Most Adults with ADHD Don't Renew Stimulant Prescriptions on a Timely Basis
Key findings
- Using data from electronic medical records, this retrospective study examined two years of data on the renewal of stimulant prescriptions by adults with attention-deficit/hyperactivity disorder (ADHD)
- Only 42% of 2,689 adults using stimulants renewed their initial prescriptions, predefined as issuance of a second prescription within 90 days (or within 120 or 150 days if the prescription was post-dated two or three months)
- Patients using long-acting formulations were more likely to renew than those on short-acting formulations (45% vs. 39%, P=0.009)
- Patients who received their prescription from a psychiatry clinic were more likely to renew than those whose prescription came from another clinic (52% vs. 32%; OR, 2.18; P<0.001)
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Stimulants are well documented to be safe and efficacious for the treatment of attention-deficit/hyperactivity disorder (ADHD), making it one of the most treatable psychiatric disorders. However, in a study published in Psychiatric Services, Massachusetts General Hospital researchers found that of 2,206 prescriptions for pediatric patients with ADHD, only 46% were refilled within the timeframe necessary for the patient to be considered consistently medicated.
Now Roy Perlis, MD, MSc, director of the Center for Quantitative Health in the Department of Psychiatry, and Joseph Biederman, MD, chief of the Pediatric Psychopharmacology & Adult ADHD Program at Mass General, and colleagues have reported similar findings for adults. The new findings appear in Psychopharmacology.
Study Methods
The team systematically searched electronic medical records at Mass General for patients 18–44 years old who were prescribed an amphetamine or methylphenidate product between January 1, 2015, and December 31, 2016. They identified 2,689 such patients with an average age of 29. The index prescription (the first prescription recorded for the period under investigation) was for methylphenidate for 53% of patients and 63% were prescribed a long-acting stimulant.
75% of the patients were randomly assigned to represent a discovery set for model development and the others served as the replication set.
The outcome metric was a renewal of the index prescription, predefined as the issuance of a second prescription within 90 days (or within 120 or 150 days if the index prescription was post-dated two or three months, respectively, as it was for 5% of patients).
Discovery Set Results
42% of patients met the definition of timely prescription renewal.
Predictors—bivariate analysis
- Patients using long-acting formulations were more likely to renew than those on short-acting formulations (45% vs. 39%, P=0.009)
- Patients who received their prescription from a psychiatry clinic were more likely to renew than those whose prescription came from another clinic (52% vs. 32%, P<0.001)
Predictor—multivariate analysis
- Prescription from psychiatry clinic (OR, 2.18; P<0.001)
However, the multivariate model yielded an area under the curve of only 0.61, indicating poor ability of treatment characteristics to predict prescription renewal.
Replication set results
39% of patients met the definition of timely prescription renewal.
Predictors—bivariate analysis
- Patients of races other than white were more likely to renew than white patients (54% vs. 37%, P=0.01)
- Patients who received their prescription from a psychiatry clinic were more likely to renew than those who did not (48% vs. 30%, P<0.001)
The multivariate model again suggested treatment characteristics were poor predictors of stimulant renewal.
Takeaway Messages
Efforts to improve initial stimulant prescription renewal for adults with ADHD may be most needed in the primary care setting. These efforts may also benefit from prescribing long-acting formulations when possible, but the initial renewal rate was still quite low.
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