The impact of long-acting medications on attention-deficit/hyperactivity disorder treatment disparities.
The impact of long-acting medications on attention-deficit/hyperactivity disorder treatment disparities.
复制标题
长效药物对注意力缺陷/多动症治疗差异的影响。
DOI：
10.1089/cap.2012.0019
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发表时间：
2013
影响因子：
1.9
通讯作者：
McGuire,Thomas
中科院分区：
文献类型：
--
作者：
Saloner,Brendan;Fullerton,Catherine;McGuire,Thomas
目的：长效兴奋剂增加了许多被诊断为注意缺陷多动障碍（ADHD）的儿童的药物依从性，但尚不清楚这种增加是否在种族/民族群体中相似。我们的目的是确定在20世纪90年代引入长效兴奋剂后，白色、黑人和西班牙裔ADHD诊断儿童和青少年的药物利用和依从性差异是否缩小。方法：我们对1996-2005财政年度的佛罗里达医疗补助索赔数据进行了回顾性分析。在三个横截面中，我们确定了3-17岁的儿童和青少年至少有两个ADHD诊断。我们使用线性回归模型的差异在研究期间的任何ADHD药物的利用（利用长效药物特别）和药物治疗的依从性，并确定患者的水平，治疗设置，和地理因素的disparities.Results：虽然ADHD药物利用率较低的ADHD诊断的少数民族比白人在所有年份，少数民族一样有可能切换到长效药物的白人。长效药物扩散后处方天数的增加在白色和黑人药物使用者中相当（分别为40和43天），但西班牙裔（27天）较低。地理和供应商设置有助于解释整体药物利用的差异，但在坚持的差异没有解释任何的协variates.Conclusions：尽管相当于切换到长效药物在研究期间，少数民族继续利用所有ADHD药物少于白人，并为较短的时间。提供者设置有助于解释ADHD药物利用率的差距。高容量，少数群体服务提供者是未来干预措施的潜在目标，这些干预措施与改善有关药物和药物开始后的后续行动的沟通有关。
Objective:Long-acting stimulants have increased medication adherence for many children diagnosed with attention deficit/hyperactivity disorder (ADHD), but it is unknown whether the increase has been similar across racial/ethnic groups. Our objective was to determine whether differences in medication utilization and adherence among white, black, and Hispanic ADHD-diagnosed children and adolescents narrowed following the introduction of long-acting stimulants in the 1990s.Methods:We conducted a retrospective analysis of Florida Medicaid claims data from fiscal years 1996–2005. At each of three cross sections, we identified children and adolescents 3–17 years of age with at least two claims with an ADHD diagnosis. We used linear regression to model disparities over the study period in utilization of any ADHD medications (utilization of long-acting medication specifically) and medication adherence, and identified patient level, treatment setting, and geographic contributors to disparities.Results:Although ADHD medication utilization was lower for ADHD-diagnosed minorities than whites in all years, minorities were as likely as whites to switch to long-acting medications. The increase in prescribed days following long-acting medication diffusion was comparable for white and black medication users (40 and 43 days, respectively), but lower for Hispanics (27 days). Geography and provider setting helped to explain disparities in medication utilization overall, but disparities in adherence were not explained by any of the covariates.Conclusions:Despite equivalent switching to long-acting medications in the study period, minorities continued to utilize all ADHD medications less than did whites, and for shorter periods. Provider setting helps explain the ADHD medication utilization gap. High-volume, minority-serving providers are potential targets for future interventions related to improved communication about medication and follow-up after medication initiation.