Trends in Use of Telemedicine for Stimulant Initiation Among Children and Adults

Abstract

Objective: The authors sought to examine trends in stimulant initiation and follow-up care for attention-deficit hyperactivity disorder (ADHD) via telemedicine.

Methods: This retrospective longitudinal study used national, deidentified commercial health insurance outpatient claims among children (ages 2-17 years; N=535,629) and adults (ages 18-64 years; N=2,116,160) from January 2019 through April 2022. Regression analyses were used to examine risk for stimulant initiation, whether initiation occurred via telemedicine or in-person care, and receipt of a follow-up visit.

Results: The mean monthly adjusted number of stimulant initiations per 100,000 enrollees was similar for children before and during the COVID-19 pandemic (prepandemic, 57 initiations; during pandemic, 56 initiations) but increased for adults (prepandemic, 27 initiations; during pandemic, 33 initiations). Initiations via telemedicine peaked at 53%-57% in April 2020 and dropped to about 14% among children and 28% among adults in April 2022. Telemedicine initiations were significantly more common among psychiatrists than among other prescribers (OR=3.70, 95% CI=3.38-4.06 [children]; OR=3.02, 95% CI=2.87-3.17 [adults]) and less common for rural residents (OR=0.57, 95% CI=0.40-0.82 [children]; OR=0.75, 95% CI=0.61-0.92 [adults]). Follow-up care was significantly more common among individuals whose care was initiated via telemedicine than among those receiving in-person care (OR=1.09, 95% CI=1.00-1.19 [children]; OR=1.61, 95% CI=1.53-1.69 [adults]).

Conclusions: Many stimulant treatments were initiated via telemedicine. Proposed rules to prohibit controlled substance prescribing without an in-person evaluation would require significant changes in current practice, potentially limiting access to stimulant medications for ADHD.

Keywords: Amphetamine; Attention deficit disorders; Child psychiatry; Stimulants; Telecommunications.

Figure 1:

Percentage of child (age 2-17) and adult (age 18-64) enrollees who initiate stimulants, January 2019-April 2022

Figure 2:

Percentage of stimulant medication initiations conducted via telemedicine for children 2-17 and adults 18-64, January 2020 through April 2022 Note: Results from logistic regression model of receipt of a stimulant initiation via telemedicine are available in Exhibit A.2. The vertical line indicates the initiation of the COVID-19 public health emergency declaration.