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

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.