A Pilot Project Addressing Health Care Inequity Among Patients with Attention-Deficit/Hyperactivity Disorder in a Primary Care Network

by Jinyu Xu

Coauthors: Jinyu Xu MPH, PhD, Gina Thompson DO, Laura McLaughlin PMP, Skyler Kalady MD

Health Inequities

Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders of childhood, affecting 9-15% of school-aged children. Optimal care for ADHD requires frequent healthcare visits for medical management and behavioral interventions. Office visits disproportionately challenge our most vulnerable Medicaid patients who experience more transportation concerns thus questioning how well we are achieving health equity in the management of ADHD. Telemedicine provides one solution by providing efficient quality care and alleviating concerns about transportation. However, disparities in the use of telemedicine mandate efforts to break down barriers to telemedicine amongst our most vulnerable pediatric patients so that equitable access to care is truly achieved.

We designed and implemented a pilot project to address the most identified barriers to telemedicine with the goal of enhancing access to care for ADHD patients. Specifically, these included providing high-quality internet service, access to a device with appropriate apps, technical support for digital health, and education on how telemedicine could support the care of their child. In July 2022, a pediatric primary care network distributed 76 ipads with paid internet service and pre-loaded apps for one year to patients with ADHD aged 6-12 years with the goal of enhancing remote access to care through telemedicine. Education and IT support were provided to the families to ensure digital literacy.

This pilot project will conclude in June 2023. Outcomes from one year before the project (July 2021 – June 2022), during the project (July 2022 – June 2023), and one year after the project (July 2023 – June 2024) will be compared. Specifically, we will evaluate the volume of completed ADHD visits, types of visits (telehealth vs office-based), and medication adherence by reviewing pharmacy data of filled stimulant prescriptions. Finally, through pre and post-questionnaires we will assess family experience with telemedicine to identify themes, perceived or real barriers, areas for improvement, and areas of value.

Initial baseline data reveals our patients represent a vulnerable population as 100% are publicly insured and the majority have either a very low (64.1%) or low (15.4%) nationally normed Child Opportunity Index. The patients are racially diverse with more than half identifying as either Black (39.7%) or Mixed races (23.1%). In the pre-program year, patients completed 397 ADHD-related encounters, of which 18.9% were telehealth and 81.1% were office-based visits. Within departments, behavioral health had a relatively higher percentage of telehealth-related ADHD visits as compared to primary care (25.3% and 17.0%, respectively). Baseline medication adherence data is being analyzed. Prior to the project, 75% of families had experience with telehealth previously and they were relatively familiar with telehealth sessions. Families have identified top reasons to use telehealth: reduced travel, no need to pay for gas, less time off school, and less time off work. Additional analyses will be reported after the intervention completes in June.