Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers

IntroductionAdherence to practice guidelines for diagnosing and treating attention-deficit/hyperactivity disorder (ADHD) by primary care providers (PCPs) is important for optimizing care for many children and youth. However, adherence is often low. To address this problem, we implemented an intensive intervention in 2009 aimed at improving diagnosis and management of ADHD among PCPs.ObjectivesThe study objective is to assess the sustainability of intervention-attributable outcomes.AimsThe study aims are to assess the sustained effect of the intervention on PCP intentions to implement, attitudes toward, and obstacles to implement ADHD practice guidelines.MethodsDuring November 2009, 48 PCPs from 31 clinical practices completed a 3-day training, 6 months of biweekly telephone peer group reinforcement, and baseline questionnaires; follow-up questionnaires were completed at 12 months. To assess sustainability, we tracked PCPs and administered the questionnaire in 2016.ResultsIntentions to implement ADHD guidelines remained stable over seven years, with all mean values ranging from “probably will” to “definitely will” implement guidelines.ConclusionsGenerally, favorable self-reported intentions (see Exhibits 1 & 2), attitudes and obstacles to implementing ADHD guidelines were sustained seven years after the intensive training and follow-up intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Attention-deficit hyperactivity disorder on the frontlines: Management in the primary care office

Comprehensive Therapy ◽

10.1007/bf02944277 ◽

1999 ◽

Vol 25 (6-7) ◽

pp. 313-325 ◽

Cited By ~ 2

Author(s):

Michael A. Taylor

Keyword(s):

Primary Care ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Hyperactivity Disorder ◽

Primary Care Office

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Stimulant Medication Use by Primary Care Physicians in the Treatment of Attention Deficit Hyperactivity Disorder

PEDIATRICS ◽

10.1542/peds.86.1.95 ◽

1990 ◽

Vol 86 (1) ◽

pp. 95-101

Author(s):

Mark L. Wolraich ◽

Scott Lindgren ◽

Ann Stromquist ◽

Richard Milich ◽

Charles Davis ◽

...

Keyword(s):

Primary Care ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Primary Care Physicians ◽

Stimulant Medication ◽

Medication Use ◽

The United States ◽

Hyperactivity Disorder ◽

Family Practitioners ◽

Behavioral Treatments

Treatment of attention deficit hyperactivity disorder (ADHD), one of the most common behavioral disorders in children in the United States, remains controversial because of concern about stimulant medication use. Extending a previous study of pediatricians, the present study surveyed a random national sample of family practitioners and then directly screened 457 patients of 10 pediatricians and family practitioners in two small midwestern cities. Responses to the national survey indicated that stimulant medication remains the main treatment prescribed by primary care physicians for children with ADHD. In the direct patient screening, the prevalence of ADHD diagnoses was 5.3% (pediatricians) and 4.2% (family practitioners) of all elementary-schoolaged children screened. Eighty-eight percent of these children were treated with methyiphenidate. Although medication was considered an effective treatment by the parents of 85% of the children given the medication, efficacy was unrelated to the accuracy of diagnosis. When explicit DSM-III-R criteria were used, only 72% of those assigned a diagnosis of ADHD by the physicians would have received that diagnosis based on a structured psychiatric interview with the parents and only 53% received that diagnosis based on teacher report of symptoms, even when the child was not receiving medication. Although the majority of physicians (in both the surveys and the direct screenings) reported using at least some behavioral treatments with their patients, parents reported infrequent use of nonpharmacologic forms of therapy, such as behavior modification. These data thus indicate a relatively modest rate of stimulant medication use for ADHD, but a serious underuse of systematic behavioral treatments in primary care.

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