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19 Aug 2020

Hohman JA et al. J Gen Intern Med 2020; Epub ahead of print

Direct-to-consumer (DTC) telemedicine is a platform that connects patients and providers via an on-demand mobile or web application, and has been proposed to increase access to care, which may be useful in patients with ADHD who are transitioning from adolescent to adult health services or who have moved house. However, to date, there is little evidence on how patients with ADHD use DTC telemedicine.

This US, retrospective, cross-sectional study was performed to assess “encounters for ADHD” conducted on the American Well DTC telemedicine platform between July 2016 and July 2018. Characteristics were described for patient, provider and encounter. Patients rated satisfaction with their providers on a scale from 0 to 5 stars, and the most frequently prescribed medications were examined based on National Drug Codes. To account for physician clustering, a mixed-effects logistic regression model was used to estimate the association between receipt of a prescription and the characteristics of the patient, provider and encounter.

A rapid increase in patients seeking care for ADHD using DTC telemedicine was observed from 2016 to 2018 – overall, the volume of ADHD visits grew by more than 500% (from 50 encounters in 2016 to 294 encounters in 2018).

  • Of the 618 encounters for ADHD, 44.3% (n = 274) were with psychiatrists, 40.0% (n = 247) were with therapists and 15.7% (n = 97) were with non-behavioural health clinicians.
  • Patients were mostly young and male, and the majority had comorbid psychiatric disorders.
  • Most patients (69.4%) provided insurance information, and most accessed the platform “after hours” (i.e. during the evening or at weekends).
  • Almost three-quarters of patients (73.3%) had only one visit, but of the patients who sought counselling, almost half (46.5%) had at least one follow-up encounter.
  • The median visit length was 48 minutes (interquartile range [IQR] 42–53 minutes) for counselling, 18 minutes (IQR 11–33 minutes) for psychiatry and 6.5 minutes (IQR 4–9 minutes) for others.
  • The mean satisfaction rating was 4.9/5.
  • Overall, 43.7% of encounters resulted in a prescription, most often for atomoxetine and bupropion (no controlled substances could legally be prescribed).
  • Medications were more likely to be prescribed by psychiatrists than by non-psychiatrists (adjusted odds ratio [aOR] = 7.09; 95% confidence interval [CI] 2.53–19.89), for patients who reported insurance than for those who did not (aOR = 2.56; 95% CI 1.32–4.95) and in visits involving comorbid psychiatric illness than in those that did not (aOR = 3.47; 95% CI 1.69–7.11).

This study had some limitations, including that the study sample was limited to one DTC telemedicine platform and may not be representative of the overall field. Also, it was not possible to determine the quality of counselling provided or what impact the non-stimulant medications prescribed had on symptom control.

The authors commented that, to their knowledge, this was the first study to describe the use of DTC telemedicine for ADHD, and they concluded that DTC telemedicine may offer one potential means of increasing access to care for adult patients with ADHD. Although most of the encounters reported in this study were one-off visits, the evidence of continuity in counselling visits along with the patients’ high overall satisfaction ratings suggest that this care model could be used more widely.

 

Read more about the use of DTC telemedicine for ADHD here

Hohman JA, Martinez KA, Anand A, et al. Use of direct-to-consumer telemedicine for attention-deficit hyperactivity disorder. J Gen Intern Med 2020; Epub ahead of print.

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