Wie Telemedizin in einem Geschäftsmodell, das den Reichen zugute kommt, zu einem Anstieg von ADHS-Skripten führt. Bis 2022 hat sich die Zahl der ADHS-bedingten Verordnungen fast verdreifacht, von 4,3 % auf 11,8 %. Etwa jede vierte Videopsychiatriekonsultation war mit der Verschreibung von Stimulanzien verbunden.
https://theconversation.com/how-telehealth-is-fuelling-a-surge-in-adhd-scripts-in-a-business-model-that-benefits-the-rich-286761
42 Kommentare
Seeing a psychiatrist via telehealth became easier from January 2022. That’s when Medicare-reimbursed telepsychiatry arrangements became permanent.
Why ADHD, specifically?
Interest in ADHD, and its diagnosis, has exploded for a number of reasons.
Social media has allowed more people to recognise their ADHD-like symptoms, particularly adults who were never assessed as children.
Search terms such as “ADHD treatment” and “ADHD medication” climbed steadily across the study period. We found this online interest tracked closely with the rise in video prescribing of stimulants.
Others point to social media platforms, digital notifications, emails and algorithmic content taxing the brain, making it harder to focus for long periods. This “attention economy”, they argue, may also contribute to people thinking they have ADHD and seeking a diagnosis.
The idea was for these video and phone consultations to provide more flexible and sooner appointment times, without needing to travel.
But our new analysis shows what happened next.
We show how telepsychiatry became dominated by consultations for stimulant prescriptions since 2022. These were mostly for people with attention-deficit hyperactivity disorder or ADHD.
Telepsychiatry for ADHD specifically did increase access for people living in rural and remote areas. But it was more likely to be provided by psychiatrists living in more affluent major towns and cities.
These types of ADHD telepsychiatry appointments are also associated with greater out-of-pocket costs than the equivalent face-to-face appointments
Interest in ADHD, and its diagnosis, has exploded for a number of reasons.
Social media has allowed more people to recognise their ADHD-like symptoms, particularly adults who were never assessed as children.
Search terms such as “ADHD treatment” and “ADHD medication” climbed steadily across the study period. We found this online interest tracked closely with the rise in video prescribing of stimulants.
Others point to social media platforms, digital notifications, emails and algorithmic content taxing the brain, making it harder to focus for long periods. This “attention economy”, they argue, may also contribute to people thinking they have ADHD and seeking a diagnosis.
None of this means the demand isn’t real, or the diagnoses are wrong. Drug treatment for ADHD has a strong evidence base and can be life-changing.
This shift was strongly associated with a higher proportion of female patients, whose ADHD has been historically under-recognised.
But these video ADHD consultations can be lucrative. They offer a way for psychiatrists to see more patients, faster. So a single “one-off” assessment of 30 minutes or longer that results in a script – the type we identified – is an attractive business model.
When ADHD comes to dominate Medicare funding for telehealth originally designed to broaden access to all psychiatric care, market access for people with other mental illnesses may be crowded out.
So yes, telepsychiatry is expanding access. But our study shows its model is focused on a single, lucrative, fast-growing diagnosis and prescription business.
https://www.sciencedirect.com/science/article/pii/S0165178126003719?via%3Dihub
Supply induced demand in medicine is an empirical fact, even with a Hippocratic oath.
I wonder if this data takes into account that it’s a controlled substance that requires regular telegraph appointments to maintain? I’ve been on ADHD meds for years and due to that fact most of my appointments have been adhd med related.
(Edit: leaving in telegraph because it’s funny, but obvi meant telehealth)
Could this also be more people with ADHD are finally being diagnosed?
So we are just assuming people are lying then, and not that more people are finally getting access to medical care?
I feel like this article misses the fact that people living with untreated ADHD have a harder time making (and keeping) in-person appointments. Telehealth is a boon for people with ADHD, so I wonder how much of this perceived increase is just people with ADHD either switching to telehealth because it works better for them or seeking care because telehealth removes enough hurdles to start.
I can’t even get my extended release meds anymore because they are either to expensive or low on stock. It been like this since after covid.
I was basically trying to do this and during my „research“ realized that I actually had ADHD. It’s a lot of work to get diagnosed and can take a long time, which ironically weeds out a lot of true ADHD folks.
I personally think Telehealth is allowing more people to get the care and diagnoses they need. Not having to have transportation is a huge barrier removed. Surely that explains some of this.
Wow, and here I was being a huge sucker going to a psychiatrist and neurologist.
There’s a ton of loaded language there. Does it benefit the rich whenever people get health care under capitalism? Sure. The problem with that isn’t the health care part.
Has it increased overall or just the telehealth increase!?
Because I know a few people that had add meds and they must see their doctor monthly because it’s a controlled medication…. After the pandemic most monthly visits moved to online….
So it may be people who used to just go to the office monthly switching to telehealth appointments…
Well, Ritalin is pretty good for being efficient at work and studying.
It’s an advantage over others to have access to this kind of stimulants.
Another factor here for ADHD specifically is frankly that telehealth removes a huge amount of activation energy from the process of getting diagnosed. I’m in my mid 40s and have an extremely hard time motivating myself to do things like go and see my primary care physician, or even *get* a primary care physician. But because telehealth exists, the logistical overhead of seeking out and going to psychiatric care is significantly less– and I can guarantee I am not the only actually ADHD person who would not have managed to get diagnosed without telehealth.
That is, telehealth *enabled me to pursue needed treatment*. It is literally a disability accommodation.
Or is that because regular doctors misdiagnosed and mistreated us for depression and anxiety for years before telehealth became a thing?
Finally diagnosed with ADHD at 59 after decades of misdiagnosis through traditional means. I finally get to start living.
They made it SO much easier here in America by cancelling our health care. I don’t have to spend any money on medicine. My bp is through the roof, my vision is fading, and I can’t concentrate on anything for more than 10 seconds or so. What a country!
I literally can’t get Adderall because it is only for rich people now. I can only get amphetamine salts which aren’t as effective
Telehealth is also undoubtedly and obviously better and more convenient for patients however, so none of this is worth concern.
All the points raised in the comments here so far are answered resp addressed in the article. Read it.
I feel like it’s probably a few things together because making a doctors appointment is hard for us with executive disfunction, tele health made it easier more accessible, then add the populations increased understanding, plus societal pressure to perform, or have your life fall apart.
Care has exploded and rightfully so. More people getting care is a good thing. The issue is that insurance premiums are gonna skyrocket alongside it. The question becomes “who should pay for these services”, “should the government step in to regulate prices for ADHD medication”, and “should tele-health psychiatrists that meet for 5 minutes to approve a script be paid less”.
Only thing insurers can do besides raising premiums is deny these claims and/or limit benefits, which people will hate. Therapists and psychiatrists will schedule as many appointments as possible to make as much money as possible. Doesn’t mean they are horrible people, but it does benefit them monetarily to do this and bigger corps will still take these customers if they don’t. They don’t really have a choice either. Pharmaceutical manufacturers will charge whatever they can for adhd meds because insurers can’t deny them and they have patent protection. It’s really up to the government to regulate all 3 sides, and our government is ran by a clown who hired a man who eats roadkill to lead HHS and a talkshow host to lead CMS. Whatever budget problems arise from high BH trend, they will probably make decisions that inflate the problem, like say tariffs on adhd medications coming from overseas.
And sadly, this is the exact type of leadership large hospitals, insurers, and rx manufacturers want because it leaves them free to gouge consumers via this goldmine knowing the Feds won’t do a damn thing about it. So all I can say is that if having affordable adhd meds and behavioral health matters to you, you have to vote blue.
telehealth makes it easy for people with adhd to make doctors appointments. anyone with adhd can tell you trying to get that first appointment while unmedicated is the hard.
As someone who was diagnosed in the ’90s and now has to use a non-stimulant medication because stimulants are too difficult to find reliably, this annoys me.
I have been on one of these medications for almost twenty years. Having to go in twice a year to check in and nail down exactly what dose and medication works the best was really beneficial. Once I got into a place where nothing needed to change anymore its been nice to just do a telehealth visit and say „Hey doctor. Yup everything is still working great.“ I think patients should have to do in person visits twice a year for a while until they can do telehealth visits for these types of drugs. It’s one of those necessary hurdles that I think need to be put in place.
This is a good thing it should be easy to get prescription stimulants, which are essentially safe drugs and people should have the ability to decide what they want to put in their body within reasonable limits. If our society banned drinking, it would be less hypocritical but stimulants aren’t opiods and the risk of therapuetic trials are low.
Extra extra, read all about it:
Making healthcare more accessible has greatly benefited a group of people who traditionally find accessing healthcare difficult.
At this point you can basically go get whatever drugs you want if you keep searching and paying money to the industry.
Has there ever been a business model that did not benefit the rich? Then why mention it in this headline?
When reviewing these findings note this research is set in Australia, and they have something called Medicare like the US does, but it serves a wider population.
Yeah this is something we doctors from 3rd world are saying for decades. Pharmacoeconomics injustice.
Just like most of people suffering from cancer pain are from 3rd world and yet something like 80-90% of morphine is used by 1st world countries and sadly a lot of it is being used in addiction contexts. The same happens to stimulants.
As a psychiatry resident I abomine the idea of telehealth appointments because the mental exam is significantly less accurate when the patient is in a consult in a screen instead of inperson. ADHD exists and lots of people suffer from that but a lot of people will use stimulants to boost productivity without a proper diagnosis ; not just it will create injustice as wealthier people will end up increasing demand for stimulants, but they are also more likely to be harmed as stimulant misuse on a non-ADHD person is more likely to trigger mania or psychotic episode.
Yep. It was also after lockdowns and the pandemic.
I’m one of them. Procrastinated a long time before getting a diagnosis. I also waited 5 months between my bloodwork and the first appointment with the psychiatrist.
I’m now currently waiting for a new psychiatrist as it was supposed to be set-up last November, and I still don’t have a new one.
Okay, but what happened in 2020 that made tele-health popular?
Access to healthcare is good, actually.
This is what happens you increase access and remove barriers to people who have a condition that does not cope well with organization, time management, and can easily be overwhelmed by the traditional requirements for diagnosis.
Seeing a psychiatrist via telehealth became easier from January 2022. That’s when Medicare-reimbursed telepsychiatry arrangements became permanent.
Why ADHD, specifically?
Interest in ADHD, and its diagnosis, has exploded for a number of reasons.
Social media has allowed more people to recognise their ADHD-like symptoms, particularly adults who were never assessed as children.
Search terms such as “ADHD treatment” and “ADHD medication” climbed steadily across the study period. We found this online interest tracked closely with the rise in video prescribing of stimulants.
Others point to social media platforms, digital notifications, emails and algorithmic content taxing the brain, making it harder to focus for long periods. This “attention economy”, they argue, may also contribute to people thinking they have ADHD and seeking a diagnosis.
The idea was for these video and phone consultations to provide more flexible and sooner appointment times, without needing to travel.
But our new analysis shows what happened next.
We show how telepsychiatry became dominated by consultations for stimulant prescriptions since 2022. These were mostly for people with attention-deficit hyperactivity disorder or ADHD.
Telepsychiatry for ADHD specifically did increase access for people living in rural and remote areas. But it was more likely to be provided by psychiatrists living in more affluent major towns and cities.
These types of ADHD telepsychiatry appointments are also associated with greater out-of-pocket costs than the equivalent face-to-face appointments
Interest in ADHD, and its diagnosis, has exploded for a number of reasons.
Social media has allowed more people to recognise their ADHD-like symptoms, particularly adults who were never assessed as children.
Search terms such as “ADHD treatment” and “ADHD medication” climbed steadily across the study period. We found this online interest tracked closely with the rise in video prescribing of stimulants.
Others point to social media platforms, digital notifications, emails and algorithmic content taxing the brain, making it harder to focus for long periods. This “attention economy”, they argue, may also contribute to people thinking they have ADHD and seeking a diagnosis.
None of this means the demand isn’t real, or the diagnoses are wrong. Drug treatment for ADHD has a strong evidence base and can be life-changing.
This shift was strongly associated with a higher proportion of female patients, whose ADHD has been historically under-recognised.
But these video ADHD consultations can be lucrative. They offer a way for psychiatrists to see more patients, faster. So a single “one-off” assessment of 30 minutes or longer that results in a script – the type we identified – is an attractive business model.
When ADHD comes to dominate Medicare funding for telehealth originally designed to broaden access to all psychiatric care, market access for people with other mental illnesses may be crowded out.
So yes, telepsychiatry is expanding access. But our study shows its model is focused on a single, lucrative, fast-growing diagnosis and prescription business.
https://www.sciencedirect.com/science/article/pii/S0165178126003719?via%3Dihub
I’m not a medical specialist.
Hot take: ADHD is a label used for an evolutionarily advantageous traits. It’s only a „problem“ because contemporary society finds no value in those traits. The answer? Pharmaceutically engineer a more compliant person.
The rich will always find a way to fix the system to benefit them. The entitlement that comes with wealth cannot be overstated.
Why are we upset that medication is more accessible to the people that need it? That’s kind of the whole point of telehealth, which it’s really not difficult to see how people with ADHD would benefit from easier-to-attend, more flexible appointments.
I have to see my doctor in person every 3 months to get my prescription that lets me do my job and not be fired. I have to contact the office every month to have my prescription refilled. It is not refillable like most other medications.
The whole process is infuriating as I normally would interact with a Nurse practioner once a year for a checkup. Now I am mandated to do all of this extra and pay for these visits. It’s almost like there is some financial incentive in having me do this that some special interest is pushing for.
I have to have monthly appointments. No way could I go in person every month. I live in a rural area and work at home to support my family.
The journalist seems very biased.
“
Telepsychiatry for ADHD specifically did increase access for people living in rural and remote areas. But it was more likely to be provided by psychiatrists living in more affluent major towns and cities.
These types of ADHD telepsychiatry appointments are also associated with greater
out-of-pocket costs than the equivalent face-to-face appointments.“
The cost of tele vs in person is odd, but sounds like a US specific problem. (Edit: reread and clarified for myself they were evaluating Austrialian service prociders. So considering they have areas of care that are covered by single payer insurance like Canada that’s definetly a flaw on admin side of governance and insurance.) Provinces in Canada pay the same or less for tele appointments. So that seems an easily addressed administrative problem.
As for specialists being in urban areas, workforce concentration in urban centres is a universal challenge for rural communities. It doesn’t matter if it’s a frontline employee for a Tim Hortons, or an anesthesiologist for a hospitals OR, rural and remote areas have difficulty attracting and keeping staff. So it’s a perfectly expected result that telemedicine removes barriers and is heavily utilized for that purpose. In many circumstances I think thats a good thing we have that option and when you look into the „why“ Dr’s live in cities vs towns/hamlets the research supports the reasons we would think.
Now if we were talking asynchronous medical services, especially ones that discourage long or frequent communication, and encourage txt and email only, as minimally as possible, that want to utilize standardized pre-signed prescriptions, where no synchronus onversation and assessment happen? Yes, those services definetly scream concern of profit at major cost of quality and safety.
That’s a very different beast then appointments over telehealth video appointment or phone call though.
I wonder how much of this is women having to find a psych via online to actually work with them in medicating their ADHD that presents differently than in men, since women have had a harder time getting treatment locally.