O2074: Telemedicine Use and Quality of ADHD Medication Management in Primary Care: An AAP PROS Study

Background: According to the National Committee for Quality Assurance’s HEDIS measures, children initiating attention-deficit/hyperactivity disorder (ADHD) medication should be seen for follow-up within 30 days. Telemedicine (TM) could reduce barriers to follow-up and has shown promise for improved ADHD management in research settings. We lack data on widespread impact of primary care TM on this quality measure. This project aims to assess the impact of TM use for ADHD visits among 6- through 12-year-old children on timely follow-up after ADHD medication initiation in a broad sample of primary care practices.

Methods: Using a retrospective repeated cross-sectional design, we analyzed the electronic health record data of 6- to 12-year-old children who received primary care for ADHD between 2020 and 2023. We evaluated data from 685 community-based health centers, 76 practices from 2 regional health systems, and 38 independent practices from the AAP Pediatric Research in Offices Settings network. We included visits associated with an ADHD diagnostic code (ICD-10 F90.*) during which medication for ADHD was initiated. We examined the association between rates of follow-up visits (outcome) and TM use at both the child and practice levels (exposure). For the child-level analyses, we defined TM exposure based on whether a child had ever received ADHD care via TM at the time of medication initiation. We conducted chi-square tests to evalute the association of TM use with follow-up care within 30 days (primary outcome, HEDIS measure) and 42 days (sensitivity analysis reflecting the challenge of 30-day follow-up). For the practice-level analysis, we defined TM exposure based on the practice’s rate of TM ADHD visits per 100 patients. We then conducted a regression analysis to evaluate the association of practice-level TM use with follow-up care received within 30 days.

Results: We analyzed 18,960 visits during which children initiated ADHD medication (7.9% of 240,357 total ADHD visits). In the child-level analysis, prior TM use was associated with a 6.7 percentage point greater follow-up rate at 30 days (40.0% vs 33.3%, 95% CI: 4.8%-8.5%, p< 0.001) and a 4.4 percentage point greater follow-up rate at 42 days (52.7% vs 48.2%, 95% CI: 2.5%-6.4%, p< 0.001) (Figure). In the practice-level analysis, higher TM use for ADHD was associated with higher 30-day follow-up rates (Table). An increase in the practice-level TM ADHD rate by 1 visit per 100 active patients was associated with a significant 3% increase in odds of follow-up (OR: 1.03, 95% CI: 1.01-1.05).

Conclusion: In this secondary data analysis including 799 primary care practices across the US, TM care for ADHD at both the child and practice levels was associated with greater follow-up rates after ADHD medication initiation among 6- to 12-year-old primary care patients, suggesting incorporating TM into primary care may increase the quality of ADHD care.