245928 Training providers to increase guideline-level care for ADHD in North Carolina

Monday, October 31, 2011: 11:10 AM

Charles Humble, MSPH, PhD , AccessCare, Morrisville, NC
Treiste Newton, RN, BSN, CCM , AccessCare, Morrisville, NC
Marisa Domino, PhD , Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
Peter Jensen, MD , The REACH Institute, New York City, NY
Lynn Wegner, MD , Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
Christopher Kratochvil, MD , Chief Medical Officer, UNeHealth, University of Nebraska Medical Center, Omaha, NE
Steven Wegner, MD, JD , AccessCare, Morrisville, NC
Alan Stiles, MD , Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
Background: North Carolina is piloting a pediatric psychopharmacology program preparing primary care providers (PCPs) to better diagnose and manage ADHD. Methods: A volunteer sample of 48 Medicaid PCPs from 31 practices attended a 3-day training on ADHD and other common child mental health conditions. The training included role-playing, small group exercises regarding guideline-level care for ADHD, and hands-on practice using 18 specific practice behaviors. Training was reinforced through small PCP peer groups in bi-weekly conference calls for 6 months. Baseline and 6 months' post-training measures of PCPs' attitudes, beliefs, and stated intentions (to do a specific behavior in the future) about the 18 carefully described clinical behaviors were compared. Results: Provider beliefs of 17 of the 18 ADHD clinical behaviors changed in a positive direction, indicating more favorable attitudes about specific evidence-based steps of care. Among measures of providers' intentions, 7 showed significant change, including intentions to a) test different medication doses weekly during initial titration; b) schedule more frequent follow-up visits, c) adjust medications to higher doses when rating scales have shown little improvement, and d) track height/weight. Lastly, PCPs showed significant reductions in their perceptions of 8 of 14 common obstacles (e.g., time pressures, family resistance, lack of training, etc.) that hinder them from applying specific guidelines. Conclusions: Results suggest high initial acceptance of 18 guideline behaviors related to PCPs' management of pediatric ADHD, followed by significant further improvements in many areas of providers' attitudes and intentions about clinical practice behaviors and obstacles related to optimal ADHD management.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
1. Describe the overall pediatric psychopharmacology program used to increase guideline adherence for common behavioral problems in children and youth. 2. Discuss study design used to evaluate the additional effect of complementary training for care managers. 3. Evaluate program effects on provider knowledge of, beliefs in, and intentions to implement practice guidelines for proper care of children and youth with ADHD

Keywords: Child/Adolescent Mental Health, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: my 35 years of experience collecting data, analyzing it and presenting results in oral and published forms have prepared me to serve as Consortium PI for this 3-organization study. In the current study I have either developed or led the use of all program surveys and the analyzes of the resulting data. I lead the preparation of all presentations and related abstracts.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.