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Web intervention on ADHD pediatric care improves quality outcomes
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Study findings in Pediatrics showed a web-portal intervention for pediatricians who prescribed medications for children with attention-deficit/hyperactivity disorder improved patients’ quality of care and may lead to greater reductions in parent ratings of their children’s symptoms.
“Approximately 7% to 9% of elementary school-age children in the United States are diagnosed with [ADHD],” Jeffery N. Epstein, PhD, professor of pediatrics in behavioral medicine and clinical psychology at Cincinnati Children’s Hospital Medical Center, and colleagues wrote. “Most of these children receive their ADHD care from primary providers. Unfortunately, ADHD care quality in these settings, especially medication monitoring and titration, is often poor.”
To assess the quality of ADHD community-based care pediatricians provide, Epstein and colleagues examined the effectiveness of a technology-assisted quality improvement (QI) intervention on outcomes among elementary school-aged children with ADHD. The randomized, cluster controlled study included 213 pediatricians at 50 primary care practices who prescribed ADHD medication to children during a 2-year period. Pediatricians were assigned to a technology-assisted QI intervention — including four 1-hour, Web-based training sessions and an ADHD internet portal for monitoring assistance — or a control condition. ADHD treatment methods and parent/teacher rated symptoms were collected from 577 children (36.7% nonwhite) in the first year; 258 were from intervention practices, and 319 were from control practices.
The researchers contacted patients’ family members at 3, 6 and 12 months to reassess the parents’ judgment on ADHD symptom ratings and contacted teachers at 3 and 6 months after baseline. Among children prescribed ADHD medications (n = 373), pediatricians experienced a significant QI with the web-portal intervention (b = –2.42; P = .04), including more treatment contacts and parent/teacher symptom ratings compared with children at control practices. This prompted the researchers to recommend future studies to encourage expanding the software to enable behavioral treatment and implementation to all pediatric ADHD patients.
“Compared with the usual care group, providers in the intervention group had 25% more patient contacts and collected 4.6 and 9.9 times more parent and teacher ratings, respectively,” the researchers wrote. “However, even the quality of care achieved at the intervention practices left much room for improvement. For example, providers did not collect parent or teacher ratings during the initial year of ADHD medication treatment for half of their patients.” – by Kate Sherrer
Disclosure: Epstein reports that he and his institution own the intellectual property and licensing rights to the internet-based software used in this study. He also reports receiving consulting fees and/or travel reimbursement from the AAP. Please see the full study for a list of all other authors’ relevant financial disclosures.
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