A Program Evaluation of Medication Adherence With Long-Acting and Pro-Drug Stimulants in Adolescents Using Telehealth and Hybrid Care Models

Abstract

Background:

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often require long-acting or pro-drug stimulants, but telehealth prescribing is constrained by the Ryan Haight Act’s in-person requirements. While pandemic-era waivers temporarily lifted these mandates, their permanent status remains uncertain.

Aims:

Assess long-acting or pro-drug stimulant medication adherence using proportion of days covered (PDC) in adolescents with ADHD (12–17) receiving telehealth or hybrid care (2022–2024), comparing rates to post-pandemic (April 2020–June 2022) adherence rates in urban pediatric populations. Examine symptom scores on the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Screening (GAD-2), and ADHD Symptom and Side Effect Tracking (ASSET). Compare visit attendance between telehealth and hybrid care.

Methods:

Program evaluation consisting of retrospective chart reviews, pre-visit surveys, and prescription data on 49 adolescents (21 telehealth and 28 hybrid) in a psychiatric clinic were evaluated.

Results:

The total sample mean PDC was .381. Hybrid group adherence was .448 and .313 for the telehealth group. PDC was the same as the post-pandemic adherence rate (.310–.440). Paired t-tests comparing GAD-2 scores were (p < .001), PHQ-9 (p < .001), and ASSET (p = .010). Telehealth attendance was lower than hybrid attendance.

Conclusions:

The hybrid care model showed better adherence and attendance than telehealth for adolescents with ADHD. PDC from this program evaluation was statistically similar to national trends in pediatric ADHD management. Future research must prioritize geographic and digital determinants, understand the impact of polypharmacy, and establish evidence-based strategies to enhance long-term adherence in telehealth care models.

Keywords

telehealth adolescents attention-deficit/hyperactivity disorder stimulants medication adherence

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