This article series is a monthly tool to help physicians maximize patient health outcomes in accordance with NCQA?s¹ HEDIS^®2 measurements for high quality care on important dimensions of services.

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HEDIS^® definition

Follow-up care for children prescribed ADHD medication: The percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed.

Two rates are reported:

• Initiation Phase. The percentage of members ages 6 – 12 as of the IPSD* with an ambulatory prescription dispensed for ADHD medication who had one follow-up visit with a practitioner prescribing authority during the 30-day Initiation Phase.
• Continuation and Maintenance (C&M) Phase. The percentage of members ages 6 – 12 as of the IPSD with an ambulatory prescription dispensed for ADHD medication who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

Why this measure is important

ADHD is one of the more common chronic conditions of childhood. Children with ADHD may experience significant functional problems, such as school difficulties; academic underachievement; troublesome relationships with family members and peers; and behavioral problems. Given the high prevalence of ADHD among school-aged children (4 – 12 percent), primary care clinicians will regularly encounter children with ADHD and should have a strategy for diagnosing and long-term management of this condition.

Practitioners can convey the efficacy of pharmacotherapy to their patients. American Psychiatric Association (APA) guidelines recommend that once a child is stable, an office visit every three to six months allows assessment of learning and behavior. Follow-up appointments should be made at least monthly until the child's symptoms have been stabilized.
? NCQA, HEDIS 2013 V1

ADHD medications

The chart below indicates the percentage of physicians, by specialty type, prescribing ADHD medications.

In a six-month prescriber review for measure–qualifying ADHD medications, 71% of prescriptions were written by pediatricians and psychiatrists.

Increasing the follow-up rates for these two specialties could drastically improve overall measure improvement.

*The IPSD, or Index Prescription Start Date, is the earliest prescription dispensing date for an ADHD medication where the date is in the Intake Period and there is a Negative Medication History.

¹The National Committee for Quality Assurance (NCQA) is the most widely recognized accreditation program in the U.S.

²The Healthcare Effectiveness Data and Information Set (HEDIS) is an NCQA tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.