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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Cheryl Hankin, PhD1, Peggy Pierson, MPP2, Deborah Cooper, PharmD, BCPS2, and Alan Wright, MD, MPH2. (1) McNeil Consumer Healthcare, 1950 Charleston Road, Mountain View, CA 94304, 650-564-2599, CHankin@MCCUS.JNJ.com, (2) Advance PCS, 11350 McCormick Road, Hunt Valley, MD 21031
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent childhood psychiatric disorders, and represents the most common reason children are referred to mental health providers. Although effective pharmacologic treatment for ADHD is widely available, research indicates that treatment is often inadequate or inappropriate. The resultant burden, in terms of chronic decrements in patient and family functioning, greater risk for parental lost work productivity, and increased use of healthcare services, merits public health concern. To reduce the burden associated with inadequate or inappropriate treatment, the American Academy of Pediatrics’ (AAP) ADHD treatment guidelines recently recommended continuous outcomes monitoring. Given growing awareness of the adverse consequences of suboptimal ADHD treatment, and recent focus on ADHD outcomes monitoring, we sought to develop a methodology to monitor quality of ADHD pharmacologic care. Among 10 million members enrolled in a pharmacy benefits management plan during the year 2000, we identified 73,484 (0.73%) as receiving 401,138 psychostimulant fills for ADHD treatment. We categorized each fill by the following drug classes: methylphenidate, amphetamine salts, dextroamphetamine, pemoline, and methamphetamine. Percentages of psychostimulant fills by drug class were: 57.2% methylphenidate, 28.6% amphetamine salts, 12.1% dextroamphetamine, 1.9% pemoline, and 0.2% methamphetamine. Mean number of psychostimulant 30-day fills per patient during this index year was 5.5. We next examined all psychostimulants filled during a 3-month index period during the same year; there were 108,819 psychostimulants filled for 51,486 unique patients. For these fills, we calculated average daily dose by psychostimulant class. Based upon previously published literature, we created a metric to convert average daily dose across psychostimulant drug classes to "Methylphenidate Equivalent Units" (MEU). Average daily MEU was 27.3 mg. Patients averaged 2.1 fills per 3-month period, at an average of 25.5 days supplied per fill. Thus, patients typically received medication coverage throughout 51 of the 91-day index period (56%). This is the equivalent of receiving medication coverage for 3.9 days per week. If medication was, in fact, taken every day (i.e., over the course of 91 days), the average daily dose in MEU would effectively be nearly halved to 15.3 mg among the entire sample [(27.3 mg * 51 days)/91 days)]. We describe a methodology for evaluating quality of ADHD pharmacologic care across psychostimulant classes. Whether our findings suggest inadequate or inappropriate treatment requires future research to link average daily doses in MEU to targeted outcomes of care, such as family functioning, healthcare utilization or costs, or parental work productivity.
Learning Objectives:
Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Full time employee of McNeil Consumer Healthcare