Comparison of Attention‐Deficit/Hyperactivity Disorder Care Between School‐Based Health Centers and a Continuity Clinic

Abstract

BACKGROUND: School-based health centers (SBHC) are in a unique position to provide guideline-driven attention-deficit/hyperactivity disorder (ADHD) care. In this study, we compared adherence to 2 components of ADHD guidelines in SBHC versus a continuity clinic. METHODS:We compared proportions of ADHD visits that had a structured symptom report available and timely follow-up in SBHC to a continuity clinic using chart review. We used multiple logistic regression to estimate the association between guideline adherence and clinic type. RESULTS:Participants who had a medication dose change were 3.9 times more likely (relative risk [RR] = 3.9, 95% confidence interval [CI] 3.0-5.1) to have a structured report present and 1.7 times more likely (RR = 1.7, 95% CI 1.2-2.2) to have follow-up within 30 days if they were seen in SBHC versus continuity clinic. Participants who were stable on their medication dose were 18 times more likely (RR = 18.0, 95% CI 11.3-29.0) to have a structured report present and 1.4 times more likely (RR = 1.4, 95% CI 1.3-1.6) to have follow-up within 100 days if they were seen in SBHC versus continuity clinic. CONCLUSIONS:Care provided in SBHC was associated with improved adherence to guidelines and has the potential to the improve pediatric ADHD outcomes. Citation: MacGeorge CA, King KL, Simpson AN, Abramson EL, Bundy DG, McElligott JT. Comparison of attention-deficit/hyperactivity disorder care between school-based health centers and a continuity clinic. J Sch Health. 2019; 89: 953-958.A ttention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, with a prevalence of 7% in school-aged children. 1 ADHD is known to cause impairment in a wide range of contexts, including relationships with families and peers, academic performance, school behavior, and social and emotional functioning. 2,3 This leads to increased risk-taking behavior, motor vehicle a Assistant Professor, (macgeorg@musc.edu), Medical

Connecting Kids to Care: Developing a School-Based Telehealth Program

“…Studies found that the care provided via this telehealth program achieved traditional quality metrics as well as, if not better than, in-person care. 13,23 Most recently, as the program has reached maturity and is serving larger numbers of children, a population health approach was used to determine associated rates of ED use among children with asthma. This study determined that rates of ED use among all children with asthma and access to the program have continually decreased over the course of the program's existence.…”

“…10 SBHCs have been shown to improve academic outcomes, reduce student absences, 11 decrease hospitalization and emergency department (ED) use for children with asthma, 12 and improve adherence to guidelines for managing attention deficit hyperactivity disorder (ADHD). 13 Despite the numerous benefits of SBHCs, some programs struggle to continue to offer services due to a lack of sustained funding. 1 Telehealth offers a solution to improve efficiency and potentially sustainability.…”

Nurse Perspectives Regarding Implementation of an Asthma Monitoring Mobile Health Application in the School Setting

“…10 Although evidence has shown that SBTH asthma programs are beneficial to the children they serve as well as the community, 9,10 caregiver engagement has been demonstrated as a barrier to full uptake of these programs. [11][12][13] Mobile health (mhealth) can potentially improve caregiver engagement and education and thus outcomes of these programs, [14][15][16] yet there is minimal knowledge and guidelines for the ideal approach to implement and incorporate m-health into existing SBTH programs. The objective of this study was to determine perceived acceptability of an asthma m-health application to be incorporated with an existing SBTH asthma program and key desired features and barriers to implementation of this novel application.…”