Differential effects of predictors on methylphenidate initiation and discontinuation among young people with newly diagnosed attention-deficit/hyperactivity disorder
| Autor: | Erin Chia-Hsuan Wu, Kuang-Hung Chen, Hsueh-Han Yeh, Chuan Yu Chen, Keh-Ming Lin, I-Shou Chang |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Time Factors Adolescent Databases Factual Population Newly diagnosed Cohort Studies mental disorders medicine Attention deficit hyperactivity disorder Humans Pharmacology (medical) education Child Proportional Hazards Models education.field_of_study business.industry Methylphenidate Hazard ratio Age Factors medicine.disease Differential effects Survival Analysis Discontinuation Psychiatry and Mental health Socioeconomic Factors Attention Deficit Disorder with Hyperactivity Child Preschool Pediatrics Perinatology and Child Health Central Nervous System Stimulants Female business Cohort study medicine.drug |
| Zdroj: | Journal of child and adolescent psychopharmacology. 21(3) |
| ISSN: | 1557-8992 |
| Popis: | Previous population-based studies have identified factors accounting for differential utilization of psychotropic medications among young patients with attention-deficit/hyperactivity disorders (ADHDs); yet, few analyses have addressed changes in such factors that can occur in the help-seeking process. The aim of this study was to examine patient- and service provider-level predictors for methylphenidate (MPH) initiation and discontinuation.This cohort study included 10,153 newly diagnosed ADHD patients under 18 years of age in 2000, identified from the National Health Insurance Research Database. The risk association was estimated by time-dependent survival analyses, as indexed by hazard ratio.Approximately 30% of young people received MPH treatment within the year of their ADHD diagnosis, and virtually none remained in treatment beyond 12 months. Regardless of co-morbidity status, the following were significantly associated with earlier initiation of MPH treatment: older age (e.g., adjusted hazard ratio [aHR] for age 12-17 = 4.5-7.6), lower socioeconomic status (aHR = 1.2-1.4), southern residence (aHR = 1.4-1.6), receiving the diagnosis while school was in session (aHR = 1.3-1.4), receiving the diagnosis from a physician specializing in pediatrics or psychiatry (aHR = 7.3-16.8), and receiving the diagnosis in a district hospital/clinic (aHR = 1.3-1.7). However, once treatment started, older ages appeared to increase the risk of early discontinuation by 15%, and the corresponding estimates for receiving initial MPH in a regional hospital or district hospital/clinic were 27% and 32%, respectively. Change in treatment location upon subsequent visit was associated with a 58% reduction in early discontinuation.This information about time-varying predictors for MPH utilization throughout treatment may provide insight into the delivery of pediatric mental health services and has important implications for the design of clinical treatment programs. |
| Databáze: | OpenAIRE |
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