Safe Stimulant Medication Prescribing for Adult ADHD

The prevalence of attention deficit hyperactivity disorder (ADHD) among adults is estimated to be as high as 5%. Although stimulants are the most commonly used medications approved to treat ADHD, concerns persist about the appropriCharacterize prescribing patterns for stimulants and related medications in primary care to identify areas for improved concordance with established recommendations.

Project Description

The American Academy of Family Physicians (AAFP) undertook this project to develop knowledge for optimizing pharmacotherapy for adult patients with ADHD and to promote safe and appropriate prescribing of stimulants and related medications in primary care. Here, a retrospective cohort study was performed using secondary data analysis of electronic health records (EHR) from primary care practices to assess diagnosis and treatment patterns; a pilot practice-based intervention study using performance reports was also undertaken. An exploratory objective was to assess practice-level barriers and facilitators in the use of Prescription Drug Monitoring Program (PDMP) data.

Project Goals

• Characterize prescribing patterns for stimulants and related medications in primary care to identify areas for improved concordance with established recommendations.
• Study whether a practice-focused intervention that includes education, provider-level performance reports (using EHR data analytics), and audit and feedback can improve provider competence, stimulant prescribing behavior, and practice guideline concordance.
• Explore feasibility of access to registry data from the PDMP and its potential use for improving practice quality.

Project Results

The final report from the researchers to the FDA included the following results:

• Based on EHR stimulant prescription data from primary care practices, the most common errors involved i) prescriptions to patients with no diagnosis matching an approved FDA indication and ii) the prescription of stimulants in combination with other medications which increase the risk for drug interactions or side effects.
• General provider/practice level education on the topics of ADHD in adults did not seem to change the prescribing patterns or levels of errors in stimulant prescribing overall.
• Most participating physicians reported they used the PDMP less than ten times per month, primarily for opioid monitoring.
• The main barriers to PDMP use were time constraints during patient visits, the inability to designate someone to assist with access to the system, and incompatibility with the EHR.

Publications

• Loskutova NY, Lutgen C, Smail C, Staton EW, Nichols SD, Pinckney RG. Stimulant Prescribing Error Assessment Rubric Development. J Patient Saf. 2020 Sep 8. doi: 10.1097/PTS.0000000000000775. Epub ahead of print. PMID: 32925567.