persistence of use regarding the days of continuous therapy without a 30-day gap were measured continuously and dichotomously. Adherence, using a medication possession ratio (MPR), was measured dichotomously (80% cut-off).


RESULTS
The cumulative incidence of index cases that initiated medication refills for ADHD treatment during the 4 year period was 0.85%. The patients who exhibited a MPR greater than 80 comprised approximately 66%. The medication type, high school age groups, physician speciality, treatment at a private clinic, and comorbid conditions were associated with medication adherence during continuous treatment using a multivariate analysis.


CONCLUSIONS
A better understanding of ADHD treatment patterns may lead to initiatives targeted at the improvement of treatment adherence and persistence. Other factors, including the severity, family history, costs, type of comorbidities, and switching patterns, will be analyzed in future studies.
Department of Psychiatry, Eulji University School of Medicine, Eulji University Eulji Hospital, Seoul, Republic of Korea.
Soo-Young
SY
Bhang
Department of Psychiatry, Jeju National University College of Medicine, Jeju, Republic of Korea.
Young Sook
YS
Kwack
Department of Psychiatry, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Yoo-Sook
YS
Joung
Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea.
Soyoung Irene
SI
Lee
Department of Psychiatry, Sanggyepaik Hospital School of Medicine, Inje University, Seoul, Republic of Korea.
Bongseog
B
Kim
Yonsei Clinic of Psychiatry, Seoul, Republic of Korea.
Seok Han
SH
Sohn
Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
Un-Sun
US
Chung
Stress Clinic, Korea Advanced Institute of Science and Technology (KAIST) Clinic, Daejeon, Republic of Korea.
Jaewon
J
Yang
Department of Psychiatry, Myongji General Hospital, Goyang, Republic of Korea.
Minha
M
Hong
Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Geon Ho
GH
Bahn
Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea.
Hyung-Yun
HY
Choi
Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
In Hwan
IH
Oh
Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea.
Yeon Jung
YJ
Lee
Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
Jun-Won
JW
Hwang
ADHD; Adherence; Atomoxetine; Cohort; Compliance; Stimulants