Helping the Healers
Jeff Epstein, PhD, created a program to help busy community doctors better manage their patients with ADHD.
“The ADHD Collaborative has helped streamline the process. Feedback from parents and teachers happens more easily, so we are better able to determine what’s working. I’m able to see what and where problems are occurring. This allows me to initiate changes that can have a big impact.”
Arthur J. Moebius, MD, community pediatrician
ADHD Collaborative helps community pediatricians manage a troubling disorder.
The teen sits sullenly, staring at the floor. Mom, alternately worried and annoyed, looks from her child to the doctor.
“Please. Do something for him. We’re at our wit’s end,” she pleads.
The scene plays out again and again, in pediatricians’ offices throughout our community. A child is having problems at home and in school. The parent describes behaviors that could be symptoms of attention deficit/hyperactivity disorder (ADHD). The doctor would like to more thoroughly evaluate, but she’s facing a surly teenager, a distraught mom and a backed-up schedule, with 10 more patients waiting.
ADHD affects around eight percent of all school-age children, so it is not surprising that diagnosing and treating the disorder has become a significant concern for doctors.
Taking the Pressure Off
It’s a problem that Jeff Epstein, PhD, and a team of physicians at Cincinnati Children’s Center for ADHD decided to help solve.
Epstein and his team see a lot of kids with ADHD. They also see a lot of room for improvement in how these kids are treated. They started the ADHD Collaborative, a program aimed at training busy community physicians to better diagnose and treat ADHD. The program promotes evidence-based guidelines for diagnosing and treating the disorder that were developed by the American Academy of Pediatrics.
So far, Epstein and his colleagues have trained more than 200 pediatricians in some 60 Cincinnati-area practices. They’ve showed support staff how to modify practice operations to accommodate the guidelines. Over the past four years, they’ve reviewed charts of more than 1000 patients assessed and treated for ADHD to examine changes in physician practices.
Beyond Anecdotes
Prior to the training, Epstein says, some doctors relied primarily on the parent’s verbal report of a child’s behavior. Faced with little time and parental pressure to “do something,” they often prescribed medication without a thorough evaluation.
“Using our model,” explains Epstein, “pediatricians routinely request parents and teachers to complete standardized rating scales, which are more reliable and accurate tools for deriving an ADHD diagnosis.”
To ease the process, the rating scales are available for parents and teachers to complete online through the ADHD Collaborative’s secure web portal. And the web portal allows physicians to continue to collect parent and teacher ratings after treatment has begun, allowing the doctor to monitor the child’s treatment progress.
Time Well Spent
Although the new process requires some additional work up front to set up efficient office systems, almost all physicians feel it is worth it, says Epstein. “The investment pays off in significant improvement in patients’ ADHD symptoms and areas of impairment.”
Epstein and his team published the results of their study in the July 2008 issue of Pediatrics, reporting that after community pediatricians were trained in the guidelines, their ADHD diagnostic and treatment practices closely emulated those recommended by the American Academy of Pediatrics.
The group is now offering the program to practices around the country and exploring ways to provide training through videoconferencing and the web.
Bonus Point
There’s another bonus for community pediatricians who participate in the ADHD Collaborative. Starting in 2010, the American Board of Pediatrics (ABP) will require all pediatricians to participate in practiceperformance and quality improvement training for re-credentialing. The ADHD Collaborative program is approved by the ABP as an official re-credentialing activity.
Ultimately, says Epstein, both doctors and patients win. “It appears that as a result of participating in the intervention, physicians are better equipped to manage kids with ADHD.”
