Pharmacist care for attention-deficit/hyperactivity disorder electronic medication refills: A cluster randomized trial.

Abstract

During the pandemic, the US government loosened restrictions on telemedicine prescribing for controlled substance refills. Parent requests for attention-deficit/hyperactivity disorder (ADHD) medication refills have increased electronic inbox workload for physicians. Pharmacists can now fulfill these requests via collaborative practice agreements, but scant information exists on the effectiveness of this approach. To compare pharmacist with pediatrician management of ADHD medication refill requests regarding quality, timeliness, and parent ratings. This cluster randomized clinical trial assigned electronic ADHD medication refill requests from 63 medical facilities in a regional health care system to either Pharmacist Care by a regional team (32 facilities) or local Pediatrician Care (31 facilities) from May 14, 2024, to June 21, 2024. The primary outcome was prespecified in the study protocol as a quality measure to be evaluated among patients without weight and height recorded within 180 days before the refill request. This measure was based on national clinical guideline recommendations to monitor weight and height in children taking ADHD medications, which can be associated with reduced weight gain. It was met if the prescribing clinician collected a weight and height by parent report or initiated an in-person appointment. Among 2,442 eligible refill requests among study patients (mean age = 11.6 [SD = 3.1] years, 28.6% female), 512 received Pharmacist Care and 1,930 received Pediatrician Care; the latter group included 706 patients with unintended crossover from the group assigned to Pharmacist Care. Of the 793 refill requests eligible for evaluation of the primary outcome, 88.6% (132/149) with Pharmacist Care and 66.1% (426/644) with Pediatrician Care met the quality measure (adjusted rate ratio = 1.26; 95% CI = 1.13-1.40). Compared with pediatricians, pharmacists had slightly longer times to prescription ordering (median = 2.15 vs 1.78 hours, difference = 22 minutes) but similar times to medication filling and similar parent ratings of quality. Pharmacist management yielded more consistent quality of care and similar timeliness and parent ratings as pediatrician management of electronic ADHD medication refill requests.<b>Study registration number:</b> ClinicalTrials.gov NCT06388694.