Collaborative Uses Evidence-Based Tools to Help Treat ADHD
Attention deficit hyperactivity disorder (ADHD) affects an estimated 5 to 7 percent of the population and is the most common behavioral disorder among elementary school-age children. Despite the prevalence of this disorder, care is often fragmented among pediatricians, mental health specialists and schools. This fragmentation frequently leads to delays in the treatment of children with this condition. Aware of the extent of the community need, Cincinnati Children's teamed with community physicians headed by Phil Lichtenstein, MD, to form the ADHD Collaborative, a group charged with identifying and implementing a plan to improve the care and change the outcome for children with ADHD.
According to Lori Stark, PhD, any clinic "with walls" that Cincinnati Children's could create would quickly be at full capacity. Members of the collaborative, therefore, needed to look for alternatives to ensure kids had the best possible treatment at the point of care. Their first step was to look to the established guidelines of the American Academy of Pediatrics (AAP) and the Cincinnati Children's evidenced-based care guidelines for the diagnosis and treatment of the disorder. According to the guidelines, with the proper support and education, primary care physicians can be empowered to conduct a diagnostic evaluation of ADHD and can discuss and begin treatment with children and their families within the primary care setting. The collaborative proposed partnering with primary care physicians to assist in providing care and to ensure that this care is evidence-based.
Post-Intervention Results
Jeff Epstein, PhD, director of the ADHD Collaborative at Cincinnati Children's, says the emphasis on using AAP and Cincinnati Children's evidence-based guidelines is vital to the success of the program. Among their many research projects, Dr. Epstein and colleagues are currently working to pilot a web-based program for ADHD diagnosis and management with participating collaborative practices. The program's aim is to provide physician education about ADHD assessment and treatment; web-based rating scales for parents and teachers; web-based access to rating scales results for physicians; and remote consultation with ADHD specialists. The scored results from ratings scales along with suggestions for treatment and further services for co-morbid disorders can be accessed through the web by the physician's office, where they can be reviewed with the family. When fully implemented, the web-based system also will provide participating physicians with a means to monitor how effectively they are delivering care in compliance with evidence-based guidelines.
The ADHD Collaborative is in its fourth year of partnering with community physicians to promote the use of evidence-based guidelines for the diagnosis and treatment of ADHD. To date, 179 community physicians are participating at 51 pediatric practices. The results of the collaborative (see chart at left) have been striking on implementation of the guidelines in pediatrician's practices. After working with the ADHD Collaborative, pediatricians are using rating scales from parents and teachers as part of their initial diagnostic work-up and in assessing progress in treatment over time. They are also following children more frequently to assess their response to medication. Seventy-four percent of the children treated by the pediatricians following the guidelines show a 25 percent reduction in ADHD symptoms by parent report and 82 percent show a reduction by teacher report.
