{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:04:49Z","timestamp":1753869889679,"version":"3.41.2"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,12]],"date-time":"2025-01-12T00:00:00Z","timestamp":1736640000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["HHSN275201000003I"],"award-info":[{"award-number":["HHSN275201000003I"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Increases in adult stimulant prescribing pose a potential risk due to the higher prevalence of contraindicated conditions among this population. We sought to identify patient, provider, and visit characteristics predictive of potentially inappropriate adult stimulant prescriptions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a repeated cross\u2010sectional study using the National Ambulatory Medical Care Survey, a nationally representative weighted sample of 5\u2009453\u2009702\u2009723 ambulatory care visits from 2012 to 2019. Potentially inappropriate prescriptions were defined as prescriptions to patients with potentially contraindicated conditions, as determined by US Food and Drug Administration stimulant labels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 5\u2009453\u2009702\u2009723 visits, stimulant use was prevalent at 121384694 (2.23%) visits and newly prescribed at 18880152 (0.34%) visits. Of these, 4\u2009620\u2009138 (24.47%) new stimulant prescriptions and 28\u2009055\u2009947 (23.11%) prevalent prescriptions were potentially inappropriate. Potentially inappropriate prescribing increased over time and with age. Visits to primary care providers (relative risk [RR] 1.65, 95% CI 1.05\u20132.59) were predictive of inappropriate prescribing. Non\u2010Hispanic Black (RR 0.48, 95% CI 0.33\u20130.70) and Hispanic race\/ethnicity (RR 0.46, 95% CI 0.35\u20130.60), coronary artery disease (RR 0.54, 95% CI 0.33\u20130.86), pregnancy (RR 0.05, 95% CI 0.03\u20130.11), hypertension (RR 0.69, 95% CI 0.56\u20130.84), and glaucoma (RR 0.07, 95% CI 0.02\u20130.24) were predictive of decreased prevalent stimulant prescriptions; substance abuse was predictive of new stimulant prescribing (RR 2.14, 95% CI 1.07\u20134.27).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The proportion of potentially inappropriate adult stimulant prescriptions increased over time and with patient age. Visits to primary care providers were predictive of potentially inappropriate prescribing, and a history of substance abuse was predictive of new stimulant prescriptions; therefore, quality improvement interventions regarding safe stimulant prescribing practices may be warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.70079","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T02:28:04Z","timestamp":1736735284000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Potentially Inappropriate Stimulant Prescribing Among Adults"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4521-6934","authenticated-orcid":false,"given":"Pavan V.","family":"Thakkar","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelique E.","family":"Boutzoukas","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute  Durham North Carolina USA"},{"name":"Department of Pediatrics Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott N.","family":"Compton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ohviya","family":"Sivashankar","sequence":"additional","affiliation":[{"name":"Hebron High School Lewisville Independent School District  Carrollton Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanecia O.","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute  Durham North Carolina USA"},{"name":"Department of Pediatrics Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Daniel K.","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute  Durham North Carolina USA"},{"name":"Department of Pediatrics Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Alan","family":"Brookhart","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7213a1"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.12m07975"},{"key":"e_1_2_12_4_1","unstructured":"Vyvanse\u00ae (Lisdexamfetamine) \u201cPrescribing Information. Food and Drug Administration \u201d2015 https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2015\/021977s039lbl.pdf."},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101524"},{"key":"e_1_2_12_6_1","unstructured":"\u201c2019 NAMCS Micro\u2010Data File Documentation \u201dhttps:\/\/ftp.cdc.gov\/pub\/Health_Statistics\/NCHS\/Dataset_Documentation\/NAMCS\/doc2019\u2010508.pdf."},{"key":"e_1_2_12_7_1","unstructured":"NAMCS\/NHAMCS \u2013 Questionnaires Datasets and Related Documentation \u201cCenters for Disease Control and Prevention \u201d2019 https:\/\/www.cdc.gov\/nchs\/ahcd\/ahcd_questionnaires.htm."},{"key":"e_1_2_12_8_1","unstructured":"Cerner Multum Drug Database \u201cOracle Cerner \u201daccessed July 20 2023 https:\/\/www.cerner.com\/solutions\/drug\u2010database."},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v009.i08"},{"key":"e_1_2_12_10_1","unstructured":"E.Hing \u201cAdvanced Programming. Presented at: National Conference on Health Statistics \u201d2015 https:\/\/www.cdc.gov\/nchs\/ppt\/nchs2015\/hing_monday_glenecho_c2.pdf."},{"key":"e_1_2_12_11_1","unstructured":"\u201cStimulant and Related Medications: Use in Adults \u201dCenters for Medicare and Medicaid Services."},{"key":"e_1_2_12_12_1","unstructured":"\u201cAttention deficit hyperactivity disorder: diagnosis and management \u201dNational Institute for Health and Care Excellence."},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31806728fa"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40615\u2010023\u201001555\u2010z"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.18.2825"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108297"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40801\u2010017\u20100129\u20102"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0198363"}],"container-title":["Pharmacoepidemiology and Drug Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pds.70079","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T02:52:50Z","timestamp":1745203970000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pds.70079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1002\/pds.70079"],"URL":"https:\/\/doi.org\/10.1002\/pds.70079","archive":["Portico"],"relation":{},"ISSN":["1053-8569","1099-1557"],"issn-type":[{"type":"print","value":"1053-8569"},{"type":"electronic","value":"1099-1557"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-02-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70079"}}