Innovative Program Helps PCPs Implement ADHD Diagnosis, Treatment Guidelines

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Title: Innovative Program Helps PCPs Implement ADHD Diagnosis, Treatment Guidelines
URL: http://www.pslgroup.com/dg/22531E.htm
Doctor's Guide
July 7, 2008

CINCINNATI, Ohio -- July 7, 2008 -- An innovative program is helping busy primary care physicians improve the care they provide for children with attention-deficit/hyperactivity disorder (ADHD), according to a study published in the July issue of Pediatrics.

The study is the first to intervene with an entire community of primary care physicians and help them more accurately diagnose and effectively monitor treatment response of their patients with ADHD, said lead author Jeff Epstein, PhD, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Although community practitioners are the first point of contact for children with ADHD, the use of standardised evidence-based diagnosis and treatment guidelines established by the American Academy of Pediatrics (AAP) was infrequent at most of the participating paediatric practices before the study began.

The intervention consisted of an innovative training program developed by Cincinnati Children's Hospital on how to implement AAP diagnosis and treatment guidelines. The training focused on modifying office systems to accommodate the AAP guidelines, said Dr. Epstein. This included building in the use of parent and teacher ADHD rating scales into the evaluation and treatment monitoring process.

After 84 Cincinnati-area community physicians finished training and implemented AAP guidelines at their practices, the use of ADHD child assessment rating scales soared from 55% by parents and 52% by teachers to nearly 100%. This led to more accurate diagnosis and fewer children being started on medication inappropriately.

Systematic monitoring of patient medication response improved from a baseline of 9% to over 40%. For patients who were being monitored systematically, most had documentation of significant symptom reduction during their first several months of treatment.

"An additional benefit of the intervention is it appears that as a result of participating in the intervention, physicians in the community are now better equipped to recommend alternatives to medication, such as behavioural therapy, engage families in setting treatment goals, and more effectively coordinate care with the child's school," said Dr. Epstein.

"A significant problem, both locally and nationally, is that guidelines, once published, rarely find their way quickly into clinical usage," said Dr. Epstein. "A large part of the problem is that no means exists for systematically exposing physicians to the guidelines and teaching them how to adapt them for use in their busy practices. This was the case in the Cincinnati-area practices with the ADHD guidelines."

SOURCE: Cincinnati Children's Hospital Medical Center

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