Improving the quality of physical health monitoring in CAMHS for children and adolescents prescribed medication for ADHD

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by a persistent, pervasive pattern of inattention, impulsivity and hyperactivity. Stimulant medication such as methylphenidate has an established evidence base in the treatment of children and adolescents with ADHD. However, it is also associated with a risk of side effects which may include decreased appetite, increased blood pressure and possible reduced growth. Monitoring physical health in children and adolescents prescribed medication for ADHD is a key clinical responsibility and includes a number of parameters as outlined in the National Institute for Health and Care Excellence Guidelines. Ascertaining the centiles of physical observations is essential to put these into developmental context and accurately inform treatment decisions. This quality improvement project aimed to improve physical health monitoring in children and adolescents prescribed stimulant medication for ADHD within a large specialist urban inner-city Child and Adolescent Mental Health Service (CAMHS) in South London and Maudsley NHS Foundation Trust. Baseline data were obtained to establish the quality of physical monitoring including blood pressure, height, weight and centiles. Targeted interventions included the development of a novel web-based application designed to calculate and record centiles. We report an improvement in total proportion compliance with physical health monitoring from 24% to 75%. The frequency of recording baseline blood pressure centiles increased from 0% to 62%; recording baseline height centiles increased from 37% to 81% and recording baseline weight centiles increased from 37% to 81%. Improvement in the delivery of high-quality care was achieved and sustained through close collaboration with clinicians involved in the treatment pathway in order to elicit and respond effectively to feedback for improvement and codevelop interventions which were highly effective within the clinical system. We believe this model to be replicable in other CAMHS services and ADHD clinics to improve the delivery of high-quality clinical care.

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Quality of Life in Caregivers of Children and Adolescents with Autistic Spectrum Disorder: Development and Validation of the Questionnaire

Brain Sciences ◽

10.3390/brainsci11070924 ◽

2021 ◽

Vol 11 (7) ◽

pp. 924

Author(s):

Claudia B. Pratesi ◽

Alessandra Baeza Garcia ◽

Riccardo Pratesi ◽

Lenora Gandolfi ◽

Mariana Hecht ◽

...

Keyword(s):

Quality Of Life ◽

Physical Health ◽

Children And Adolescents ◽

Internal Consistency ◽

Autistic Spectrum Disorder ◽

Spectrum Disorder ◽

Autistic Spectrum ◽

The Social ◽

Health Domains

Studies have shown that children and adolescents with autism and their relatives present a high level of stress and more family problems, impacting parents’ and caregivers’ quality of life (QoL). Despite studies on this subject, there is no specific questionnaire to evaluate QoL in parents or caregivers of children and adolescents with an autistic spectrum disorder (ASD) in Brazil. Therefore, this study’s primary purpose was to develop and validate a specific questionnaire to evaluate QoL in these individuals. The study was performed using the following steps: development of the ASD Parent/caregiver QoL questionnaire (autistic spectrum disorder parent/caregiver quality of life—ASDPC-QoL), subjective evaluation, validation of the questionnaire by the Delphi method, assessment of internal consistency, responsiveness, and reliability of the ASLPC-QoL, and administration of the questionnaire to 881 Brazilian ASD caregivers or parents. ASDPC-QoL comprises 28 questions divided into four domains (social, concerns, physical and mental health) with good psychometric properties (reproducibility, reliability, internal consistency, responsiveness, and validity). Our data showed that worries and physical health were the domains with the lowest scores in ASDPCA-QoL. ASDPCA-QoL did not differ among gender and age of child considering the total and all domains. Older participants (≥41 y/o) presented the best scores for social and worries domains but did not differ in other domains and the total. Parents or caregivers of ASD children diagnosed for more than three years have better mental and physical health domains than those recently diagnosed (up to 1 year) but did not differ in the total and other domains. Individuals with a partner and with the highest educational level present the best score for the social domain. Employed individuals showed better scores than unemployed ones for all domains and the total, except for worries, which did not differ. It also occurred comparing the individuals that do not use antidepressants and the ones that use them. Assessing and better understanding the QoL of caregivers is highly relevant. By understanding the social, worries, physical, and emotional health domains of caregivers, it is possible to track harmful aspects, prevent and treat pathologies, in addition to assisting in the implementation of effective public policies.

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Quality of Life and Symptom Burden 1 Month After Concussion in Children and Adolescents

Clinical Pediatrics ◽

10.1177/0009922818806308 ◽

2018 ◽

Vol 58 (1) ◽

pp. 42-49 ◽

Cited By ~ 4

Author(s):

David R. Howell ◽

Julie C. Wilson ◽

Michael W. Kirkwood ◽

Joseph A. Grubenhoff

Keyword(s):

Quality Of Life ◽

Physical Health ◽

Children And Adolescents ◽

Symptom Burden ◽

Psychosocial Health ◽

Post Injury ◽

Persistent Symptoms ◽

Patient Reported ◽

A Prospective Study

We conducted a prospective study of children and adolescents (n = 176; mean age = 13.0 ±2.7 years; 38% female) assessed acutely post-concussion and again 30 days later. We investigated the association between symptom burden and quality of life (QOL) outcomes, as well as the effect of age on QOL. We assessed QOL using patient-reported Pediatric Quality of Life Inventory 4.0, and symptoms using the Health and Behavior Inventory (HBI). Acute (<2 days post-injury) HBI ratings demonstrated a low correlation ( R2 = 0.08) with physical health QOL and a moderate correlation with psychosocial health QOL ( R2 = 0.21) 30 days post-concussion. HBI ratings 30 days post-concussion demonstrated a moderately high correlation with physical health QOL ( R2 = 0.35) and psychosocial health QOL ( R2 = 0.57). Age was not significantly associated with physical or psychosocial QOL ratings. Impairments in QOL following concussion may identify children and adolescents who need additional referral to address persistent symptoms at this time.

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Do you mind if I take your blood pressure? Physical health monitoring of children and young people on ADHD medication amidst a pandemic

BJPsych Open ◽

10.1192/bjo.2021.497 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S183-S184

Author(s):

Emma Davies ◽

Maham Khan ◽

Claire Jones

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Young People ◽

Physical Health ◽

Health Monitoring ◽

Neurodevelopmental Disorder ◽

Adhd Medication ◽

Children And Young People ◽

Nice Guidance ◽

The Impact

AimsTo establish whether physical health monitoring for CYP on ADHD medication is according to NICE guidance (2018).To determine the impact of COVID-19 pandemic restrictions on physical health monitoring for CYP on ADHD medication.Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity, directly impacting on academic, occupational, or social functioning. It affects between 1-5% of children and young people (CYP) most often presenting in early-mid childhood.Pharmacological treatment can be considered in CYP if certain criteria are met, where licensed medications include methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine. Stimulant and non-stimulant medications require frequent physical health monitoring due to their side effects including an increase in blood pressure and/or heart rate, loss of appetite, growth restriction and tics.MethodStandards and criteria were derived from the NICE guidance (2018), whilst local trust policies were reviewed, demonstrating discrepancies. Standards were expected to be met for 100% of patients.Electronic patient records were reviewed retrospectively from a representative cohort of CYP reviewed by clinicians in a community CAMHS service during March-November 2020. Data were entered manually into a spreadsheet for evaluation.ResultA total of 27 CYP records were reviewed, average age 13yo, on a range of stimulant/non-stimulant preparations.5 (19%) had height checked every 6 months, with 4 delayed to 7-8 months.For those >10yo, only 5 (19%) had weight checked every 6 months.Only 2 (7%) had their height and weight plotted on a growth chart and reviewed by the healthcare professional responsible for treatment.Just 4 (15%) had heart rate and blood pressure recorded before and after each dose change, whilst similarly only 4 (not the same) had these parameters recorded every 6 months.17 patients were reviewed by telephone/video call, where 5 patients provided physical health parameters (measured at home).ConclusionAcross all parameters, standards are not being met for the required physical health monitoring for CYP on ADHD medication.The COVID-19 pandemic has significantly changed the working conditions for community teams, impacting face to face reviews, creating challenges for physical health monitoring.Our ongoing implementations for change include the use of a proforma for physical health measurements, improving psychoeducation for families, exploring potential barriers with senior colleagues and collaborating with pharmacy colleagues to update local guidelines in accordance with the latest NICE recommendations. We aim to re-audit in June 2021.

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Developing a Research Database of Primary Aldosteronism: Rationale and Baseline Characteristics

10.21203/rs.3.rs-228327/v1 ◽

2021 ◽

Author(s):

Wen Wang ◽

Yuanmei Li ◽

Qianrui Li ◽

Tingting Zhang ◽

Wei Wang ◽

...

Keyword(s):

Blood Pressure ◽

Primary Aldosteronism ◽

Prospective Cohort ◽

Research Database ◽

High Quality ◽

Plasma Aldosterone Concentration ◽

Confirmatory Testing ◽

The Mean ◽

High Level

Abstract BackgroundManagement of primary aldosteronism (PA) has become a research hotspot in the field of endocrinology. To obtain reliable research evidence, it is necessary to establish a high-quality PA research database. MethodsThe establishment of PA research database involved two steps. Firstly, patients with confirmation of PA diagnosis between 1 Jan 2009 to 31 Aug 2019 at West China Hospital were identified and data were extracted. Secondly, patients with confirmatory testing for PA will be enrolled into a prospective cohort. Data will be prospectively collected based on the case report forms since 1 Sep 2019. We evaluated the quality of research database through assessment of quality of key variables.ResultsTotally, 862 patients diagnosed as PA were identified, of which 507 patients who had positive confirmatory testing for PA were included into the retrospective database. Among 862 patients diagnosed as PA, the mean systolic blood pressure (SBP) was 156.1 mmHg, mean diastolic blood pressure (DBP) was 97.2 mmHg. Among included patients, the mean serum potassium level was 2.85 mmol/L, and the mean plasma aldosterone concentration (PAC) was 28.1 ng/dL. The characteristics patients with positive confirmatory testing for PA were similar. Validation of data extracting and linking showed the accuracy were 100%. Evaluation of missing data showed that the completeness of BMI (95.9%), SBP (99.4%) and DBP (99.4%) were high. ConclusionThrough integrating retrospective and prospective cohort of PA, a research database of PA with high quality and comprehensive data can be established. We anticipate that the research database will provide a high level of feasibility for management of PA in China.

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P3415Will less developed countries be capable of giving high-quality universal coverage to cardiovascular disease survivors? Results from a national health survey, Chile ENS 2016–2017

European Heart Journal ◽

10.1093/eurheartj/ehz745.0289 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Margozzini ◽

A Passi ◽

M Kruk ◽

G Danaei

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Care ◽

Quality Of Care ◽

National Health ◽

Health Survey ◽

Universal Coverage ◽

National Health Survey ◽

High Quality

Abstract Background Chilean Health System has fully implemented Universal Health Coverage (UHC) for acute cardiovascular events since 2005. Age-adjusted cardiovascular mortality has decreased, but there is limited information about coverage and quality of chronic health care given to cardiovascular disease (CVD) survivors at the national level. Purpose To assess the prevalence and quality of care in Chilean adult CVD survivors. Methods Chilean National Health Survey 2016–2017 (ENS 2016–2017) is a random stratified multistage sample of non-institutionalized population over 14 years (n=6240). Age, education, gender, rural/urban and geographical area weighted prevalence of CVD survivors (self-reported medical diagnosis of myocardial infarction or cerebrovascular attack) were calculated. High quality of care was defined as meeting six criteria simultaneously: under 70mg% LDL- C level, statin use, aspirin use, blood pressure under 130/80 mmHg, HgA1C<7 or 8 (>74-year-old) and non-smoking. Quality of care was explored using multivariate linear and logistic regression adjusting by age, gender, education and year of diagnosis (before or after UHC). Results Weighted national prevalence of CVD survivors in over 20-year-old population was 6.1%. The sample size for the CVD survivor analyses was n=455. 28.7% of CVS had their first event before the year 2005 (n=141). Overall 27.9% had LDL-C under 70mg%, 37.8% used statins, 41.4% used aspirin, 37.8% had controlled blood pressure, 78.3% were non-smokers and 84.3% had good glycemic control. National “high quality of care” prevalence in CVD survivors was 0.3%, 0.4% and 0.1% for men and women respectively. LDL and Blood pressure control prevalence (meet both criteria simultaneously) was 4,4%. In the adjusted multivariate model age was associated to a higher number of quality criteria achievement. Conclusion The number of CVD survivors in Chile is a huge challenge for the health care system. Universal coverage does not guarantee the quality of chronic life long care. Specific surveillance in high-risk population is needed to assess the system's effectiveness and accountability. Acknowledgement/Funding ENS 2016-2017 was funded by the chilean Ministry of Health (MINSAL)

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Physical health monitoring in a scottish cohort of schizophrenia patients - the role of ECG and blood pressure monitoring

European Psychiatry ◽

10.1016/j.eurpsy.2007.01.337 ◽

2007 ◽

Vol 22 ◽

pp. S106-S107 ◽

Cited By ~ 1

Author(s):

C. Bushe ◽

O'Neil J. ◽

C. Wood ◽

A. Bradley ◽

M. Farren ◽

...

Keyword(s):

Blood Pressure ◽

Physical Health ◽

Health Monitoring ◽

Blood Pressure Monitoring ◽

Pressure Monitoring

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Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol

BMJ Open ◽

10.1136/bmjopen-2020-038646 ◽

2020 ◽

Vol 10 (9) ◽

pp. e038646

Author(s):

Maíra Ramos Alves ◽

Cristiane de Cássia Bergamaschi ◽

Flávia Blaseck Sorrilha ◽

Izabela Fulone ◽

Silvio Barberato-Filho ◽

...

Keyword(s):

Clinical Practice ◽

Children And Adolescents ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Future Research ◽

High Quality ◽

Agree Ii ◽

Ethical Approval ◽

Over Time

IntroductionThe number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents.Methods and analysisCPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations.Ethics and disseminationEthical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations.Protocol registration numberCRD42020164899.

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Evaluation of Quality and Readability of Online Health Information on High Blood Pressure Using DISCERN and Flesch-Kincaid Tools

Applied Sciences ◽

10.3390/app10093214 ◽

2020 ◽

Vol 10 (9) ◽

pp. 3214

Author(s):

Muhammad Tahir ◽

Muhammad Usman ◽

Fazal Muhammad ◽

Shams ur Rehman ◽

Imran Khan ◽

...

Keyword(s):

Blood Pressure ◽

Health Information ◽

High Blood Pressure ◽

Statistical Significance ◽

Treatment Options ◽

Online Health Information ◽

High Quality ◽

Average Value ◽

Pertinent Data

High Blood Pressure (BP) is a vital factor in the development of cardiovascular diseases worldwide. For more than a decade now, patients search for quality and easy-to-read Online Health Information (OHI) for symptoms, preventions, therapy and other medical conditions. In this paper, we evaluate the quality and readability of OHI about high BP. In order that the first 20 clicks of three top-rated search engines have been used to collect the pertinent data. Using the exclusion criteria, 25 unique websites are selected for evaluation. The quality of all included links is evaluated through DISCERN checklist, a questionnaire for assessing the quality of written information for a health problem. To enhance the reliability of evaluation, all links are separately assessed by two different groups—a group of Health Professional (HPs) and a group of Lay Subjects (LS). A readability test is performed using Flesch-Kincaid tool. Fleiss’ kappa has been calculated before considering average value of each group. After evaluation, the average DISCERN value of HPs is 49.43 ± 14.0 (fair quality) while for LS, it is 48.7 ± 12.2; the mean Flesch-Reading Ease Score (FRES) is 58.5 ± 11.1, which is fairly difficult to read and the Average Grade Level (AGL) is 8.8 ± 1.9. None of the websites scored more than 73 (90%). In both groups, only 4 (16%) websites achieved DISCERN score over 80%. Mann-Whitney and Cronbach’s alpha have been computed to check the statistical significance of the difference between two groups and internal consistency of DISCERN checklist, respectively. Normality and homoscedasticity tests have been performed to check the distribution of scores of both evaluating groups. In both groups, information category websites achieved high DISCERN score but their readability level is worse. Highest scoring websites have clear aim, succinct source and high quality of information on treatment options. High BP is a pervasive disease, yet most of the websites did not produce precise or high-quality information on treatment options.

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Antipsychotic monitoring in dementia: quality of completion of antipsychotic monitoring forms in an older adult mental health service

BJPsych Bulletin ◽

10.1192/bjb.2021.70 ◽

2021 ◽

pp. 1-7

Author(s):

Helen Anderson ◽

Anna Kolliakou ◽

Daniel Harwood ◽

Nicola Funnell ◽

Robert Stewart ◽

...

Keyword(s):

Mental Health ◽

Physical Health ◽

Health Monitoring ◽

Psychological Symptoms ◽

Antipsychotic Treatment ◽

Pharmacological Interventions ◽

Health Records ◽

People With Dementia ◽

Adult Mental Health Service

Aims and method To support safe prescribing of antipsychotics in dementia, antipsychotic monitoring forms were embedded into our electronic health records. We present a review of the data collected on these forms to assess prescribing and identify areas for improvement in our practice and processes. Data were extracted from the structured fields of antipsychotic initiation and review forms completed between 1 January 2018 and 31 January 2020. Results We identified gaps in practice where improvements could be made, mainly with regard to physical health monitoring (and particularly electrocardiograms, performed in only 50% of patients) and the low (less than 50%) recorded use of non-pharmacological interventions for behavioural and psychological symptoms of dementia. In addition, antipsychotic treatment was continued despite lack of benefit in almost 10% of reviews. Clinical implications We advocate for recommendations on physical health monitoring of people with dementia taking antipsychotics to be added to the National Institute for Health and Care Excellence guidance on dementia and the Prescribing Observatory for Mental Health (POMH-UK) national audit.

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The Association of Health Literacy with High-Quality Home Blood Pressure Monitoring for Hypertensive Patients in Outpatient Settings

International Journal of Hypertension ◽

10.1155/2020/7502468 ◽

2020 ◽

Vol 2020 ◽

pp. 1-15 ◽

Cited By ~ 1

Author(s):

Sau Nga Fu ◽

Man Chi Dao ◽

Carlos King Ho Wong ◽

Bernard Man Yung Cheung

Keyword(s):

Blood Pressure ◽

Health Literacy ◽

Educational Level ◽

Blood Pressure Monitoring ◽

Home Blood Pressure ◽

Limiting Factors ◽

Home Blood Pressure Monitoring ◽

Pressure Monitoring ◽

High Quality

Worldwide hypertension (HT) guidelines recommend use of home blood pressure monitoring (HBPM) in patients with persistent suboptimal blood pressure (BP) readings. It is not clear how patients with limited health literacy could perform HBPM to assist BP control. This study aimed at finding the association between HBPM and patients from lower socioeconomic classes, particularly on the effect of health literacy or educational level. Three electronic databases (MEDLINE, EMBASE, and PubMed) were searched for primary studies with keywords including educational level, health literacy, numeracy, home blood pressure monitoring, accuracy, and quality. The PRISMA guideline was followed. The quality of the literature was assessed by the Cochrane tool and modified Newcastle-Ottawa Scale. Nineteen interventional studies and 29 cross-sectional studies were included. Different populations used different cutoffs to report patients’ educational level, whereas health literacy was rarely measured. Three studies used psychometric validated tools to assess health literacy. The quality of HBPM could be assessed by the completion of the procedures’ checklist or the number of HBPM readings recorded. The association between subjects’ health literacy or educational level and the quality of HBPM was variable. The interventional studies showed that increasing professional-patient contact time could improve patients’ knowledge, efficacy, and quality of HBPM. Conclusion. Patients’ educational level and literacy were not the limiting factors to acquire high-quality HBPM. High-quality HBPM could be achieved by the structured educational intervention. The quality and amount of evidence on this topic are limited. Therefore, further studies are warranted.

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