Optimizing pediatric psychopharmacology for ADHD in North Carolina

Background: North Carolina has a shortage of child psychiatrists, mostly concentrated in major medical centers. NC Medicaid's Community Care of North Carolina is piloting a pediatric psychopharmacology program preparing primary care providers (PCP) to diagnose and manage Attention Deficit/Hyperactivity Disorder (ADHD) and other common mental health conditions. Methods: Fifty-five providers who prescribe medications attended a 3-day training. This training is reinforced with hands-on problem-solving through access to additional web-based tools providers can use to obtain information and expand their knowledge base. Support networks are developed through small PCP peer groups in bi-weekly conference calls. Care coordinators in the randomly selected practices received training in: removal of practice obstacles to use of behavioral rating scales, medication side effect checklists, and tools empowering parents seeking evaluation and accommodation for their child with special needs. The program includes baseline and follow-up assessments of providers' knowledge of current practice guidelines for ADHD and provider self-assessed competence using these guidelines to diagnose and monitor patient care. Medicaid Claims data will be used to evaluate changes in guideline compliant care. Baseline Results: These providers report high levels of competence treating ADHD in their patients, but report low compliance with clinical practice guidelines for ADHD care by other providers in similar settings. E.g., 58% said other providers use rating scales to assess symptoms at baseline; but only 19% would use parent side effect scales during regular visits. Conclusions: Results suggest opportunities for improving adherence to guidelines for ADHD diagnosis and patient treatment during this year-long pilot.