Changes in ADHD prescribing after psychotropic medication training

Background: North Carolina conducted a regional pediatric psychopharmacology training program to improve PCPs ability to diagnose and manage ADHD in Medicaid populations.

Methods: 48 PCPs from 31 practices attended a 3-day training on ADHD and other child mental health conditions and participated in bi-weekly conference calls. Medicaid claims data from one year pre-training to one year post training were collected for patients of trained providers and non-trained control providers for over 20,000 Medicaid-eligible children with ADHD medication use. Outcome measures include the probability of dosing outside of recommended ADHD medication range. Preliminary difference-in-difference logit models compared outcomes by trained vs untrained providers in pre- and post-training periods.

Results: Over 11% of children with a filled ADHD prescription had at least one medication that was dosed lower than the suggested dosing range in a typical month whereas just over 6% of children had a dose that was higher than the suggested range. Results from difference-in-differences models indicate that trained providers were significantly less likely to prescribe medications at lower doses as compared to trends in the pre-training period and the non-trained controls. Trained providers were also more likely to prescribe at higher doses post-training than the comparison groups. Estimated effect sizes were small, however, with marginal effects in both directions of less than one percentage point.

Conclusions: Provider training affected prescribing behavior among children receiving ADHD medications. Future analyses will examine whether training affects the number of treated children and whether other service use outcomes were affected by the training.