Sankaranarayanan Jayashri, Puumala Susan E, Kratochvil Christopher J
Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986045 Nebraska Medical Center, Omaha, NE 68198, USA.
Curr Med Res Opin. 2006 Aug;22(8):1475-91. doi: 10.1185/030079906X112615.
To determine national-estimates and characteristics of United States (US) ambulatory care visits made by adults, aged 18 years or older, with attention-deficit hyperactivity disorder (ADHD) diagnosis, treatment patterns, and significant factors associated with adult-ADHD treatment.
Retrospective analyses were conducted of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey over a combined 8-year period (1996-2003). Mental-health disorder (including ADHD) visits were identified using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnostic codes. Significant factors of adult-ADHD treatment were determined in multivariable logistic regression analyses.
An estimated total 10.5 million ambulatory-ADHD visits accounted for 3.5% of 301 million adult mental-health disorder visits. The census-adjusted visit rate was 0.3-0.4%. Increasing in numbers from the year 2000, ADHD visits were most often to psychiatrists, by Caucasian men, aged 18 to 40 years. Significantly fewer ADHD visits without, versus with, psychiatric comorbidity (mainly depression) received various treatments-- behavioral (46% vs. 83%), antidepressant (18% vs. 66%), or combined behavioral and ADHD-specific (stimulant or atomoxetine) pharmacotherapy (36% vs. 57%) respectively. However, more ADHD visits without than with psychiatric comorbidity received ADHD-specific pharmacotherapy alone (76% vs. 68%) or no treatment (14% vs. 6.5%). At ADHD visits, adjusting for gender, age, and US census geographic-region, psychiatric comorbidity (odds ratio [OR], 6.5, 95% confidence interval [Cl], 3.5-12.4, p < 0.05) and self-pay reimbursement-source (OR, 2.7, 95% Cl, 1.3-5.7, p < 0.05) significantly increased the likelihood of behavioral treatment. Insurance reimbursement-sources other than private and self-pay significantly decreased the likelihood of an ADHD-specific pharmacotherapy (OR, 0.4, 95% Cl, 0.2-0.7, p < 0.05) or any ADHD-treatment (OR, 0.2, 95% Cl, 0.1-0.5, p < 0.05).
Adult-ADHD visits have increased in recent years, with a census-adjusted visit rate of 0.3-0.4%. Psychiatric comorbidity and reimbursement-source were associated with ADHD-treatment. Limited treatment may be a significant problem in US-ambulatory care. It is important to continue validation studies, educate providers, examine the efficacy of multimodal-treatments, and study insurance-related barriers to adult ADHD-treatment.
确定美国18岁及以上患有注意力缺陷多动障碍（ADHD）的成年人的门诊就诊全国估计数及特征、治疗模式以及与成人ADHD治疗相关的重要因素。
对国家门诊医疗调查和国家医院门诊医疗调查在1996 - 2003年这8年期间进行回顾性分析。使用国际疾病分类第九版临床修订本（ICD - 9 - CM）诊断代码识别精神健康障碍（包括ADHD）就诊情况。在多变量逻辑回归分析中确定成人ADHD治疗的重要因素。
估计共有1050万次门诊ADHD就诊，占3.01亿次成人精神健康障碍就诊的3.5%。经人口普查调整后的就诊率为0.3% - 0.4%。自2000年起数量不断增加，ADHD就诊最常发生在18至40岁的白人男性的精神科医生处。与伴有精神科合并症（主要是抑郁症）的ADHD就诊相比，不伴有精神科合并症的ADHD就诊接受各种治疗的比例明显较低——行为治疗（46%对83%）、抗抑郁药治疗（18%对66%）或行为治疗与ADHD特异性（兴奋剂或托莫西汀）药物联合治疗（36%对57%）。然而，不伴有精神科合并症的ADHD就诊比伴有精神科合并症的就诊接受单纯ADHD特异性药物治疗的比例更高（76%对68%）或未接受治疗的比例更高（14%对6.5%）。在ADHD就诊中，在对性别、年龄和美国人口普查地理区域进行调整后，精神科合并症（优势比[OR]为6.5，95%置信区间[Cl]为3.5 - 12.4，p < 0.05）和自费报销来源（OR为2.7，95% Cl为1.3 - 5.7，p < 0.05）显著增加了行为治疗的可能性。除私人和自费之外的保险报销来源显著降低了ADHD特异性药物治疗（OR为0.4，95% Cl为0.2 - 0.7，p < 0.05）或任何ADHD治疗（OR为0.2，95% Cl为0.1 - 0.5，p < 0.05）的可能性。
近年来成人ADHD就诊有所增加，经人口普查调整后的就诊率为0.3% - 0.4%。精神科合并症和报销来源与ADHD治疗相关。有限的治疗可能是美国门诊医疗中的一个重大问题。继续进行验证研究、对医疗服务提供者进行教育、检查多模式治疗的疗效以及研究与成人ADHD治疗相关的保险障碍很重要。
