Exploratory study of barriers to successful office contacts for attention deficit hyperactivity disorder

The American Academy of Pediatrics published attention deficit hyperactivity disorder (ADHD) guidelines, but significant variability exists in care. This exploratory study aimed to understand barriers to compliance with primary care office contacts for ADHD medication management. The study was conducted at a single academic medical center via retrospective chart review between 6/1/15 and 5/31/16 in combination with telephone interviews. Participants included 306 children 6-12 years old with an ADHD-related ICD-9/ICD-10 diagnosis. Factors affecting compliance were assessed via multivariable linear regression using the outcome of unsuccessful office contacts based on the percentage of missed, canceled, or rescheduled appointments. ADHD patients averaged 28.3% (SD 23.8%) unsuccessful office contacts. Unsuccessful contacts significantly increased by 15% for Hispanic ethnicity, 8% for public insurance, 8% for inattentive subtype, and 3% for every 10 miles additional distance from the office. Telephone interviews were attempted for those missing ≥ 3 appointments, which represented 18.3% (56/306) of the sample. Interviews were successfully completed with 37.5% (21/56). Of these, 52.3% (11/21) of parents preferred in-person visits. Structural barriers were not a concern, but 52.3% (11/21) reported high caregiver strain and fatigue. The results indicate that cultural barriers to understanding of ADHD and its management must be reconsidered. Use of Internet-based platforms may be a novel approach to address issues of distance, financial difficulty, and parental stress.