Effect of Australian telepsychiatry services on attention-deficit hyperactivity disorder prescriptions

OBJECTIVES: Telepsychiatry expansion has facilitated patient access to ADHD assessments in Australia, yet the determinants of access remain underexplored. We examined provider- and patient-level factors associated with ADHD-related video consultations and assessed policy impacts on ADHD-linked video consultations. We hypothesised that the expansion and consolidation of telepsychiatry policies led to a preferential, market-driven increase in video-mode consultations for ADHD prescriptions, shaped by sociodemographic and geographical factors. METHODS: We analysed nearly 4 million psychiatric consultations (2017-2023) by linking Medicare, Pharmaceutical Benefits Schedule, and 2021 Census data. We compared psychotropic and ADHD prescription rates across consultation modes (face-to-face, video, and telephone). Fractional logit regressions modelled the video fraction of ADHD prescriptions, while a Difference-in-Differences analysis assessed the causal impact of telehealth consolidation on ADHD- versus other psychotropic-linked video consultations. RESULTS: ADHD prescriptions increased from 4.3% (pre-expansion) to 11.8% post-consolidation, with ADHD prescription-linked video consultations surging from 1.8% to 23.4%. The video-consultation fraction of ADHD prescriptions rose by 12.9% during consolidation. Higher proportions of female patients and greater patient remoteness-but not provider remoteness-were associated with higher video prescribing. Growth in video prescribing following telehealth consolidation was markedly higher for ADHD medications than for other psychotropics, particularly for one-off initial assessments. CONCLUSION: Video-based ADHD prescribing has become widespread in Australia, improving accessibility but raising concerns about health equity and sustainability in psychiatric care. Parallel rises in online ADHD interest and increased video prescribing, in the context of stagnant overall video-telehealth-related psychotropic prescribing, may indicate market-driven influences within telepsychiatry.