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Fawaz Stifo. Kai Gran, Massachusetts. Erica A. Rodriguez, Bachelor of Science; Jordan F. Karp, MD
Publication date: October 14, 2024
Inattentional Attention Deficit/Hyperactivity Disorder (ADHD) 1(p62) Frequent cannabis use and other cannabis-related disorders can have an impact. Cognition, particularly memory and executive function, can contribute to difficulties with performance at school and work. 2 During clinical work in our department’s Medicaid-licensed behavioral health homes, 3 we anecdotally observed that cannabis use was frequent among young adult patients diagnosed with (1) That’s what it means. ADHD, (2) prescribing stimulants to young adult patients who use cannabis, and (3) inaccurate coding of cannabis use even if cannabis was described in the encounter narrative. Describe the accuracy of ADHD diagnoses and overlap, cannabis use, and prescribed treatments for ADHD to explore the extent of comorbidity, documentation accuracy, and potential for inappropriate prescribing of stimulants We retrospectively (using de-identified data) examined medical records. In a group of primarily young adult patients who received Medicaid. 4
method
We reviewed electronic medical records of patients aged 18–30 years who had at least one clinic visit from January to December 2023. We then abstracted and tabulated both the International Classification of Diseases, 10th Revision (ICD-10), ADHD codes, and cannabis use. , and mentions either condition in the narrative of the encounter. Frequency of use and description of dosage were recorded in clinical notes and were therefore excluded from analysis. Indeed, when we performed a sensitivity analysis on 12 of the 33 charts in which cannabis use was recorded, only one case had cannabis abuse recorded in the clinical record. However, the document did not provide details regarding frequency or amount of use. We also extracted both stimulants and non-stimulants prescribed for ADHD from the drug list.
result
Of the 300 patients identified, 87 were on the problem list with an ICD-10 diagnosis of ADHD, and 94 patients had ADHD listed in the encounter description. This reflects a 93% agreement between ICD-10 codes and descriptions.
Of the 94 patients with ADHD listed in the text of the conference, the clinical records of 33 (35%) included a description of current marijuana use. Nevertheless, only 3 (3%) of these 94 patient records contained a coded diagnosis of marijuana use.
In our prescribing study, 26 of 206 (13%) patients who did not have a coded diagnosis or description of ADHD in their narratives prescribed stimulants for inconsistently documented reasons. I observed what happened. Of the 94 patients diagnosed with ADHD, 68 (72%) were on stimulant medications and 20 (21%) were on non-stimulant medications. Of the 33 patients with both ADHD and marijuana use documented in clinical practice, 24 (73%) were prescribed stimulants.
discussion
The high agreement between clinical record descriptions of ADHD and coded diagnoses indicates that documentation practices for ADHD are robust. However, this clinical improvement effort reveals that cannabis use is significantly underreported as a coded diagnosis and that there are gaps in accurate coding of cannabis use among patients with ADHD. The finding that 73% of patients with both ADHD and cannabis use described in this encounter were prescribed stimulants calls for increased training and education of clinicians regarding the appropriate prescribing of stimulants. Such education should include best practices for managing ADHD in patients who use cannabis to minimize the potential for inaccurate prescribing, iatrogenic effects of stimulant exposure, and community diversion. may occur. Some patients with co-occurring cannabis use and attention problems (diagnosed with ADHD) may experience cognitive benefits by reducing or discontinuing cannabis use instead of taking stimulants. there is. This harm reduction or abstinence approach may reduce the risk of cardiovascular disease and diversion associated with stimulant drugs. In summary, these observations are a reminder of the importance of (1) diagnostic and documentation accuracy; If included in the body of the note, consider including it as a coded diagnosis to support communication between the care team and support medical complexity and treatment planning. (2) reduced cannabis use among young people who report attention problems; and (3) decreased use of cannabis among young people whose complaints of cognitive impairment may not be secondary to ADHD but may be impaired by cannabis. Careful prescribing of stimulants to patients.
We acknowledge as a limitation that our focus was on documenting cannabis use and not limited to misuse/disorder. This may affect the interpretation of findings regarding coding practices for cannabis use.
Article information
Published online: October 14, 2024. https://doi.org/10.4088/JCP.24l15496
© 2024 Physicians Postgraduate Press, Inc.
J Clin Psychiatry 2024;85(4):24l15496
Citation: Stipho F, Glahn K, Rodriguez EA, et al. Cannabis use and attention-deficit/hyperactivity disorder in community mental health: Consideration of comorbidity and accurate documentation. J Clinic Psychiatry. 2024;85(4):24l15496.
Author affiliation: Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona (Stifo, Grahn, Rodriguez, Karp); Banner University Medical Center and Group, Tucson, Arizona (Rodriguez, Karp).
Corresponding author: Jordan F. Karp, MD, Banner University Medical Center and Group, 2800 E Ajo Way, Behavioral Health Pavilion, Ste P3016, Tucson, AZ 85713 ((email protected)).
Relevant Financial Relationships: Mr. Stifo, Mr. Grahn, and Mr. Rodriguez have nothing to report. Dr. Karp has reported the following over the past two years: Stock Potential in Aifred Health. Scientific advice to Biogen. Compensation for editorial board service from the American Journal of Geriatric Psychiatry and Physians Postgraduate Press. Research support from Janssen/JJ Neuroscience. and research support from the National Institutes of Health and the Patient-Centered Outcomes Research Institute (PCORI).
Funding/Support: This project was supported by in-kind support from both the University of Arizona Tucson School of Medicine Department of Psychiatry and Banner University Medical Center in Tucson, Arizona.
Previous presentation: These data were presented at the University of Arizona College of Medicine’s Annual Research Day in Tucson on April 17, 2024.
