Improving Stimulant Medicine Adherence
by Richard Rubin, MD
Clinical Associate Professor, University of Vermont
College of Medicine
The benefits of ADHD medicines are often lost from
lapsed use, recently cited at about 50% after two
months of ongoing prescription. These observations
have been similar despite the specific medicine
prescribed. Since ADHD impairments can affect people
for years, and often decades, modern treatment
planning supports continuous, maintenance
medication. New Research poster sessions at the
October 2006 American Academy of Child and
Adolescent Psychiatry Annual Meeting included three
presentations useful for improving adherence to
continuous medicine use with stimulants.
To summarize these reports, adherence in children
and adolescents is improved by more frequent
physician visits and the use of long-acting
medicines, including available capsule forms and the
new Methylphenidate Transdermal System patch.
Two of the reports measured the relationship between
the frequency of physician visits and medication
adherence. Using insurance claims data on 16,383
patients with a new diagnosis of ADHD, Dr Steven
Grcevich found that those who had a greater number
of office visits within a year filled more ADHD
medicine prescriptions. This suggests that more
conscientious scheduling of physician follow up
helps adherence. Overall medicine continuation was
still poor, however, with 78% having 1-3 office
visits and only 53% filling 1-3 prescriptions. Dr
Grcevich also found that filling of short-acting
stimulants was done less than long-acting medicines,
up to 27.5% (AACAP E22). Dr. Kenneth Steinhoff
reviewed claims data for newly diagnosed children
and adolescents, comparing rates of adherence one
year later with the number of physician visits and
the use of long-acting OROS methylphenidate
(Concerta) versus short-acting methylphenidates.
Patients who were seen for follow up in the first 30
days and at least twice more in the year had 48%
more adherence than those seen less often. In
addition, chances of adequate medicine continuation,
defined as 70% or more of the time, were
significantly higher for those initiated with the
long-acting methylphenidate (AACAP E41).
In the third report, Jeanne Landgraf and Dr Tim
Wilens assessed the effects of variable
Methylphenidate Transdermal System (Daytrana) wear
times and parent satisfaction for continuing use in
children 6 to 12. Measurements were done in a
laboratory classroom setting with a randomized,
placebo controlled procedure. 78% of the parents
reported improved quality of life and overall
satisfaction with the MTS, including effectiveness
and ease of use. This is expected to enhance
continued adherence.
Dr. Rubin practices Child and Adult Psychiatry,
directs The Clinical Study Center in Burlington
Vermont, and serves as Clinical Associate Professor
at the University of Vermont College of Medicine.
