Changes in perceptions of 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 12 months' post-training measures of PCP-perceptions of their ability to provide and others' attitudes toward 18 carefully described evidence-based steps of care were compared. Results: Provider attitudes toward 14 of 18 ADHD clinical behaviors changed in a positive direction. Self-rated abilities to deliver the 18 steps of care increased on average 0.73 points on an 11-point scale with larger increases for testing different medication doses, use of symptom rating scales when testing doses and scheduling frequent visits to follow treatment response. PCP perceptions of 7 of 14 common obstacles that hinder application of specific guidelines (e.g., time pressures, lack of scales, lack of training) showed significant reductions. Perceived approval by colleagues increased for all aspects of care. Chart reviews found increased use of symptoms scales and follow-up visits after training. Conclusions: Initial good acceptance of 18 guideline behaviors related to PCPs' management of pediatric ADHD was followed by maintenance of or significant improvements in perceived ability to provide and peer approval of many areas related to optimal ADHD management.