Introduction
The COVID-19 pandemic significantly disrupted healthcare delivery worldwide. For school-age children with attention-deficit/hyperactivity disorder (ADHD), consistent Primary Care Diagnosis And Treatment are crucial for managing their condition and ensuring optimal development. This study investigates the impact of the pandemic on primary care provider (PCP) services for ADHD, comparing diagnosis and treatment rates during the pandemic to pre-pandemic years. Understanding these shifts is essential for addressing potential disparities in care and improving healthcare access for children with ADHD.
Methods
This retrospective study leveraged electronic health records from a large community-based primary health care network. The data encompassed primary care visits, both in-person and via telehealth, for children aged 6 to 17 years, spanning from January 2016 to March 2021. This timeframe allowed for a comprehensive comparison between pre-pandemic (January 1, 2016 – March 14, 2020) and pandemic (March 15, 2020 – March 15, 2021) periods.
The key outcomes measured included:
- Total number of primary care visits
- Visits specifically related to ADHD diagnosis (ADHD-related visits)
- PCP prescriptions for ADHD medications
- New diagnoses of ADHD
- Initial PCP prescriptions for ADHD medications
Interrupted time series analysis was employed to assess changes in these outcome rates across four quarters of the pandemic year, relative to pre-pandemic trends. Demographic characteristics of the patient population were also compared between the pre-pandemic and pandemic periods to identify any shifts in patient profiles accessing care.
Results
The initial phase of the pandemic witnessed a notable decrease in ADHD-related visits to primary care providers. Specifically, there was a 33% drop (95% confidence interval, 22.2%-43.6%) in ADHD-related visits during the first quarter of the pandemic year. However, these visits rebounded in subsequent quarters, returning to rates observed before the pandemic.
Interestingly, while ADHD-related visits fluctuated, the rate of ADHD medication prescriptions by PCPs remained stable throughout the pandemic year. This suggests that ongoing treatment for children already diagnosed with ADHD was largely maintained.
In contrast, the rates of new ADHD diagnoses and first-time ADHD medication prescriptions by PCPs experienced a significant and sustained decline compared to pre-pandemic levels. This finding indicates a potential disruption in the identification and initiation of treatment for children newly presenting with ADHD symptoms.
Furthermore, the study revealed socioeconomic disparities in access to ADHD-related care during the pandemic. The proportion of ADHD-related visits for children residing in low-income neighborhoods decreased during the pandemic year compared to pre-pandemic years. This suggests that children from lower socioeconomic backgrounds may have faced greater barriers to accessing primary care services for ADHD during the pandemic.
Discussion
The findings of this study highlight the complex impact of the COVID-19 pandemic on primary care diagnosis and treatment of ADHD in school-age children. While ongoing treatment for established ADHD cases was generally sustained, likely facilitated by the rapid adoption of telehealth, the pandemic appears to have created significant obstacles to the initial diagnosis and treatment of new cases. The observed drop in new diagnoses and first prescriptions raises concerns about potential delays in care for children who developed ADHD symptoms or whose symptoms became more apparent during the pandemic.
The persistence of socioeconomic disparities in ADHD-related care during the pandemic is particularly concerning. These disparities underscore the critical need to proactively address barriers to healthcare access for vulnerable populations. Factors such as limited access to technology for telehealth, economic hardship, and disruptions in community support systems may have disproportionately affected low-income families’ ability to seek and receive primary care for their children’s ADHD.
Conclusion
This study demonstrates that while primary care providers effectively maintained ongoing ADHD treatment for school-age children during the COVID-19 pandemic, particularly within higher-income families, the pandemic negatively impacted the initiation of new diagnoses and treatments. The exacerbation of socioeconomic disparities in ADHD care emphasizes the urgent need for targeted interventions to improve equitable access to primary care diagnosis and treatment for all children with ADHD, both during and beyond public health crises. Future efforts should focus on strengthening telehealth infrastructure, addressing socioeconomic barriers to care, and ensuring continuous access to essential mental health services within primary care settings.
