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Further evidence of low adherence to stimulant treatment in adult ADHD: an electronic medical record study examining timely renewal of a stimulant prescription

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Abstract

Rationale

ADHD is a prevalent and morbid neurobiological disorder affecting up to 5% of adults. While stimulants have been documented to be safe and effective in adults with ADHD, uncertainties remain about adherence to these treatments.

Objectives

The main aim of this article was to evaluate contemporaneous rates and correlates of adherence to stimulants in adults with ADHD using data from electronic medical records from a large healthcare organization focusing on timely renewal of an initial prescription.

Methods

Subjects were patients 18 to 44 years of age who had been prescribed a stimulant between January 1, 2015, and December 31, 2016. Prescription and sociodemographic data were extracted from the Partners HealthCare Research Patient Data Registry (RPDR). Our outcome metric was renewal of the index stimulant prescription defined as the first prescription recorded in the electronic record for the period under investigation.

Results

We identified 2689 patients with an index prescription for a stimulant medication. Results showed that only 42% of patients renewed their prescriptions in a timely enough fashion to be considered consistently medicated.

Conclusions

Results indicate that adults with ADHD have a low rate of renewal of their initial stimulant prescription indicating poor patient engagement in their treatment for ADHD.

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Funding

This study was financially supported in part by the MGH Pediatric Psychopharmacology Council Fund.

Author information

Authors and Affiliations

  1. Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, YAW 6900, Boston, MA, 02114, USA

    Joseph Biederman, Ronna Fried, Maura DiSalvo, K. Yvonne Woodworth, Itai Biederman, Haley Driscoll, Elizabeth Noyes & Roy H. Perlis

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Joseph Biederman, Ronna Fried & Roy H. Perlis

  3. Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen V. Faraone

  4. K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway

    Stephen V. Faraone

  5. Center for Quantitative Health, Massachusetts General Hospital, Boston, MA, USA

    Roy H. Perlis

Authors
  1. Joseph Biederman
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  2. Ronna Fried
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  3. Maura DiSalvo
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  4. K. Yvonne Woodworth
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  5. Itai Biederman
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  6. Haley Driscoll
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  7. Elizabeth Noyes
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  8. Stephen V. Faraone
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  9. Roy H. Perlis
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Corresponding author

Correspondence to Joseph Biederman.

Ethics declarations

This study was approved by the Institutional Review Board at Massachusetts General Hospital.

Conflict of interest

Dr. Biederman’s program has received departmental royalties from a copyrighted rating scale used for ADHD diagnoses, paid by Ingenix, Prophase, Shire, Bracket Global, Sunovion, and Theravance; these royalties were paid to the Department of Psychiatry at MGH. Through MGH corporate licensing, he has a US patent (#14/027,676) for a non-stimulant treatment for ADHD, and a patent pending (#61/233,686) on a method to prevent stimulant abuse.

Dr. Biederman reports grants from AACAP, grants from Feinstein Institute for Medical Research, grants from Food & Drug Administration, grants from Headspace, Inc., grants from Lundbeck AS, grants from Neurocentria, Inc., grants from NIDA, grants from Pfizer Pharmaceuticals, grants from Roche TCRC, Inc., grants from Shire Pharmaceuticals, Inc., grants from Sunovion Pharmaceuticals, Inc., grants from NIH, other from Avekshan LLC, personal fees from Akili, personal fees from Shire, personal fees from Alcobra, personal fees from Arbor Pharmaceuticals, Inc., grants from Department of Defense, grants from PamLab, personal fees from Aevi Genomics, personal fees from Guidepoint, personal fees from Medgenics, grants from Merck, grants from SPRITES, personal fees from Ironshore, personal fees from Piper Jaffray, personal fees from MGH Psychiatry Academy, and personal fees from APSARD, outside the submitted work; and Dr. Biederman’s program has received departmental royalties from a copyrighted rating scale used for ADHD diagnoses, paid by Ingenix, Prophase, Shire, Bracket Global, Sunovion, and Theravance; these royalties were paid to the Department of Psychiatry at MGH. Through MGH corporate licensing, he has a US patent (#14/027,676) for a non-stimulant treatment for ADHD, and a patent pending (#61/233,686) on a method to prevent stimulant abuse.

Dr. Ronna Fried received grant research support from Shire Pharmaceuticals and Roche Pharmaceuticals in the past 36 months.

Maura DiSalvo, K. Yvonne Woodworth, Itai Biederman, Haley Driscoll, and Elizabeth Noyes have no conflicts to disclose.

In the past 3 years, Dr. Faraone received income, potential income, travel expenses continuing education support and/or research support from Tris, Otsuka, Arbor, Ironshore, Shire, Akili Interactive Labs, VAYA, Ironshore, Sunovion, Supernus, and Genomind. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD.

Dr. Perlis reports personal fees from Psy Therapeutics, personal fees from Genomind, and personal fees from RID Ventures, outside the submitted work.

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Biederman, J., Fried, R., DiSalvo, M. et al. Further evidence of low adherence to stimulant treatment in adult ADHD: an electronic medical record study examining timely renewal of a stimulant prescription. Psychopharmacology 237, 2835–2843 (2020). https://doi.org/10.1007/s00213-020-05576-y

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  • DOI: https://doi.org/10.1007/s00213-020-05576-y

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