Implementing ADHD Guidelines in Primary Care: Does One Size Fit All?

Leslie, Laurel K.; Stallone, Kimberly; Weckerly, Jill; McDaniel, Amy L; Monn, Amy R.

doi:10.1353/hpu.2006.0064

Cited by 41 publications

(42 citation statements)

References 60 publications

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“…The children in the general pediatric clinic at the public hospital had a very similar profile to those in the public psychiatric clinic. These findings are consistent with those of other studies that compared public with private clinic samples [36]. Similar to another study, the current findings raise questions as to whether children with more socioeconomic disadvantage are at a higher risk of long-term negative outcomes of ADHD [37].…”

Section: Discussionsupporting

confidence: 92%

An Assessment of Comorbidity and Social Demographics in a Primarily African-American and Hispanic Population of Boys with ADHD Treated in Psychiatric/Non-Psychiatric and Public/Private Clinics in Miami, Florida

Rothe¹,

Lewis²

2016

J Child Adolesc Behav

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Objective: To determine whether social disadvantage and comorbidity in boys with attention-deficit/hyperactivity disorder (ADHD) differ among psychiatric versus non-psychiatric and public versus private clinics. Methods:This cross-sectional study included boys 6-12 years of age, clinically diagnosed, and pharmacologically treated for ADHD at 1 of 5 clinics in Miami, Florida. The child's caregiver completed a demographics form, the Child Behavior Checklist, and the Child Symptom Inventory. Results:The study included 174 boys (28% African-American and 64% Hispanic). The sample included 42% psychiatric practices and 73% public clinics. Compared to the non-psychiatric sample, children in the psychiatric samples presented more often with ADHD hyperactive-impulsive subtype and combined subtype. Children in the psychiatric clinics had the most severe forms of ADHD and the most comorbid diagnoses, particularly behavioral, mood, and anxiety disorders. Compared to the private clinics, children in the public psychiatric clinic presented more markers of socioeconomic disadvantage. Public clinics also had more severe ADHD, social phobia, aggressive behavior, and externalizing behaviors than private clinics. Conclusions:Comorbidity and severity of ADHD in children treated in primary care clinics were lower than, but clinically comparable to, that found in psychiatric clinics. Socioeconomic disadvantages are present in children treated in public clinics.

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Section: Discussionsupporting

confidence: 92%

An Assessment of Comorbidity and Social Demographics in a Primarily African-American and Hispanic Population of Boys with ADHD Treated in Psychiatric/Non-Psychiatric and Public/Private Clinics in Miami, Florida

Rothe¹,

Lewis²

2016

J Child Adolesc Behav

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“…The low rates of evidence-based ADHD treatment practices have repeatedly been found to be resistant to reliable implementation. 5,7 Additional intervention components (eg, community collaborations 20 or assignment of case managers [21][22][23] ) might possibly help parents and teachers to improve adherence to prescribed practices.…”

Section: Discussionmentioning

confidence: 99%

“…For example, it is likely that barriers at the patient level (eg, poverty and parents' drug use 21,26 ) and physician level (eg, computer access in patient rooms and attitudes regarding change 27 ) prevent uniform adoption of this study's intervention. Furthermore, the Internetbased portal presented additional technological challenges to parents in the form of the need for Internet access 21 and to physicians in terms of adding another electronic patient medical record. Identifying and addressing these barriers may facilitate consistent implementation and widespread dissemination of this intervention.…”

Section: Discussionmentioning

confidence: 99%

Use of an Internet Portal to Improve Community-Based Pediatric ADHD Care: A Cluster Randomized Trial

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT:Although evidence-based guidelines for pediatric attention-deficit/hyperactivity disorder (ADHD) care exist, adherence to the guidelines in communitybased settings has been problematic. Effective interventions that improve the quality of pediatricians' ADHD care and are ready for widespread dissemination do not currently exist. WHAT THIS STUDY ADDS:By using a cluster-randomized trial design, results of this study provide evidence that a quality improvement intervention that is conducive to widespread dissemination improves the ADHD assessment and treatment behaviors of community-based pediatricians.abstract OBJECTIVE: To determine the effectiveness of a quality improvement program to improve pediatricians' adherence to existing, evidencebased, attention-deficit/hyperactivity disorder (ADHD) practice guidelines. METHODS: Forty-nine community-based pediatricians at 8 practices participated in a cluster-randomized trial. Practices were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid. The medical charts for a random sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months. All practices participated in 4 sessions of training, including didactic lectures and office flow modification workshops. Practices were then given access to an ADHD Internet portal that allowed parents, teachers, and pediatricians to input information (eg, rating scales) about patients, after which information was scored, interpreted, and formatted in a report style that was helpful for assessment and treatment of patients with ADHD. Physicians evaluated their practice behaviors quarterly and addressed underperforming areas. RESULTS: Pediatricians in the intervention group, compared with those in the control group, demonstrated significantly higher rates of many American Academy of Pediatrics-recommended ADHD care practices, including collection of parent (Cohen's d ϭ 0.69) and teacher (d ϭ 0.68) rating scales for assessment of children with ADHD, use of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (d ϭ 0.85), and use of teacher rating scales to monitor treatment responses (d ϭ 1.01). CONCLUSION: A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric settings.

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“…At least half of individuals with ADHD are identified and treated within primary care settings, rather than by a mental health professional (Epstein et al 2008;Leslie et al 2006;Leslie et al 2004). For most children, pediatricians or family physicians provide primary care.…”

Section: The Diagnosis Of Adhd Within Primary Care Settingsmentioning

confidence: 99%

The Role of Neuropsychological Assessment in the Functional Outcomes of Children with ADHD

et al. 2011

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The value of evidence-based services is now recognized both within clinical communities and by the public at large. Increasingly, neuropsychologists must justify the necessity of often costly and time-consuming neuropsychological assessments in the diagnosis and treatment of common childhood disorders, such as Attention-deficit/Hyperactivity Disorder (ADHD). Published medical guidelines and prominent researchers, however, have argued against the need for formal neuropsychological assessment of ADHD. The present review examines the literature on developmental outcomes in childhood ADHD, with emphasis on the utility of formal neuropsychological assessment among children diagnosed and treated in primary care settings. The review yields three central findings: 1) adherence to published diagnostic guidelines for ADHD is poor among pediatric and primary care physicians; 2) ADHD most often co-exists with other disorders, thus diagnoses made without formal psychometric assessment can be incomplete or incorrect, ultimately increasing treatment costs; and, 3) untreated children with ADHD, and those who have untreated comorbidities, are at greater risk for poor outcomes in social, academic, vocational, and practical settings. The available literature suggests that neuropsychological assessment provides information that can potentially reduce risks for poor outcomes and improve quality of life among children with ADHD. Controlled studies directly examining the impact of neuropsychological assessments in improving outcomes among children with ADHD are needed.

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Implementing ADHD Guidelines in Primary Care: Does One Size Fit All?

Cited by 41 publications

References 60 publications

An Assessment of Comorbidity and Social Demographics in a Primarily African-American and Hispanic Population of Boys with ADHD Treated in Psychiatric/Non-Psychiatric and Public/Private Clinics in Miami, Florida

An Assessment of Comorbidity and Social Demographics in a Primarily African-American and Hispanic Population of Boys with ADHD Treated in Psychiatric/Non-Psychiatric and Public/Private Clinics in Miami, Florida

Use of an Internet Portal to Improve Community-Based Pediatric ADHD Care: A Cluster Randomized Trial

The Role of Neuropsychological Assessment in the Functional Outcomes of Children with ADHD

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