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Group Visits to Improve Pediatric Attention-Deficit Hyperactivity Disorder Chronic Care Management
Nerissa S Bauer1, Dorota Szczepaniak, Paula D Sullivan
1*Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; †Section of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; ‡Regenstrief Institute, Inc., Indianapolis, IN; §Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
Insights
Group visits for children with attention-deficit hyperactivity disorder (ADHD) improved adherence to follow-up appointments and enhanced adaptive functioning. This pilot study suggests group visits are a beneficial model for pediatric ADHD management.
Area of Science:
- Pediatric Medicine
- Behavioral Health
- Clinical Trial Methodology
Background:
- Children with attention-deficit hyperactivity disorder (ADHD) often experience persistent functional impairments despite medication.
- Pediatric medical homes can enhance care delivery for chronic conditions like ADHD.
- Group visit models offer a potential solution for extended patient-provider interaction.
Purpose of the Study:
- To evaluate the efficacy of a group visit model for managing ADHD in a pediatric setting.
- To assess the impact of group visits on ADHD symptom management and family functioning.
- To determine if group visits improve adherence to follow-up care.
Main Methods:
- A pilot randomized controlled trial comparing group visits to usual care for children aged 6-18 with ADHD.
- Data collection included ADHD follow-up visit attendance, parent-rated ADHD symptoms, adaptive functioning, and quality of life.
- Longitudinal linear and generalized linear mixed models were employed for statistical analysis.
Main Results:
- Twenty families (29 children) were randomized; intervention and control groups had similar baseline characteristics.
- Intervention families demonstrated significantly improved adaptive functioning at 12 months (p = .003).
- All families in the intervention group attended all scheduled follow-up visits, unlike the control group.
Conclusions:
- Group visits in pediatric medical homes can enhance adherence to ADHD follow-up care.
- Preliminary findings indicate positive effects on family adaptive functioning.
- The group visit model shows promise for improving ADHD management within the pediatric medical home setting.
Objective:
Children with attention-deficit hyperactivity disorder (ADHD) may experience continued impairment at home and school even after medication initiation. Group visits offer a way for pediatricians to provide more time to address ongoing needs. A pilot study was undertaken to examine whether a group visit model improved ADHD management in the pediatric medical home.
Methods:
Parents and children aged 6 to 18 years with ADHD were recruited and randomized to group visits or a usual care control. Data included attendance at ADHD follow-up visits, parent-rated ADHD symptoms, adaptive functioning, and quality of life. Longitudinal linear mixed models (continuous variables) and generalized linear mixed models (binary outcomes) were used to compare groups. In our statistical models, child and family were random effects; study assignment was a fixed effect.
Results:
Twenty families representing 29 children participated (intervention: 9 parents/13 children and control: 11 parents/16 children). Aside from race, baseline characteristics of participants were similar. None of the intervention families missed the expected 5 ADHD follow-up visits over 1 year; control families missed 1 or more visits over the same period. Intervention families reported an improved level of adaptive functioning at 12 months compared with control (mean severity score: 3.7 vs 4.4, p = .003). All families reported greater limitations and poorer quality of life compared with national norms.
Conclusion:
Group visits in the pediatric medical home can improve adherence, and preliminary results show a variety of improvements for the family.
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