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  1. Safe Use Initiative

Safe Stimulant Medication Prescribing for Adult ADHD

Performer: American Academy of Family Physicians (AAFP)
Principal Investigator:
Natalia Loskutova, MD, PhD

Project Duration: 9/30/15-9/29/17

Regulatory Science Challenge

The estimated prevalence of attention deficit hyperactivity disorder (ADHD) among adults is up to 5%. Stimulants are the most commonly prescribed medications for ADHD. Although the FDA provides guidance on approved indications for stimulants, there have been concerns about the appropriate use of these medications and their potential for being abused and causing unintended harms. Most primary care providers have shown low confidence and knowledge level about ADHD and stimulant medication prescribing. So far, there have not been any systematic investigations of potentially harmful and inappropriate prescribing or interventions to improve safe and appropriate prescribing of stimulant medications for adults with ADHD.

Project Description

The American Academy of Family Physicians (AAFP) aims to optimize pharmacotherapy for adult patients with ADHD and to promote safe and appropriate prescribing of stimulants and related medications in primary care. This study will include a retrospective cohort study using secondary data analysis of electronic health records (EHR) from primary care practices to assess the diagnosis and treatment patterns, and a pilot practice-based intervention study using performance reports and the audit and feedback approach. An exploratory objective is to assess the practice-level barriers and facilitators of using the Prescription Drug Monitoring Program (PDMP) data.

Project Goals

  • Characterize stimulant and related medication prescribing patterns in primary care and concordance with prescribing recommendations to identify areas for improvement
  • Study whether a practice-focused intervention that includes education, provider-level performance reports (using EHR data analytics) and audit and feedback improves provider competence, stimulant prescribing behavior and practice guideline concordance
  • Explore feasibility of access to registry data from the PDMP and its potential use for practice quality improvement activities


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