Who Provides Outpatient Clinical Care for Adults With ADHD? Analysis of Healthcare Claims by Types of Providers Among Private Insurance and Medicaid Enrollees,2021

Abstract

Objective:

To characterize provider types delivering outpatient care overall and through telehealth to U.S. adults with ADHD.

Method:

Using employer-sponsored insurance (ESI) and Medicaid claims, we identified enrollees aged 18 to 64 years who received outpatient care for ADHD in 2021. Billing provider codes were used to tabulate the percentage of enrollees receiving ADHD care from 10 provider types overall and through telehealth.

Results:

Family practice physicians, psychiatrists, and nurse practitioners/psychiatric nurses were the most common providers for adults with ESI, although the distribution of provider types varied across states. Lower percentages of adults with Medicaid received ADHD care from physicians. Approximately half of adults receiving outpatient ADHD care received ADHD care by telehealth.

Conclusion:

Results may inform the development of clinical guidelines for adult ADHD and identify audiences for guideline dissemination and education planning.

Keywords

Adults ADHD physicians nurse practitioners telehealth

Get full access to this article

View all access options for this article.

References

Adamis

Flynn

Wrigley

Gavin

McNicholas

(2022). ADHD in adults: A systematic review and meta-analysis of prevalence studies in outpatient psychiatric clinics. Journal of Attention Disorders, 26(12), 1523–1534. https://doi.org/10.1177/10870547221085503

Adler

L. A.

Farahbakhshian

Romero

Flood

Doll

(2019). Healthcare provider perspectives on diagnosing and treating adults with attention-deficit/hyperactivity disorder. Postgraduate Medicine, 131(7), 461–472. https://doi.org/10.1080/00325481.2019.1647080

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Andrilla

C. H. A.

Patterson

D. G.

Garberson

L. A.

Coulthard

Larson

E. H.

(2018). Geographic variation in the supply of selected behavioral health providers. American Journal of Preventive Medicine, 54(6S3), S199–S207. https://doi.org/10.1016/j.amepre.2018.01.004

Barbaresi

W. J.

Campbell

Diekroger

E. A.

Froehlich

T. E.

Liu

Y. H.

O’Malley

Pelham

W. E. J.

Power

T. J.

Zinner

S. H.

Chan

(2020). Society for Developmental and Behavioral Pediatrics clinical practice guideline for the assessment and treatment of children and adolescents with complex attention-deficit/hyperactivity disorder. Journal of Developmental & Behavioral Pediatrics, 41, S35–S57. https://doi.org/10.1097/DBP.0000000000000770

Bishop

T. F.

Press

M. J.

Keyhani

Pincus

H. A.

(2014). Acceptance of insurance by psychiatrists and the implications for access to mental health care. JAMA Psychiatry, 71(2), 181. https://doi.org/10.1001/jamapsychiatry.2013.2862

Board

A. R.

Guy

Jones

C. M.

Hoots

(2020). Trends in stimulant dispensing by age, sex, state of residence, and prescriber specialty — United States, 2014–2019. Drug and Alcohol Dependence, 217, 108297. https://doi.org/10.1016/j.drugalcdep.2020.108297

Breaux

Dunn

N. C.

Cash

A. R.

Shroff

D. M.

(2023). Telemedicine to manage ADHD. In Matson

J. L.

(Ed.), Clinical handbook of ADHD assessment and treatment across the lifespan (pp. 591-609). Springer International Publishing. https://doi.org/10.1007/978-3-031-41709-2_23

Butt

D. A.

Stephenson

Kalia

Moineddin

(2023). Patient visits and prescriptions for attention-deficit/hyperactivity disorder from 2017-2021: Impacts of COVID-19 pandemic in primary care. PLoS One, 18(3), e0281307. https://doi.org/10.1371/journal.pone.0281307

10.

Callen

E. F.

Clay

T. L.

Alai

Goodman

D. W.

Adler

L. A.

Shields

Faraone

S. V.

(2023). Progress and pitfalls in the provision of quality care for adults with attention deficit hyperactivity disorder in primary care. Journal of Attention Disorders, 27(6), 575–582. https://doi.org/10.1177/10870547231155875

11.

Childress

Sibley

Solanto

M. V.

Wiznitzer

Newcorn

J. H.

(2023). Guidelines in the united states for the diagnosis and treatment of Attention-Deficit/Hyperactivity Disorder in Adults: Why they are needed. Psychiatric Annals, 53(10), 461–469. https://doi.org/10.3928/00485713-20230911-04

12.

Danielson

M. L.

Bohm

M. K.

Newsome

Claussen

A. H.

Kaminski

J. W.

Grosse

S. G.

Siwakoti

Arifkhanova

Bitsko

R. H.

Robinson

L. R.

(2023). Trends in prescription stimulant fills among commercially insured children and adults — United States, 2016–2021. MMWR Morbidity and Mortality Weekly Report, 72(13), 327–332. https://doi.org/10.15585/mmwr.mm7213a1

13.

Lee

Bably

Inneh

I. A.

Patel

(2023). Prevalence and predictors of multimodal treatment among U.S. adults newly diagnosed with ADHD. American Journal of Preventive Medicine. Advance online publication. https://doi.org/10.1016/j.amepre.2023.11.018

14.

Faraone

S. V.

Banaschewski

Coghill

Zheng

Biederman

Bellgrove

M. A.

Newcorn

J. H.

Gignac

Al Saud

N. M.

Manor

Rohde

L. A.

Yang

Cortese

Almagor

Stein

M. A.

Albatti

T. H.

Aljoudi

H. F.

Alqahtani

M. M. J.

Asherson

. . . Wang

(2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 23(7), 519–529. https://doi.org/10.1016/j.neubiorev.2021.01.022

15.

Goodman

D. W.

Mattingly

(2023). Practice guidelines development: The APSARD United States guidelines for the diagnosis and treatment of ADHD in adults. Psychiatric Annals, 53(10), 449–454. https://doi.org/10.3928/00485713-20230911-05

16.

Goodman

D. W.

Surman

C. B.

Scherer

P. B.

Salinas

G. D.

Brown

J. J.

(2012). Assessment of physician practices in adult attention-deficit/hyperactivity disorder. Primary Care Companion to the Journal of Clinical Psychiatry, 14(4). https://doi.org/10.4088/PCC.11m01312

17.

Hart

L. C.

Grosse

S. D.

Danielson

M. L.

Baum

R. A.

Kemper

A. R.

(2021). Changes in provider type and prescription refills among privately insured children and youth with ADHD. Journal of Attention Disorders, 25(14), 2028–2036. https://doi.org/10.1177/108705472095

18.

Hinshaw

S. P.

Nguyen

P. T.

O’Grady

S. M.

Rosenthal

E. A.

(2022). Annual research review: Attention-deficit/hyperactivity disorder in girls and women: Underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480

19.

Hollingdale

Adamo

Tierney

(2021). Impact of COVID-19 for people living and working with ADHD: A brief review of the literature. AIMS Public Health, 8(4), 581–597. https://doi.org/10.3934/publichealth.2021047

20.

Huang

Spottswood

Ghaemi

(2020). Approach to evaluating and managing adult attention-deficit/hyperactivity disorder in primary care. Harvard Review of Psychiatry, 28(2), 100–106. https://doi.org/10.1097/hrp.0000000000000248

21.

Kessler

R.C.

Adler

Barkley

Biederman

Conners

K. C.

Demler

Faraone

S. V.

Greenhill

L. L.

Howes

M. J.

Secnik

Spencer

Ustun

T. B.

Walters

E. E.

Zaslavsky

A. M.

(2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716

22.

Leeb

R. T.

Danielson

M. L.

Bitsko

R. H.

Cree

R. A.

Godfred-Cato

Hughes

M. M.

Powell

Firchow

Hart

L. C.

Lebrun-Harris

L. A.

(2020). Support for transition from adolescent to adult health care among adolescents with and without mental, behavioral, and developmental disorders - United States, 2016-2017. MMWR Morbidity and Mortality Weekly Report, 69(34), 1156–1160. https://doi.org/10.15585/mmwr.mm6934a2

23.

Modesto-Lowe

Boninsegna

Fredeen

(2023). Improving attention-deficit/hyperactivity disorder recognition in family practice. Family Practice. Advance online publication. https://doi.org/10.1093/fampra/cmad026

24.

Sibley

M. H.

Faraone

S. V.

Nigg

J. T.

Surman

C. B. H.

(2023). Sudden increases in U.S. stimulant prescribing: Alarming or not? Journal of Attention Disorders, 27(6), 571–574. https://doi.org/10.1177/10870547231164155

25.

Simon

Czobor

Bálint

Mészáros

Bitter

(2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: Meta-analysis. British Journal of Psychiatry, 194(3), 204–211. https://doi.org/10.1192/bjp.bp.107.048827

26.

Song

Zha

Yang

Zhang

Rudan

(2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health, 11, 04009. https://doi.org/10.7189/jogh.11.04009

27.

U.S. Surgeon General. (2021). Protecting youth mental health: The U.S. Surgeon General’s advisory. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

28.

Waite

Vlam

R. C.

Irrera-Newcomb

Babcock

(2013). The diagnosis less traveled: NPs’ role in recognizing adult ADHD. Journal of the American Association of Nurse Practitioners, 25(6), 302–308. https://doi.org/10.1111/j.1745-7599.2012.00788.x

29.

Willcutt

(2012). The prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490–499. https://doi.org/10.1007/s13311-012-0135-8

30.

Wolraich

M. L.

Hagan

J. F.

Allan

Chan

Davison

Earls

Evans

S. W.

Flinn

S. K.

Froehlich

Frost

Holbrook

J. R.

Lehmann

C. U.

Lessin

H. R.

Okechukwu

Pierce

K. L.

Winner

J. D.

Zurhellen

, & Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactive Disorder. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528

31.

Yeung

Abi-Jaoude

(2022). TikTok and attention-deficit/hyperactivity disorder: A cross-sectional study of social media content quality. Canadian Journal of Psychiatry, 67(12), 899–906. https://doi.org/10.1177/07067437221082854

32.

Zangani

Ostinelli

E. G.

Smith

K. A.

Hong

J. S. W.

Macdonald

Reen

Reid

Vincent

Syed Sheriff

Harrison

P. J.

Hawton

Pitman

Bale

Fazel

Geddes

J. R.

Cipriani

(2022). Impact of the COVID-19 pandemic on the global delivery of mental health services and telemental health: Systematic review. JMIR Mental Health, 9(8), e38600. https://doi.org/10.2196/38600

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.05 MB