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

Epstein, Jeffery N.; Langberg, Joshua M.; Lichtenstein, Philip; Kolb, Rebecca C.; Altaye, Mekibib; Simon, Jay R.

doi:10.1542/peds.2011-0872

Cited by 72 publications

(96 citation statements)

References 30 publications

(36 reference statements)

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“…Such efforts may take the form of quality improvement, 8,[25][26][27] clinical decision support tools, 28,29 using pay-for-performance incentives, 30 and/or partnering with mental health professionals. 31,32 Fortunately, the US government has mandated the use of electronic health records (EHRs) and has set up incentives encouraging physicians to "meaningfully use" EHRs to improve care.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, recent research reviewing ADHD patient charts suggests a poorer quality of care. 8 Among 49 pediatricians from 8 practices, only 20% of patients were evaluated with parent or teacher rating scales during ADHD assessment. Further, none of the pediatricians used ADHD parent and teacher ratings to monitor treatment progress.…”

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confidence: 99%

“…Further, none of the pediatricians used ADHD parent and teacher ratings to monitor treatment progress. 8 The small number of practices sampled in Epstein et al 8 did not allow for analyses of whether variability in ADHD care was associated with patients, pediatricians, and/or practices. Also, although some investigators speculated that rural location, academic affiliation, and serving patients of low socioeconomic status may affect patient care, [9][10][11][12][13][14][15] there are few published data about the effect of practice characteristics on ADHD care.…”

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confidence: 99%

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Variability in ADHD Care in Community-Based Pediatrics

et al. 2014

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attentiondeficit/hyperactivity disorder (ADHD) care. According to pediatricians' self-report of adoption of these guidelines, community-based ADHD care appears to be marginally adequate.WHAT THIS STUDY ADDS: Using reviews of .1500 patient charts, this study demonstrates that community-based ADHD care is not consistent with evidence-based practice. Furthermore, variability in much of community-based ADHD care is unrelated to the provider, suggesting that innovative, system-wide interventions are needed to improve ADHD care. abstract BACKGROUND: Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder (ADHD) in community-based pediatric settings, little is known about typical ADHD care in these settings other than rates garnered through pediatrician self-report. METHODS:Rates of evidence-based ADHD care and sources of variability (practice-level, pediatrician-level, patient-level) were determined by chart reviews of a random sample of 1594 patient charts across 188 pediatricians at 50 different practices. In addition, the associations of Medicaid-status and practice setting (ie, urban, suburban, and rural) with the quality of ADHD care were examined.RESULTS: Parent-and teacher-rating scales were used during ADHD assessment with approximately half of patients. The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4% of patients. The vast majority (93.4%) of patients with ADHD were receiving medication and only 13.0% were receiving psychosocial treatment. Parent-and teacher-ratings were rarely collected to monitor treatment response or side effects. Further, fewer than half (47.4%) of children prescribed medication had contact with their pediatrician within the first month of prescribing. Most variability in pediatriciandelivered ADHD care was accounted for at the patient level; however, pediatricians and practices also accounted for significant variability on specific ADHD care behaviors. CONCLUSIONS:There is great need to improve the quality of ADHD care received by children in community-based pediatric settings. Improvements will likely require systematic interventions at the practice and policy levels to promote change. Dr Epstein contributed to the conceptualization and the design of the study, and drafted the initial manuscript; Drs Kelleher, Baum, Brinkman, Lichtenstein, and Langberg contributed to the conceptualization and the design of the study, and reviewed and revised the manuscript; Drs Peugh and Gardner carried out the initial analysis, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.www.pediatrics.org/cgi

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Variability in ADHD Care in Community-Based Pediatrics

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“…There is still a wide range of variation in adherence of clinical practice to available guidelines among various healthcare paediatric professionals involved in managing children with ADHD and across various locations [24][25][26]. There are clear indications and scope for improvement of clinicians' adherence to existing guidelines [27].…”

Section: Clinical Care Pathwaysmentioning

confidence: 99%

A Study of Comparative Clinical and Socio-Economic Characteristics of School-Age Children Screened for ADHD: Implications for Development of ADHD Clinical Care Pathway

Ogundele¹

2017

PBS

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ADHD is the most frequently occurring neurobiological disorder in childhood and is defined by cardinal symptoms of inattention and/or hyperactivity and impulsivity. We evaluated school-age children referred for behaviour problems and screened for ADHD over a 22-month period. We compared the clinical and socio-economic characteristics of the two groups of children: those diagnosed with ADHD and non-ADHD. A total of 63 children were assessed for possible ADHD over the period. There was no statistically significant difference between both groups in relation to several characteristics including sex ratio, mean age at referral and diagnosis, mean number of clinics attended, the time taken to complete the assessment and the socioeconomic status of patients' families. The highest proportion of the ADHD and non-ADHD children lived in the most deprived areas. The main difference between both groups was the high rate of negative teachers' responses. No teacher's rating was positive for any child without a diagnosis. An ideal ADHD care pathway should follow multidisciplinary approach, and rely on evidence-based feedback from the school, as a more reliable pointer to confirmed diagnosis of ADHD compared to just parental report. This will likely reduce assessment duration and avoid delays in diagnosis confirmation.

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“…Original provider survey used to assess provider compliance with the ADHD guideline. Permission to duplicate and adapt this survey was provided by the author (Epstein et al, 2011). 12.…”

Section: Adhd Treatmentmentioning

confidence: 99%

Military Children with Attention Deficit Hyperactivity Disorder (ADHD): Maximizing Adherence to Clinical Practice Guidelines

Henson¹

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

Cited by 72 publications

References 30 publications

Variability in ADHD Care in Community-Based Pediatrics

Variability in ADHD Care in Community-Based Pediatrics

A Study of Comparative Clinical and Socio-Economic Characteristics of School-Age Children Screened for ADHD: Implications for Development of ADHD Clinical Care Pathway

Military Children with Attention Deficit Hyperactivity Disorder (ADHD): Maximizing Adherence to Clinical Practice Guidelines

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