Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic

Abstract

The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care. Method: We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n 5 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020-March 15, 2021) compared with prepandemic years (January 1, 2016-March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared. Results: ADHD-related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%-43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years. Conclusion: Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHDrelated care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

Patient visits and prescriptions for attention-deficit/hyperactivity disorder from 2017–2021: Impacts of COVID-19 pandemic in primary care

“…Consistent with these findings, we found that the number of patients visiting related to ADHD increased from 2.4 (per 1000 patients) in 2017 to 5.5 (per 1000 patients) in 2021 (Table 2), and similarly the number of patients being prescribed ADHD medication at least once annually increased from 12.9 (per 1000 patients) in 2017 to 21.9 (per 1000 patients) in 2021 (Table 3). A US retrospective cohort study involving children aged 6-17 years using electronic health records from primary care providers (mainly pediatricians) found that ADHD medication rates remained stable throughout the first year of the pandemic (March 15, 2020-March 15, 2021) [42]. We also found that ADHD medication prescribing patterns did not deviate significantly from prepandemic trends.…”

“…several studies have demonstrated that family physicians in North America are neither familiar with the diagnostic criteria for ADHD or use the criteria appropriately in their practices [16,25,26]. A US study found that ADHD management is not increasingly undertaken by recently trained pediatric primary care providers [42] and that pediatricians who were 10 years or more in practice were more likely to report regular ADHD care [44]. Family physician surveys in Ontario and British Columbia have indicated that most primary care physicians referred patients to a specialist for the diagnosis and management of ADHD [16,[45][46][47].…”

“…Other provincial health administrative databases for medications in Canada may not have information about prescriptions for all age groups. This study also provided data on the pandemic period which spanned from March 2020 to December 2021, capturing a total period of 22 months where other published studies have reported on the immediate impact of the pandemic over a much shorter time [12,13,15,42,49]. This study also has limitations.…”