Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr. 2019 Oct;213:155-162.e1. doi: 10.1016/j.jpeds.2019.06.025. Epub 2019 Jul 9.
To examine patient- and provider-level factors associated with receiving attention-deficit/hyperactivity disorder (ADHD) medication treatment in a community care setting. We hypothesized that the likelihood of ADHD medication receipt would be lower in groups with specific patient sociodemographic (eg, female sex, race other than white) and clinical (eg, comorbid conditions) characteristics as well as physician characteristics (eg, older age, more years since completing training).
A retrospective cohort study was conducted with 577 children (mean age, 7.8 years; 70% male) presenting for ADHD to 50 community-based practices. The bivariate relationship between each patient- and physician-level predictor and whether the child was prescribed ADHD medication was assessed. A multivariable model predicting ADHD medication prescription was conducted using predictors with significant (P < .05) bivariate associations.
Sixty-nine percent of children were prescribed ADHD medication in the year after initial presentation for ADHD-related concerns. Eleven of 31 predictors demonstrated a significant (P < .05) bivariate relationship with medication prescription. In the multivariable model, being male (OR, 1.34; 95% CI, 1.01-1.78; P = .02), living in a neighborhood with higher medical expenditures (OR, 1.11 for every $100 increase; 95% CI, 1.03-1.21; P = .005), and higher scores on parent inattention ratings (OR, 1.06; 95% CI, 1.03-1.10; P < .0001) increased the likelihood of ADHD medication prescription.
We found that some children, based on sociodemographic and clinical characteristics, are less likely to receive an ADHD medication prescription. An important next step will be to examine the source and reasons for these disparities in an effort to develop strategies for minimizing treatment barriers.
在社区护理环境中，研究与接受注意力缺陷/多动障碍 (ADHD) 药物治疗相关的患者和提供者因素。我们假设，具有特定患者社会人口统计学（例如，女性，非白种人）和临床（例如，合并症）特征以及医生特征（例如，年龄较大，完成培训后的年限较长）的组中，接受 ADHD 药物治疗的可能性较低。
对 577 名（平均年龄 7.8 岁；70%为男性）因 ADHD 到 50 个社区实践就诊的儿童进行了回顾性队列研究。评估了每个患者和医生水平的预测因子与儿童是否被处方 ADHD 药物之间的双变量关系。使用具有显著（P<.05）双变量关联的预测因子进行了预测 ADHD 药物处方的多变量模型。
在首次出现与 ADHD 相关的问题后的一年中，69%的儿童被处方 ADHD 药物。有 31 个预测因素中的 11 个与药物处方有显著（P<.05）的双变量关系。在多变量模型中，男性（OR，1.34；95% CI，1.01-1.78；P=.02）、居住在医疗支出较高的社区（OR，每增加 100 美元增加 1.11；95% CI，1.03-1.21；P=.005）和父母注意力评分较高（OR，1.06；95% CI，1.03-1.10；P<.0001）的儿童更有可能开 ADHD 药物处方。
我们发现，根据社会人口统计学和临床特征，一些儿童不太可能开 ADHD 药物处方。下一步将重要的是检查这些差异的来源和原因，以便制定策略来尽量减少治疗障碍。
