How can the internet help improve community-based pediatric ADHD care?
Cincinnati Children's Hospital Medical Center, ML #10006, Cincinnati, OH 45229-43039, USA. .Expert Review of Neurotherapeutics (Impact Factor: 2.96). 05/2012; 12(5):501-3. DOI: 10.1586/ern.12.37
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ABSTRACT: To test whether adoption of a collaborative consultative service model results in improved patient outcomes. Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group. Community-based pediatric offices. Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder (ADHD). Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance. Main Outcome Measure Physician practice behaviors and child ADHD symptomatology. Using self-report of pediatricians, the collaborative consultative service increased the use of evidence-based practices by pediatricians, but no difference in children's ADHD symptomatology was observed between the groups. However, many pediatricians did not fully use the collaborative consultative services. Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services. When actually implemented by pediatricians, the collaborative consultative service appears to be an effective method for facilitating evidence-based treatment procedures for ADHD and use of these procedures appear to improve children's outcomes. Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood.Archives of Pediatrics and Adolescent Medicine 10/2007; 161(9):835-40. DOI:10.1001/archpedi.161.9.835 · 4.25 Impact Factor
Pediatric Annals 07/2003; 32(6):413-8; quiz 421-2. DOI:10.3928/0090-4481-20030601-10 · 0.29 Impact Factor
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ABSTRACT: Several guidelines have been published for the care of children with attention-deficit/hyperactivity disorder (ADHD); however, few data describe adoption of practice guidelines. Our study sought 1) to describe primary care diagnosis and management of ADHD, 2) to determine whether the care is in accordance with American Academy of Pediatrics (AAP) practice guidelines, and 3) to describe factors associated with guideline adherence. We conducted a mail survey of 1374 primary care physicians in Michigan. Main outcome measures were reported adherence to practices specified in the AAP guidelines; ADHD practice patterns; and other measures, including attitudes about parent, teacher, and community influences on ADHD diagnosis and treatment. Bivariate and multivariate analyses were performed to assess patient and physician factors associated with adherence to guideline components. The overall response rate was 60%. The majority (77.4%) of primary care physicians were familiar with AAP guidelines on ADHD, and many (61.1%) reported incorporating the guidelines into their practice. Differences were apparent by specialty: 91.5% of pediatricians were familiar with the guidelines in contrast to 59.8% of family physicians. The majority of clinicians reported practices consistent with individual components of the diagnostic and treatment guidelines. However, when adherence to multiple components was analyzed together, only 25.8% of clinicians reported routine use of all 4 diagnostic components in the survey. In addition, some physicians continue to use diagnostic modalities that are currently not recommended for routine evaluation of school-aged children with ADHD--continuous performance testing, neuroimaging, and laboratory tests (eg, thyroid, lead, or iron testing). With regard to ADHD treatment, the majority (66.6%) of respondents reported routine recommendation of pharmacotherapy and titration of medications in the first month when prescribed (81.3%). However, just over half (53.1%) reported routine follow-up visits (3-4 times per year) for children who have ADHD and are taking medications. Most (53.4%) clinicians also recommended behavioral therapy for children who had a diagnosis of ADHD. Patterns of specialty differences were less consistent for treatment components: pediatricians were more likely to recommend medications, but family physicians reported more frequent follow-up evaluations for children who receive medications. There were no specialty differences in recommendations for behavioral therapy. In addition to physician specialty variations, differences in management were apparent by practice type and other demographic characteristics. There were few significant associations between adherence to guideline components and physician attitudes about parent, teacher, or community influences. However, these factors were noted by many respondents. Only 32.5% agreed that their community had adequate, accessible mental health resources. Half (50.1%) of the physicians reported that insurers limit coverage for assessment and treatment of ADHD. Primary care physicians generally report awareness of pediatric ADHD guidelines and follow these clinical practice recommendations. However, some physician variations are apparent, and areas for improvement are noted. Many primary care physicians report poor access to mental health services, limited insurance coverage, and other potential system barriers to the delivery of ADHD care. Additional study is needed to confirm provider-reported data; to determine what constitutes high-quality, long-term management of this chronic condition; and to confirm how reported practices associate with long-term outcomes for children with ADHD.PEDIATRICS 08/2004; 114(1):e23-8. · 5.30 Impact Factor
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