Medicaid ADHD treatment needs to be better

The care that children with attention-deficit/hyperactivity disorder (ADHD) receive under managed-care Medicaid programs has much room for improvement, a new study in the Journal of the American Academy of Child and Adolescent Psychiatry suggests.

Investigators examined care processes and clinical outcomes in 530 children aged 5 to 11 years who were receiving ADHD care in primary care clinics or specialty mental health clinics in a large, countywide, managed care Medicaid program in California.

For example, whereas less than one-third of children in mental health clinics received any stimulant medication, 80% to 85% of children in primary care had at least 1 stimulant prescription filled. However, unlike children in primary care, those attending mental health clinics received psychosocial interventions averaging more than 5 visits a month. Medication refill persistence was poor in both groups, ranging from 33% to 44% in primary care and 31% to 49% in specialty mental health care across 3 separate time points 6 months apart.

According to data collected via Medicaid service and pharmacy claims information, school records, parent and child interviews, and telephone interviews, 34% of the children received no care in the 6 months before the baseline interview, and 44% had no care between the 6- and 12-month follow-up time points. Thirteen percent to 20% of patients did not receive needed mental health services. Yet overall, ADHD diagnosis, impairment, academic achievement, parent distress, and improved family functioning did not differ between children who remained in care and those who had no care. The study also revealed that the primary and specialty care groups had little crossover and that clinical ADHD severity was similar in both groups.

The researchers noted that their findings show that areas needing improvement are alignment of provider type with clinical severity, follow-up visits (children in primary care had only 1 or 2 visits a year), stimulant use in specialty mental health facilities, documented delivery of evidence-based psychosocial treatment, and persistence in refilling stimulant medication prescriptions.

Zima BT, Bussing R, Tang L, et al. Quality of care for childhood attention-deficit/hyperactivity disorder in a managed care Medicaid program. J Am Acad Child Adolesc Psychiatry. 2010;49(12):1225-1237.