This study aims to investigate the factors influencing medication adherence among adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and impact of central nervous system stimulants (CNS) adherence on healthcare utilization (HCU). Methods: This was a cross-sectional study using Medical Expenditure Panel Survey 2013 to 2019, with participants (≥18 years of age) with ADHD and had at least one CNS prescription. Multivariate logistic and linear regression were utilized to evaluate the medication adherence and its impact on HCU, respectively.
Result:
Total 798 (10,718,005 weighted) ADHD patients, were mostly White (81%), aged between 18 and 25 (35%), and non-adherent to CNS (65%). The use of extended-release medications (OR = 1.51 [1.03, 2.23]) and new users (OR = 3.46 [2.12, 5.63], p ≤ .05) were positively associated with medication adherence. The adherent group utilized more outpatient visits (0.04 vs. 0.46) and prescription refills (18.38 vs. 31.25) compared to non-adherent.
Conclusion:
Our findings can be applied to improve the medication adherence, patient education, and optimize intervention for adults with ADHD.
AdlerL. D.NierenbergA. A. (2010). Review of medication adherence in children and adults with ADHD. Postgraduate Medicine, 122(1), 184–191. https://doi.org/10.3810/pgm.2010.01.2112
2.
Agnew-BlaisJ. C.PolanczykG. v.DaneseA.WertzJ.MoffittT. E.ArseneaultL. (2016). Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood. JAMA Psychiatry, 73(7), 713–720. https://doi.org/10.1001/jamapsychiatry.2016.0465
3.
Barnard-BrakL.KudeseyC. (2022). Reported side or adverse effects associated with medication nonadherence among adolescents and young adults with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 32(10), 539–542. https://doi.org/10.1089/cap.2022.0043
4.
Barnard-BrakL.MarquesA.KudeseyC. (2023). Medication non-adherence and tolerance breaks among adolescents and young adults with ADHD. Journal of Attention Disorders, 27(9), 1020–1026. https://doi.org/10.1177/10870547231167562
5.
BejerotS.RydénE. M.ArlindeC. M. (2010). Two-year outcome of treatment with central stimulant medication in adult attention-deficit/hyperactivity disorder. The Journal of Clinical Psychiatry, 71(12), 1590–1597. https://doi.org/10.4088/JCP.09m05168pur
6.
BijlengaD.KulcuS.van GellecumT.EryigitZ.KooijJ. J. S. (2017). Persistence and adherence to psychostimulants, and psychological well-being up to 3 years after specialized treatment of adult attention-deficit/hyperactivity disorder. Journal of Clinical Psychopharmacology, 37(6), 689–696. https://doi.org/10.1097/JCP.0000000000000787
7.
BrownM.SinskyC. A. (2018). Medication adherence improve patient outcomes and reduce costs developed in partnership with. https://edhub.ama-assn.org/
8.
Brunkhorst-KanaanN.LibutzkiB.ReifA.LarssonH.McNeillR. v.Kittel-SchneiderS. (2021). ADHD and accidents over the life span: A systematic review. Neuroscience & Biobehavioral Reviews, 125, 582–591. https://doi.org/10.1016/j.neubiorev.2021.02.002
9.
BurnierM. (2019). Is there a threshold for medication adherence? Lessons learnt from electronic monitoring of drug adherence. Frontiers in Pharmacology, 9, 1540. https://doi.org/10.3389/fphar.2018.01540
10.
CayeA.RochaT. B.-M.AnselmiL.MurrayJ.MenezesA. M. B.BarrosF. C.GonçalvesH.WehrmeisterF.JensenC. M.SteinhausenH.-C.SwansonJ. M.KielingC.RohdeL. A. (2016). Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood. JAMA Psychiatry, 73(7), 705. https://doi.org/10.1001/jamapsychiatry.2016.0383
11.
Centers for Disease Control and Prevention. (2021). What is ADHD?
12.
ChangT.BridgesJ. F. P.BynumM.JacksonJ. W.JosephJ. J.FischerM. A.LuB.DonneyongM. M. (2021). Association between patient-clinician relationships and adherence to antihypertensive medications among black adults: An observational study design. Journal of the American Heart Association, 10(14), e019943. https://doi.org/10.1161/JAHA.120.019943
13.
ChungW.JiangS.-F.PaksarianD.NikolaidisA.CastellanosF. X.MerikangasK. R.MilhamM. P. (2019). Trends in the prevalence and incidence of attention-deficit/hyperactivity disorder among adults and children of different racial and ethnic groups. JAMA Network Open, 2(11), e1914344. https://doi.org/10.1001/jamanetworkopen.2019.14344
14.
CutlerR. L.Fernandez-LlimosF.FrommerM.BenrimojC.Garcia-CardenasV. (2018). Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open, 8(1), e016982. https://doi.org/10.1136/bmjopen-2017-016982
15.
DanielsonM. L.BitskoR. H.GhandourR. M.HolbrookJ. R.KoganM. D.BlumbergS. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860
16.
DarredeauC.BarrettS. P.JardinB.PihlR. O. (2007). Patterns and predictors of medication compliance, diversion, and misuse in adult prescribed methylphenidate users. Human Psychopharmacology: Clinical and Experimental, 22(8), 529–536. https://doi.org/10.1002/hup.883
17.
DoshiJ. A.HodgkinsP.KahleJ.SikiricaV.CangelosiM. J.SetyawanJ.ErderM. H.NeumannP. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 990–1002.e2. https://doi.org/10.1016/j.jaac.2012.07.008
18.
FaraoneS. v.BanaschewskiT.CoghillD.ZhengY.BiedermanJ.BellgroveM. A.NewcornJ. H.GignacM.al SaudN. M.ManorI.RohdeL. A.YangL.CorteseS.AlmagorD.SteinM. A.AlbattiT. H.AljoudiH. F.AlqahtaniM. M. J.AshersonP.. . . WangY. (2021). The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
19.
ForbesC. A.DeshpandeS.Sorio-VilelaF.KutikovaL.DuffyS.Gouni-BertholdI.HagströmE. (2018). A systematic literature review comparing methods for the measurement of patient persistence and adherence. Current Medical Research and Opinion, 34(9), 1613–1625. https://doi.org/10.1080/03007995.2018.1477747
20.
GajriaK.LuM.SikiricaV.GrevenP.ZhongY.QinP.XieJ. (2014). Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder: A systematic literature review. Neuropsychiatric Disease and Treatment, 10, 1543–1569. https://doi.org/10.2147/NDT.S65721
21.
GeffenJ.ForsterK. (2018). Treatment of adult ADHD: A clinical perspective. Therapeutic Advances in Psychopharmacology, 8(1), 25–32. https://doi.org/10.1177/2045125317734977
22.
GillespieC. W.MorinP. E.TuckerJ. M.PurvisL. (2020). Medication adherence, health care utilization, and spending among privately insured adults with chronic conditions in the United States, 2010-2016. The American Journal of Medicine, 133(6), 690–704.e19. https://doi.org/10.1016/j.amjmed.2019.12.021
23.
GinsbergY.QuinteroJ.AnandE.CasillasM.UpadhyayaH. P. (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients. The Primary Care Companion For CNS Disorders, 16, PCC.13r01600. https://doi.org/10.4088/PCC.13r01600
24.
HalmøyA.FasmerO. B.GillbergC.HaavikJ. (2009). Occupational outcome in adult ADHD: Impact of symptom profile, comorbid psychiatric problems, and treatment. Journal of Attention Disorders, 13(2), 175–187. https://doi.org/10.1177/1087054708329777
25.
JimmyB.JoseJ. (2011). Patient medication adherence: Measures in daily practice. Oman Medical Journal, 26(3), 155–159. https://doi.org/10.5001/omj.2011.38
26.
Kamimura-NishimuraK. I.BrinkmanW. B.FroehlichT. E. (2019). Strategies for improving ADHD medication adherence. Current Psychiatry, 18(8), 25–38.
27.
KhanM. U.AslaniP. (2019). A review of factors influencing the three phases of medication adherence in people with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 29(6), 398–418. https://doi.org/10.1089/cap.2018.0153
28.
KooijJ. J. S.RöslerM.PhilipsenA.WächterS.DejonckheereJ.van der KolkA.van AgthovenM.SchäubleB. (2013). Predictors and impact of non-adherence in adults with attention-deficit/hyperactivity disorder receiving OROS methylphenidate: Results from a randomized, placebo-controlled trial. BMC Psychiatry, 13(1), 36. https://doi.org/10.1186/1471-244X-13-36
29.
KüpperT.HaavikJ.DrexlerH.Ramos-QuirogaJ. A.WermelskirchenD.PrutzC.SchaubleB. (2012). The negative impact of attention-deficit/hyperactivity disorder on occupational health in adults and adolescents. International Archives of Occupational and Environmental Health, 85(8), 837–847. https://doi.org/10.1007/s00420-012-0794-0
30.
LiY.LiuW.ZhuY.LiuX.WintersteinA. G. (2017). Determinants of pharmacological treatment initiation and persistence in publicly insured adults with attention-deficit/hyperactivity disorder. Journal of Clinical Psychopharmacology, 37(5), 546–554. https://doi.org/10.1097/JCP.0000000000000759
31.
O’CallaghanP. (2014). Adherence to stimulants in adult ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 6(2), 111–120. https://doi.org/10.1007/s12402-014-0129-y
32.
OlfsonM.MarcusS.WanG. (2009). Stimulant dosing for children with ADHD: A medical claims analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 48(1), 51–59. https://doi.org/10.1097/CHI.0b013e31818b1c8f
33.
PosnerJ.KassE.HulvershornL. (2014). Using stimulants to treat ADHD-related emotional lability. Current Psychiatry Reports, 16(10), 478. https://doi.org/10.1007/s11920-014-0478-4
34.
Prieto-MerinoD.MulickA.ArmstrongC.HoultH.FawcettS.EliassonL.CliffordS. (2021). Estimating proportion of days covered (PDC) using real-world online medicine suppliers’ datasets. Journal of Pharmaceutical Policy and Practice, 14(1), 113. https://doi.org/10.1186/s40545-021-00385-w
35.
SafrenS. A.DuranP.YovelI.PerlmanC. A.SprichS. (2007). Medication adherence in psychopharmacologically treated adults with ADHD. Journal of Attention Disorders, 10(3), 257–260. https://doi.org/10.1177/1087054706292165
36.
SemerciB.TaskıranS.TufanE.ŞanlıI. (2016). Factors predicting treatment adherence in patients with adult attention-deficit/hyperactivity disorder: A preliminary study. ADHD Attention Deficit and Hyperactivity Disorders, 8(3), 139–147. https://doi.org/10.1007/s12402-016-0194-5
37.
ShahC. H.BalkrishnanR.DiabyV.XiaoH. (2020). Examining factors associated with adherence to hormonal therapy in breast cancer patients. Research in Social and Administrative Pharmacy, 16(4), 574–582. https://doi.org/10.1016/j.sapharm.2019.08.005
38.
ShapiroK.BombatchC.GarrettS.DrewA.VeverkaA. (2020). 2020 NAPLEX Course Book (2020th ed.). RxPrep.
39.
SobanskiE.RetzW.FischerR.OseC.AlmB.HennigO.RöslerM. (2014). Treatment adherence and persistence in adult ADHD: Results from a twenty-four week controlled clinical trial with extended release methylphenidate. European Psychiatry, 29(5), 324–330. https://doi.org/10.1016/j.eurpsy.2013.08.004
40.
SpaldingW.FarahbakhshianS.MaculaitisM. C.PeckE. Y.GorenA. (2022). The Association of oral stimulant medication adherence with work productivity among adults with ADHD. Journal of Attention Disorders, 26(6), 831–842. https://doi.org/10.1177/10870547211020113
41.
TorgersenT.GjervanB.NordahlH. M.RasmussenK. (2012). Predictive factors for more than 3 years’ duration of central stimulant treatment in adult attention-deficit/hyperactivity disorder. Journal of Clinical Psychopharmacology, 32(5), 645–652. https://doi.org/10.1097/JCP.0b013e3182664dbc
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