Guideline adherence in German routine care of children and adolescents with ADHD: an observational study

Abstract

Although guidelines for the assessment and treatment of mental disorders in childhood and adolescence have been available in Germany for several years, there are barely any data on adherence to guidelines in national routine care. Therefore, the study aimed at a nationwide evaluation of guideline adherence (GA) for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) in German routine care in various groups of health care providers (HCPs). Besides a detailed description of GA, the study focused on examining possible differences between professional groups. Furthermore, data based on global self-reports of clinicians were compared with ratings of documented care in individual patients. Protocols of 73 clinicians regarding their handling of ADHD in routine care for 167 patients were rated according to German guideline recommendations for ADHD care. GA was measured as the proportion of components fulfilled in each individual patient as documented by the HCP. The results were compared to a preceding interview with clinicians regarding their GA. Multilevel models were constructed to detect differences in GA between professional groups. Based on mandatory guideline components, adherence rates of 38.9–72.7% were found and classified as moderate (33.3% < GA ≤ 66.6%) to high (GA > 66.6%). The comparison of the GA between the professional groups generally yielded only small differences. Correlations between GA reported globally by the HCPs and GA documented and rated for individual cases were low. Overall, most rates of GA for ADHD in German routine care lay within a moderate range. Targets for enhancement of GA may be the involvement of teachers and schools in the treatment process, the implementation of psychoeducational methods in general, as well as a careful examination of patients, including monitoring of treatment effects during titration trials. The development of further strategies to monitor the quality of ADHD routine care is needed. Electronic supplementary material The online version of this article (10.1007/s00787-020-01559-8) contains supplementary material, which is available to authorized users.

Co-occurring ASD Mediates Impact of ADHD on Atopic Dermatitis and Acne: A Retrospective Cohort Study

“…The association with acne and eczema found in those with ADHD may indicate an opportunity for providers to aid this unique patient population further. Patients with ADHD struggle with routine tasks, particularly those that do not have an immediate benefit (Mücke et al, 2021). Unfortunately, skincare may have a direct cost of time and effort with delayed benefits; however, dermatologists, psychiatrists, and primary care providers may overcome this uneven cost-benefit analysis perceived by patients through suitable communication.…”

Examining the pharmacological and psychological treatment of child and adolescent ADHD in Australia: Protocol for a retrospective cohort study using linked national registry data

“…In Germany, adherence to the country’s clinical practice guideline with respect to prescribing pharmacotherapy for ADHD was very high (97.2%) in a study by Mücke et al . 12 However, another German study of nearly 20 000 initial paediatric ADHD medication claims found that, while the majority were commenced on stimulants, 13% of children were commenced on a second-line or combination of medications, rather than trialling the stimulants first. 13 In the USA, McElligott et al 14 found that all surveyed prescribers offered stimulants as first-line intervention in moderate or severe ADHD cases, but that some prescribers opted for lisdexamfetamine as the first-line intervention, rather than methylphenidate.…”

“…Ellis et al ’s11 study did not examine the practice of psychiatrists and only examined pharmacological therapies. In Germany, adherence to the country’s clinical practice guideline with respect to prescribing pharmacotherapy for ADHD was very high (97.2%) in a study by Mücke et al 12. However, another German study of nearly 20 000 initial paediatric ADHD medication claims found that, while the majority were commenced on stimulants, 13% of children were commenced on a second-line or combination of medications, rather than trialling the stimulants first 13.…”

Preliminary evaluation of music-based emotion-regulation skills to augment CBT for adolescents with ADHD

“…Clinical trials among adolescents with ADHD suggest that they are more likely to engage with and comply with their treatment when they have an active role in the treatment process (DuPaul et al, 2020; Sibley et al, 2017). According to recent treatment guidelines, developmentally appropriate types of treatment (modalities) and adjunctive strategies that effectively incorporate adolescents’ developmental needs and preferences may increase treatment adherence and amplify the therapeutic benefits of current psychosocial interventions (DuPaul et al, 2020; Mücke et al, 2021; Wolraich et al, 2019; Zemestani et al, 2021). However, little research has been conducted on potential adjunctive modalities for augmenting the therapeutic benefits of current psychosocial interventions for adolescents with ADHD.…”