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. 2017 Jun;62(6):393-402.
doi: 10.1177/0706743716689055. Epub 2017 Jan 19.

ADHD Treatment in Primary Care: Demographic Factors, Medication Trends, and Treatment Predictors

Tanya S Hauck  1 , Cindy Lau  2 , Laura Li Foa Wing  2 , Paul Kurdyak  1   2   3   4 , Karen Tu  2   4   5   6
Affiliations

ADHD Treatment in Primary Care: Demographic Factors, Medication Trends, and Treatment Predictors

Tanya S Hauck et al. Can J Psychiatry. 2017 Jun.

Abstract
in English, French

Background: The aim of this study is to determine the prevalence and characteristics of youth with attention-deficit hyperactivity disorder (ADHD) in Ontario, Canada, and to determine the predictors of psychotropic medication prescriptions in youth with ADHD.

Method: This is a cross-sectional retrospective chart abstraction of more than 250 000 medical records from youth aged 1 to 24 years in a large geographical region in Ontario, Canada, linked to population-based health administrative data. A total of 10 000 charts were randomly selected and manually reviewed using predetermined criteria for ADHD and comorbidities. Prevalence, comorbidities, demographic indicators, and health service utilization characteristics were calculated. Predictors of treatment characteristics were determined using logistic regression modelling.

Results: The prevalence of ADHD was 5.4% (7.9% males, 2.7% females). Youth with ADHD had significant psychiatric comorbidities. The majority (70.0%) of ADHD patients received prescriptions for stimulant or nonstimulant ADHD medication. Antipsychotic prescriptions were provided to 11.9% of ADHD patients versus 0.9% of patients without ADHD. Antidepressant prescriptions were provided to 19.8% versus 5.4% of patients with and without ADHD, respectively. Predictors of antidepressant prescriptions were increasing age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.07 to 1.21), psychiatric consultation (OR, 2.04; 95% CI, 1.16 to 3.58), and diagnoses of both anxiety and depression (OR, 18.4; 95% CI, 8.03 to 42.1), whereas the only predictor of antipsychotic prescriptions was psychiatric consultation (OR, 3.85; 95% CI, 2.11 to 7.02).

Conclusions: Youth with ADHD have more psychiatric comorbidities than youth without ADHD. The majority of youth with ADHD received stimulant medications, and a significant number received additional psychotropic medications, with psychiatric consultation predicting medication use.

Objectif:: Déterminer la prévalence et les caractéristiques des adolescents souffrant du trouble de déficit de l’attention avec hyperactivité (TDAH) en Ontario, au Canada. Déterminer les prédicteurs des prescriptions de médicaments psychotropes chez les adolescents souffrant du TDAH.

Méthode:: Nous présentons une extraction transversale rétrospective des données de plus de 250 000 dossiers médicaux d’adolescents âgés de 1 à 24 ans d’une grande région géographique de l’Ontario, au Canada, liée aux données de santé administratives dans la population. Dix mille dossiers ont été choisis au hasard et examinés manuellement à l’aide de critères prédéterminés pour le TDAH et les comorbidités. La prévalence, les comorbidités, les indicateurs démographiques et les caractéristiques de l’utilisation des services de santé ont été calculés. Les prédicteurs des caractéristiques de traitement ont été déterminés à l’aide d’un modèle de régression logistique.

Résultats:: La prévalence du TDAH était de 5,4% (7,9% hommes, 2,7% femmes). Les adolescents souffrant d’un TDAH avaient des comorbidités psychiatriques significatives. La majorité (70,0%) des patients du TDAH recevait des prescriptions de médicaments du TDAH stimulants ou non stimulants. Des prescriptions d’antipsychotiques ont été données à 11,9% des patients du TDAH, contre 0,9% des patients sans TDAH. Des prescriptions d’antidépresseurs ont été offertes à 19,8% contre 5,4% des patients avec et sans TDAH, respectivement. Les prédicteurs des prescriptions d’antidépresseurs étaient l’augmentation de l’âge (RC 1,14; IC à 95% 1,07 à 1,21), la consultation psychiatrique (RC 2,04; IC à 95% 1,16 à 3,58) et les diagnostics d’anxiété et de dépression (RC 18,4; IC à 95% 8,03 à 42,1), alors que le seul prédicteur de prescriptions d’antipsychotiques était la consultation psychiatrique (RC 3,85; IC à 95% 2,11 à 7,02).

Conclusions:: Les adolescents souffrant du TDAH ont plus de comorbidités psychiatriques que les adolescents qui n’en souffrent pas. La majorité des adolescents souffrant du TDAH a reçu des médicaments stimulants et un nombre significatif a reçu des médicaments psychotropes additionnels. La consultation psychiatrique prédisait l’utilisation de médicaments.

Keywords: ADHD; antipsychotics; child and adolescent psychiatry; epidemiology; pharmacoepidemiology.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Method of chart abstraction and validation, including criteria applied to select charts and diagnoses used in abstraction. All possible and definite cases were reviewed by a psychiatry resident (T.S.H.), resulting in 536 confirmed charts with a definite attention-deficit hyperactivity disorder diagnosis.
Figure 2.
Figure 2.
(A) Antipsychotic prescriptions by age and attention-deficit hyperactivity disorder (ADHD) diagnosis. (B) Antidepressant prescriptions by age and ADHD diagnosis. *Data suppressed due to small cell size (≤5 cases).
See this image and copyright information in PMC

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