Electronic decision support improves ADHD treatment guideline adherence

WASHINGTON — The use of an electronic template and a uniform workflow improved adherence to AAP evidence-based guidelines for the treatment of attention-deficit hyperactivity disorder with stimulant medication, according to data presented at the 2015 AAP National Conference and Exhibition.

“In primary care pediatrics, ADHD is one of three really major conditions,” Robert T. Rohloff, MD, a pediatrician at the Children’s Hospital of Wisconsin, told Infectious Diseases in Children. “It’s an important condition that needs to be treated, and there is evidence-based guidelines that have been developed to support the treatment.”

A physician groupwide survey of 22 pediatric primary care clinics with 70 board-certified pediatricians conducted in 2013 revealed wide variation in the management of patients with ADHD, attributed to the lack of a consistent system to support guideline implementation.

“While 60% or more pediatricians [in our physician group] understand the guidelines, much fewer actually followed them,” Rohloff said.

To address the gap between guidelines and physician practice within their group, Rohloff and colleagues implemented a common ADHD care management system based on the AAP guidelines for medication management of patients aged 6 to 12 years. Medication management was chosen first due to its greatest immediate impact at clinics.

The researchers built an electronic version of the refill encounter in the electronic medical record, supported by interdisciplinary streamlined workflows designed to be the lowest energy default supporting ADHD medication management.

The researchers measured completion of the electronic refill encounter tool by using an electronic provider signature embedded in the tool, which helped to identify patients due for biannual follow up visits, prompting staff to schedule appointments. Adherence to the 182-day follow-up schedule was measured by identifying the date of last scheduled visit at the time of refill request. Patients seen within the previous 182 days at time of refill were considered compliant with guidelines.

According to study results, all selected physicians used the ADHD template in more than 80% of refill telephone encounters. The investigators noted that this also improved adherence to medication check appointments.

“With electronic decision support, it is possible for busy pediatricians to provide care for kids with chronic conditions like ADHD in a medical home, following guidelines,” Rohloff said. “Hopefully, we can affect long-term outcomes in ADHD, which has a great cost to society, by implementing the right process based on the evidence-based guidelines.” – by Bob Stott

Reference:

Rohloff RT, et al. Abstract 31244. Presented at: AAP National Conference and Exhibition; Oct. 24-27, 2015; Washington, D.C.

Disclosure: The researchers report no relevant financial disclosures.