Clinicians' Adherence to Guidelines When Initiating Methylphenidate Treatment
Anne-Flore M Matthijssen1, Andrea Dietrich1, Renee Kleine Deters1
1Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Journal of Child and Adolescent Psychopharmacology
|November 16, 2022
Summary
Methylphenidate prescriptions for children increased, but guideline adherence for attention-deficit/hyperactivity disorder (ADHD) assessment and off-label use remained stable between 2008 and 2012 in the Netherlands.
Area of Science:
- Child and Adolescent Psychiatry
- Pediatrics
- Pharmacology
Background:
- Methylphenidate prescriptions for children and adolescents in the Netherlands rose by 35.6% between 2008 and 2012.
- Attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment are critical areas in child mental health.
- Understanding guideline adherence and off-label use is essential for optimizing patient care.
Purpose of the Study:
- To determine guideline adherence for ADHD assessment in children and adolescents receiving methylphenidate.
- To assess rates of off-label methylphenidate use during the study period.
- To compare guideline adherence between mental health and pediatrics settings.
Main Methods:
- A medical file audit of 506 children and adolescents who received their first methylphenidate prescription in 2008 or 2012.
- Inclusion of patients from both mental health and pediatrics outpatient clinics in the Netherlands.
- Assessment of adherence to seven specific guideline recommendations for ADHD diagnosis.
Main Results:
- Mean adherence to guidelines remained stable at 43% in 2008 and 45% in 2012.
- Off-label methylphenidate use decreased slightly from 35% in 2008 to 30% in 2012.
- Adherence was highest for assessing comorbidities (89%) and lowest for assessing ADHD severity (1%) and teacher psycho-education (1%).
- Mental health settings demonstrated better adherence than pediatrics settings in several areas, including structured interviews and psycho-education.
Conclusions:
- Despite an increase in methylphenidate prescriptions, guideline adherence for ADHD assessment and off-label use rates did not significantly change between 2008 and 2012.
- There is substantial room for improvement in adhering to ADHD diagnostic guidelines, particularly in assessing severity and providing psycho-education.
- Differences in adherence between mental health and pediatrics settings highlight potential areas for targeted interventions and training.
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