Specific Components of Pediatricians' Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder
Jeffery N Epstein1, Kelly J Kelleher2, Rebecca Baum2
1Cincinnati Children's Hospital Medical Center, Cincinnati.
Insights
Timely communication with healthcare providers and collecting teacher feedback significantly improve attention-deficit/hyperactivity disorder (ADHD) symptom reduction in children. These factors are crucial for enhancing ADHD care quality metrics.
Area of Science:
- Pediatric Health
- Neurodevelopmental Disorders
- Healthcare Quality Improvement
Background:
- Improving the quality of community-based pediatric care for attention-deficit/hyperactivity disorder (ADHD) requires robust quality measurements.
- Existing ADHD care quality metrics lack a strong evidence base.
- Identifying key components of ADHD care that predict patient outcomes is essential.
Purpose of the Study:
- To determine which specific components of ADHD care are most effective in predicting patient outcomes.
- To inform the development of evidence-based quality metrics for pediatric ADHD care.
Main Methods:
- A cohort of 372 medication-naïve children (grades 1-5) diagnosed with ADHD was studied.
- Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at baseline and 12 months post-medication initiation.
- 12 components of ADHD care were assessed through chart reviews.
Main Results:
- The average decrease in VAPRS total symptom score was 11.6 over the first year of treatment.
- Shorter times to initial patient contact and increased collection of teacher ratings predicted greater symptom reduction.
- Timeliness of all communications (visits, calls, emails), not just office visits, correlated with improved ADHD symptom scores.
Conclusions:
- Specific components of ADHD care, particularly timely communication and teacher input, are associated with significant symptom reduction.
- These findings support the inclusion of timely contact and teacher rating collection in future ADHD quality care metrics.
- Enhancing care quality metrics can lead to better outcomes for children with ADHD.
Objective:
The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes.
Method:
Parents of 372 medication-naïve children in grades 1 to 5 presenting to their community-based pediatrician (N = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and then approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure 12 different components of ADHD care.
Results:
Across all children, the mean decrease in VAPRS total symptom score during the first year of treatment was 11.6 (standard deviation 10.1). Of the 12 components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater decreases in patient total symptom scores. Notably, it was timeliness of contacts, defined as office visits, phone calls, or email communication, that predicted more ADHD symptom decreases. Office visits alone, in terms of number or timeliness, did not predict patient outcomes.
Conclusion:
The magnitude of ADHD symptom decrease that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development and modifications of ADHD quality care metrics should include these ADHD care components.
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