PNP4: PHYSICIAN PERCEPTIONS ON THE USE OF MEDICATIONS FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER

Abstract

Children with ADHD require more than 1.5 times more pri- mary care visits, 9 times more outpatient mental health visits, and 3 times more prescriptions per year, compared to children without ADHD. 4 The total annual health care costs for children with ADHD are estimated to be more than twice that of children without the disorder, and these costs become significantly larg- er when a child with ADHD is diagnosed with a comorbid con- dition. 4-6 In a study conducted in the United States using data from the 1996 Medical Expenditure Panel Survey, the unad- justed mean health care expenditures for a child with ADHD were $1,151, much higher than the $661 in expenditures incurred by a healthy child in that same year. 6 ABSTRACT BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent mental health condition, occurring in 3% to 5% of school-aged children. Although stimulant medications are a recommended treatment for this disorder, physi- cians' views of these medications have not been systematically evaluated. OBJECTIVE: This study examined physician-prescriber perceptions of using medications to treat ADHD symptoms in children or adolescents. METHODS: A survey was developed with 4 physicians expert in treating ADHD in children. The survey was pilot-tested with a sample of 10 practicing physicians. A sample of 1,000 physicians, with a history of prescribing stimulant medications to children or adolescents, was randomly selected and mailed a 30-item survey. Items were rated on a 7-point response scale (strongly agree, agree, slightly agree, undecided, slightly disagree, disagree, strongly disagree). RESULTS: A total of 365 physicians responded to the survey, for a 37% response rate. More than 92% of respondents strongly agreed or agreed that ADHD symp- toms cause problems in pediatric patients and stimulants are effective in treating ADHD. The stimulant drug side effects of decreased appetite or weight loss, sleep disruption, and exacerbation of anxiety were a concern (strongly agree or agree response) for 32%, 50%, and 22% of physicians, respectively. Diversion of ADHD medication was a concern for 19% of respondents. Physicians reported that con- trolled medications for children or adolescents with ADHD are a burden for them- selves (32% strongly agreed or agreed), for their staff (37% strongly agreed or agreed), and for parents (40% strongly agreed or agreed). Approximately 38% of physicians responded that they would prefer prescribing a nonstimulant medica- tion with a U.S. Food and Drug Administration indication for treating children or adolescents instead of a stimulant medication, and 58% would prefer prescribing a noncontrolled medication that does not have evidence of abuse potential ver- sus one that is controlled and has evidence of abuse potential. CONCLUSION: Although physicians overwhelmingly perceive stimulant medica- tions as being effective for treating ADHD symptoms in children or adolescents, many would prefer a nonstimulant medication. While many physicians consider the side effects of the stimulants easily managed, others are concerned about prescribing stimulants because of their side effects, risk of diversion, and admin- istrative burden. The majority of physicians would prefer to prescribe a noncon- trolled medication without abuse potential instead of a controlled medication to treat children or adolescents with ADHD.