Overlapping Prescriptions of Stimulants for Children and Adolescents With Attention-Deficit Hyperactivity Disorder

Chen, Chuan-Yu; Yeh, Hsueh‐Han; Fang, Shao-You; Wu, Erin Chia-Hsuan; Chang, I‐Shou; Lin, Keh‐Ming

doi:10.1176/appi.ps.201100473

Cited by 6 publications

(13 citation statements)

References 34 publications

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“…Different methods have previously been used to identify deviant patterns of drug use with data from prescription databases, [14][15][16][17][18][19][20][21][22][23][24] such as individuals visiting multiple prescribers and/or multiple pharmacies (doctor/pharmacy shopping), high levels of dispensed drugs and simultaneous dispensings of drugs with a known abuse potential. 21 Some may be used as proxy measures of medical misuse of prescription drugs.…”

Section: Introductionmentioning

confidence: 99%

Deviant patterns of methylphenidate use in adults: a Danish nationwide registry-based drug utilization study

Rasmussen

Zoëga

Hallas

et al. 2015

Pharmacoepidemiol Drug Saf

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Section: Introductionmentioning

confidence: 99%

Deviant patterns of methylphenidate use in adults: a Danish nationwide registry-based drug utilization study

Rasmussen

Zoëga

Hallas

et al. 2015

Pharmacoepidemiol Drug Saf

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“…In addition, the treatment gap (i.e., drug holiday) and combination therapy were not analyzed in this study [ 49 ]. Furthermore, a number of patients who switch from IR–MPH to OROS–MPH or ATX may eventually change their drug therapy back to IR–MPH [ 50 ]. These particular patient groups were not separately analyzed in this study.…”

Section: Discussionmentioning

confidence: 99%

Initiation and Persistence of Pharmacotherapy for Youths with Attention Deficit Hyperactivity Disorder in Taiwan

et al. 2016

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BackgroundPharmacotherapy is an effective therapeutic option for attention deficit hyperactivity disorder (ADHD). Understanding the patterns of medication treatment is crucial for clinical practice. This study employed nationwide population-based data to elucidate the initiation and persistence of pharmacotherapy (immediate-release methylphenidate [IR–MPH], osmotic controlled-release formulations of methylphenidate [OROS–MPH] and atomoxetine [ATX]) for youths with ADHD in Taiwan.MethodsPatients first receiving an ADHD diagnosis at age 18 or younger between January 2000 and December 2009 (n = 112,140; mean age at ADHD diagnosis: 7.7 years) were selected from Taiwan’s National Health Insurance database. All patients were monitored through December 31, 2011, with an average follow-up time of 5.8 years. The initiation of ADHD drug therapy was defined as the first patient prescription, and discontinuation was defined as the cessation of ADHD medication for 180 days or longer.ResultsWithin the first year after ADHD diagnosis, 47.3%, 14.4%, and 0.8% of the patients were prescribed IR–MPH, OROS–MPH, and ATX, respectively. Regarding the patients prescribed IR–MPH, OROS–MPH, and ATX, 17.8%, 12.6%, and 18.8%, respectively, received the prescription only once and never returned for a drug refill, and 51.0%, 38.9%, and 58.8%, respectively, discontinued drug therapy within 1 year after the first prescription. Male sex and neuropsychiatric comorbidities were associated with higher probabilities of being prescribed one of the medications. An older age at first prescription and a higher daily dose of prescription were significant predictors of early discontinuation of ADHD medication.ConclusionsThe current findings suggest that IR–MPH is the most frequently prescribed drug for ADHD treatment in Taiwan. Patients treated with OROS–MPH possessed the highest persistence rate, whereas those treated with ATX had the lowest persistence rate. The results provide insight into the delivery of pediatric mental health services and have crucial implications for ADHD medication treatment in real clinical settings.

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“…For this reason, paediatric populations constitute a small percentage of the subjects analysed, for example, 7.4% in the study on opioid use by Cepeda et al, 15 19.1% in the study by Lin et al 21 on the use of primary health resources, and 28.5% in the study on upper respiratory infections by Wang et al 23 Only three studies exclusively reported on children, investigating ADHD, fever, and emergency visits. 16,19,22 Another factor that has to be considered as a limitation is the heterogeneity in defining doctor-shopping phenomenon and the formats of its prevalence. The heterogeneity in data presentation hindered comparisons between studies as well.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, 4 (36.4%) out of 11 studies analysed the use of controlled substances such as opioids and stimulants. [15][16][17][18] Another six (54.5%) studies focused on the use of health care facilities either in general or in terms of a specific complaint such as a fever and respiratory infection and the need for an emergency consultation, [19][20][21][22][23][24] while one of the papers analysed doctor shopping as a form of child abuse. 14…”

Section: Specialities Covered By Doctor-shopping Studiesmentioning

confidence: 99%

“…In studies using prescription databases, doctor shopping was defined based on the number of prescriptions filled within a specified period of time and the time overlap. [15][16][17][18] The number of visits to different physicians within a specified time frame was investigated in insurance databases with medical appointments and surveys. 17,[19][20][21][22][23][24] The definitions used and types of studies on doctor shopping are depicted in Table 3.…”

Section: Definition Of Doctor Shoppingmentioning

confidence: 99%

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Second opinions, multiple physician appointments, and overlapping prescriptions in the paediatric population: A systematic literature review

Biernikiewicz¹,

Germain

Toumi

2020

Evaluation Clinical Practice

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Objectives: Doctor shopping, double doctoring, and overlapping prescriptions are often used as synonyms for multiple physician appointments in the same disease episode. Such behaviours translate into poor patient satisfaction and patient-doctor communication as well as abuse or misuse of drugs, increasing health care costs and resulting in negative health consequences. This systematic review of the literature was conducted to identify factors that drive doctor-shopping behaviour in children's caregivers. Methods: The search was conducted in PubMed and grey literature and was based on the following search terms: included doctor or physician shopping, drug seeking, double doctoring, children, and combinations of those. Overall, 500 records were identified, of which 11 were selected for qualitative synthesis. Data extracted considered definitions of doctor shopping, co-morbidities, and target population characteristics. Results: Definitions of doctor shopping were inconsistent. The frequency of doctor shopping was high for acute illnesses and ranged from 53% in children with a fever in Hong Kong to 18% at an emergency department in Canada. The incidence of this phenomenon was low when taking into account addictive drugs and was rated at 0.02% to 0.3% in the full paediatric population. This phenomenon was more prevalent in children younger than 1 year, in children with attention-deficit hyperactivity disorder (ADHD) and co-morbid psychiatric conditions, and in those whose caregivers themselves had psychiatric conditions. It was more frequent in cases with an acute disease (eg, fever, gastroenteritis, and urinary tract infection) than a chronic disease (eg, asthma). Conclusions: The knowledge about doctor shopping by children's caregivers is limited, despite that this is a frequent behaviour. There is a need for further research covering a broader range of diseases. The causes and consequences of doctor

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Overlapping Prescriptions of Stimulants for Children and Adolescents With Attention-Deficit Hyperactivity Disorder

Abstract: In an effort to improve the quality and safety of prescription of controlled substances in younger populations, interventions or policies should be devised to target both the service providers and the patients.

Cited by 6 publications

References 34 publications

Deviant patterns of methylphenidate use in adults: a Danish nationwide registry-based drug utilization study

Deviant patterns of methylphenidate use in adults: a Danish nationwide registry-based drug utilization study

Initiation and Persistence of Pharmacotherapy for Youths with Attention Deficit Hyperactivity Disorder in Taiwan

Second opinions, multiple physician appointments, and overlapping prescriptions in the paediatric population: A systematic literature review

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