As we previously published, attention deficit hyperactivity disorder (ADHD) diagnoses are increasing.¹ Additionally, we noted in a collaboration with Kaiser Family Foundation (KFF) that mental health specialties are some of the few specialties that continued to care for a large percentage of their patient population using telehealth in 2021 and 2022.² As the U.S. Drug Enforcement Administration (DEA) considers whether to continue to allow prescribing of stimulants used for the treatment of ADHD via telehealth³, we wanted to assess whether there were differences in prescribing rates for patients seen through telehealth or in-person. Stimulant medications are considered first-line treatment for ADHD but have additional prescribing requirements due to classification as controlled substances.⁴

We analyzed 205,065 initial visits for ADHD and 933,455 initial visits for anxiety from January 1, 2020, through March 31, 2023, to determine medication prescribing rates for telehealth and office visits. We matched patients with telehealth encounters to patients with office visit encounters by diagnosis, sex, race, ethnicity, social vulnerability index, calendar quarter of the visit, and age group. We chose anxiety visits for our comparator, as stimulant medications are not typically prescribed for anxiety diagnoses.

We found that prescribing rates for ADHD medication (including both stimulant and non-stimulant medications) within 30 days of initial diagnosis are similar for both telehealth and office visits for ADHD, hovering around 60% of visits, as shown in Figure 1. Most initial ADHD prescriptions were for stimulant medications in both telehealth (84%) and office visits (87%) for ADHD. Prescribing rates for anti-anxiety medications within 30 days of a telehealth or office visit with patient’s first anxiety diagnosis followed similar trends. However, anti-anxiety medications were prescribed less often than ADHD medications, with medications prescribed for around 50% of anxiety visits.

These findings suggest that, for health systems providing mental health services, providers are no more or less likely to prescribe a medication during a telehealth visit than they are during an office visit for ADHD and anxiety. Of note, this analysis does not include telehealth-only providers, which the DEA has been investigating for potential overprescribing of medications.⁵

These data come from Cosmos, a HIPAA-defined Limited Data Set of more than 190 million patients from 208 Epic organizations including 1,197 hospitals and more than 25,400 clinics, serving patients in all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions.

References

1. Russell J, Franklin B, Piff A, et. al. Number of ADHD Patients Rising, Especially Among Women. Epic Research. March 30, 2023. https://www.epicresearch.org/articles/number-of-adhd-patients-rising-especially-among-women Accessed on June 13, 2023.
2. Lo J, Rae M, Amin K, et. al. Telehealth Has Played an Outsized Role Meeting Mental Health Needs During the COVID-19 Pandemic. Kaiser Family Foundation. March 15, 2022. https://www.kff.org/coronavirus-covid-19/issue-brief/telehealth-has-played-an-outsized-role-meeting-mental-health-needs-during-the-covid-19-pandemic/. Accessed on June 13, 2023.
3. Drug Enforcement Administration. DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities. https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities Accessed March 10, 2023. 
4. UpToDate. Attention Deficit Hyperactivity Disorder in Children and Adolescents: Treatment with Medications. UpToDate. Accessed on June 13, 2023.
5. Landi, H. Cerebral Under Federal Investigation for Possible Violations of Controlled Substances Law. Fierce Healthcare. May 7, 2022. https://www.fiercehealthcare.com/health-tech/cerebral-under-federal-investigation-possible-violation-controlled-substances-law. Accessed on June 13, 2023.