Testing Physicians’ Attention Deficit/Hyperactivity Disorder (ADHD) Practices with vs. without Care Manager Support Rethinking What Works
Main Article Content
Abstract
Objective: To understand the benefits of an intensive 6-months-long practice change intervention (with or without assistance of an embedded care manager) on primary care providers’ (PCPs’) adoption of evidence-based practices for diagnosing and managing Attention-Deficit/Hyperactivity Disorder (ADHD).
Methods: Following an intensive weekend training in primary care pediatric mental health service delivery, 47 PCPs were randomly assigned to 6 months of ongoing educational support via twice-monthly conference calls, either with or without additional assistance of a care manager. In addition to the impact of a care manager, basic science-derived predictors of behavior change were examined to explore impact on PCPs’ initial and subsequent intentions/decisions to adopt 11 specific changes in ADHD practices. Effects of practice obstacles on PCPs’ practice decisions, both initially and over 6 months, were also examined.
Results: PCPs’ initial and subsequent decisions to employ program-targeted ADHD evidence-based practices increased over time and were significantly predicted by underlying hypothesized predictors. Additional support of a care manager had minimal effects on PCPs’ initial and subsequent decisions to apply specific evidence-based ADHD practices. Of note, PCPs’ initial worries/perceptions concerning practice obstacles decreased significantly over time, likely due to twice-monthly support calls.
Conclusions: With intensive and sustained support, PCPs will adopt most evidence-based practices for ADHD diagnosis and treatment. Many initially anticipated obstacles dissipated over time. Additional support of care managers had little impact on PCPs’ longitudinal decisions to adhere to ADHD practice guidelines. Basic science predictors of behavior change are robust correlates of PCPs’ practice changes and should be more routinely applied to understand and improve training outcomes in multiple areas of health service delivery.
Article Details
How to Cite
JENSEN, Peter S et al.
Testing Physicians’ Attention Deficit/Hyperactivity Disorder (ADHD) Practices with vs. without Care Manager Support.
Medical Research Archives, [S.l.], v. 11, n. 7.1, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4081>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i7.1.4081.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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13. Davis DA, Taylor-Vaisey A: Translating guidelines into practice; a systematic review of theoretical concepts, practical experience, and research evidence in the adoption of clinical practice guidelines. Can Med Assoc J 157:408-416, 1997
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17. Fox RD, Bennett NL: Continuing medical education: Learning and change: implications for continuing medical education. BMJ 316:466-468, 1998
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27. Ajzen I, Fishbein M: Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice Hall, 1980
28. Ajzen I: The theory of planned behavior. Organ Behav Hum Decis Process 50:179-211, 1991
29. Janz NK, Becker MH: The health belief model: A decade later. Health Education Quarterly 11:1-47, 1984
30. Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: Toward an integrated model of change. J Consult Clin Psych 51:390-395, 1983
31. Rogers EM: Lessons for guidelines from the diffusion of innovation. Jt Comm J Qual Improv 21:324-328, 1995
32. Armitage CJ, Conner M: Efficacy of the Theory of Planned Behaviour: A meta-analytic review. British Journal of Social Psychology 40:471-499, 2001
33. Fishbein, M: Developing effective behavior change intervention: Some lessons learned from behavioral research (pp. 246-261). In T.E. Backer, S.L. David, & G. Saucy (Eds.), Reviewing the behavioral science knowledge base on technology transfer. Rockville, MD: NIDA, 1995
34. Fishbein M, Triandis HC, Kanfer FH, Becker M, Middlestadt SE, Eichlar A: Factors influencing behavior and behavior change. In: Baum A, Revenson TA, Singer JE, eds. Handbook of Health Psychology. Mahwah NJ, Lawrence Erlbaum Associates; pp. 3-17, 2001.
35. Guilamo-Ramos, V., Jaccard, J., Pena, J., & Goldberg, V. (2005). Acculturation-related variables, sexual initiation, and subsequent sexual behavior among PuertoRican, Mexican, and Cuban youth. Health Psychology: Official J Div Health Psychol, American Psychological Association, 24(1), 88-95.
36. Guilamo-Ramos, V., Litardo, H. A., & Jaccard, J. Prevention programs for reducing adolescent problem behaviors: Implications of the co-occurrence of problem behaviors in adolescence. The Journal of Adolescent Health 36(1), 82-86, 2005
37. Jaccard J, Dodge, T., & Dittus, P. (2003). Maternal discussions about pregnancy and adolescents, attitudes toward pregnancy. The Journal of Adolescent Health. 33(2), 84-87.
38. Love AL, Jensen PS, Khan-Kapadia LA, Brandt TW, Jaccard J, for the PPP Steering Committee: The basic science of behavior change and its application to pediatric providers. Child and Adolescent Psychiatric Clinics. 26:851-874, 2017. doi: 10.1016/j.chc.2017.06.011.
39. Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Mainwaring, B. A., Luzader, C. P., & Stark, L. J. Community-wide intervention to improve the attention-deficit/hyperactivity disorder assessment and treatment practices of community physicians. Pediatrics;2008:122:19-27.
40. Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Kolb, R., Altaye, M., & Simon, J. O. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics;2011:128:e1201-1208.
41. Rushton, J.L., Fant, K.E. & Clark, S.J. Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder. Pediatrics;2004:114:e23-8.
42. Olson B.G., Rosenbaum P.F., Dosa N.P., & Roizen N.J. Improving guideline adherence for the diagnosis of ADHD in an ambulatory pediatric setting. Ambul Pediatr;2005:5:138-142.
43. Epstein, J.N., et al. Improving Attention-Deficit/Hyperactivity Disorder treatment outcomes through use of a collaborative consultation treatment service by community-based pediatricians: A cluster randomized trial. Arch Pediatr Adolesc Med;2007:161:835-840.
44. Epstein, J.N., Langberg, J.M., Lichtenstein, P.K., Kolb, R., & Simon, J.O. (2013). The myADHDportal.com Improvement Program: An inovative quality improvement intervetnion for improving the quality of ADHD care among community-based pediatricians. Clin Pract Pediatr Psychol;2013:1:55
45. Schlesinger A, Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M; AACAP Committee on Quality Issues (CQI), Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry. 2022 Jun 6:S0890-8567(22)00291-X. doi: 10.1016/j.jaac.2022.06.001. Online ahead of print.
46. Xiao L, Qi H, Zheng W, Xiang Y-T, Carmody TJ, Mayes TL, Trivedi MH, Wang G. The effectiveness of enhanced evidence-based care for depressive disorders: a meta-analysis of randomized controlled trials. Transl Psychiatry. 2021; 11: 531. Published online 2021 Oct 16. doi: 10.1038/s41398-021-01638-7
47. Gillies D, Buykx P, Parker AG, Hetrick SE. Consultation liaison in primary care for people with mental disorders. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007193. DOI: 10.1002/14651858.CD007193.pub2.
48. Yonek J, Lee C-M, Harrison A, Mangurian C, Tolou-Shams M. Key components of effective pediatric integrated mental health models. JAMA Pediatr 174:487-498, 2020, doi: 10.1001/jamapediatrics.2020.0023.
2. Jensen PS, Hinshaw SP, Swanson JM, Greenhill LL, and the MTA Cooperative Group: Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and Applications for Primary Care Providers. J Dev Behav Pediatrics 22:1-14, 2001.
3. American Academy of Pediatrics Committee on Quality Improvement Subcommittee on Attention-Deficit/Hyperactivity Disorder. Clinical practice guideline: Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics. 2000;105:1158-1170.
4. American Academy of Pediatrics Subcommittee on Attention-Deficit/Hyperactivity Disorder Committee on Quality Improvement. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics;2001:108:1033-1044.
5. American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry;1997:36:85S-121S.
6. American Academy of Pediatrics Subcommittee on Attention-Deficit/hyperactivity Disorder Steering Committee on Quality Improvement and Management. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics;2011:128.
7. Wolraich, M. L., Bard, D. E., Stein, M. T., Rushton, J. L., & O'Connor, K. G. Pediatricians' attitudes and practices on ADHD before and after the development of ADHD pediatric practice guidelines. J Atten Disord;2010:13:563-572.
8. Polaha, J., Cooper, S. L., Meadows T., & Kratochvil, C. J. The assessment of attention-deficit/hyperactivity disorder in rural primary care: The portability of the American Academy of pediatrics guidelines to the “real world”. Pediatrics;2005:115:e120-126.
9. Reiff, M., & Tippins, S. ADHD: A complete and authoritative guide. Elk Grove, IL: American Academy of Pediatrics; 2003. Brown, R.T., et al., Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Pediatrics;2005:115:e749-757.
10. American Academy of Pediatrics. Caring for Children With ADHD: A Resource Toolkit for Clinicians. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2011.
11. Leslie, L. K., Weckerly, J., Plemmons, D., Landsverk, J., & Eastman, S. Implementing the American Academy of Pediatrics attention-deficit/hyperactivity disorder diagnostic guidelines in primary care settings. Pediatrics;2004:114:129-140.
12. Perkins, M.B., et al., Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know? Psychiatr Serv:2007:58:342-348.
13. Davis DA, Taylor-Vaisey A: Translating guidelines into practice; a systematic review of theoretical concepts, practical experience, and research evidence in the adoption of clinical practice guidelines. Can Med Assoc J 157:408-416, 1997
14. Oxman AD, Thomson MA, Davis DA, Haynes RB: No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. Can Med Assoc J 153:1423-1431, 1995
15. Bauer MS: A review of quantitative studies of adherence to mental health clinical practice guidelines. Harvard Review of Psychiatry 10(3):138-53, 2002
16. Cabana M, Rand C, Powe NR, et al: Why don’t physicians follow clinical practice guidelines? Journal of the American Medical Association 282(15):1458-65, 1999
17. Fox RD, Bennett NL: Continuing medical education: Learning and change: implications for continuing medical education. BMJ 316:466-468, 1998
18. Davis DA, Thomson MA, Oxman AD, Haynes RB: Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA 274:700-705, 1995
19. Institute of Medicine, Committee of Quality of Health Care in America. Crossing the Quality Chasm. A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001. https://doi.org/10.17226/10027.
20. Katon W, Von Korff M, Lin E, Walker E, Simon GE, Bush T, Robinson P, Russo J: Collaborative management to achieve treatment guidelines: impact on depression in primary care. JAMA 273:1026-1031, 1995
21. Katon W, Robinson P, Von Korff M, Lin E, Bush T, Ludman E, Simon G, Walker E: A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry 53:924-932, 1996
22. Soumerai SB, Avorn J: Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA 263:549-556, 1990
23. Unutzer J, Katon WJ, Ming-Yu F, Schoenbaum MC, Lin EHB, Della Penna RD, Powers R. Long-term Cost Effects of Collaborative Care for Late-life Depression. Am J Manag Care 14(2): 95-100, 2008.
24. Brettschneider C, Heddaeus D, Steinmann M, Haerter M, Watzke B, Koenig H. Cost-effectiveness of guideline-based stepped and collaborative care versus treatment as usual for patients with depression—A cluster-randomized trial. BMC Psychiatry Aug 28;20:427, 2020. doi: 10.1186/s12888-020-02829-0
25. Davis R, Campbell R, Hildon Z, Hobbs L, Michie S. Theories of behaviour and behaviour change across the social and behavioural sciences: A scoping review. Health Psychol Rev 9:323-344, 2015. doi: 10.1080/17437199.2014.941722
26. Bandura, A: Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall, 1986
27. Ajzen I, Fishbein M: Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice Hall, 1980
28. Ajzen I: The theory of planned behavior. Organ Behav Hum Decis Process 50:179-211, 1991
29. Janz NK, Becker MH: The health belief model: A decade later. Health Education Quarterly 11:1-47, 1984
30. Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: Toward an integrated model of change. J Consult Clin Psych 51:390-395, 1983
31. Rogers EM: Lessons for guidelines from the diffusion of innovation. Jt Comm J Qual Improv 21:324-328, 1995
32. Armitage CJ, Conner M: Efficacy of the Theory of Planned Behaviour: A meta-analytic review. British Journal of Social Psychology 40:471-499, 2001
33. Fishbein, M: Developing effective behavior change intervention: Some lessons learned from behavioral research (pp. 246-261). In T.E. Backer, S.L. David, & G. Saucy (Eds.), Reviewing the behavioral science knowledge base on technology transfer. Rockville, MD: NIDA, 1995
34. Fishbein M, Triandis HC, Kanfer FH, Becker M, Middlestadt SE, Eichlar A: Factors influencing behavior and behavior change. In: Baum A, Revenson TA, Singer JE, eds. Handbook of Health Psychology. Mahwah NJ, Lawrence Erlbaum Associates; pp. 3-17, 2001.
35. Guilamo-Ramos, V., Jaccard, J., Pena, J., & Goldberg, V. (2005). Acculturation-related variables, sexual initiation, and subsequent sexual behavior among PuertoRican, Mexican, and Cuban youth. Health Psychology: Official J Div Health Psychol, American Psychological Association, 24(1), 88-95.
36. Guilamo-Ramos, V., Litardo, H. A., & Jaccard, J. Prevention programs for reducing adolescent problem behaviors: Implications of the co-occurrence of problem behaviors in adolescence. The Journal of Adolescent Health 36(1), 82-86, 2005
37. Jaccard J, Dodge, T., & Dittus, P. (2003). Maternal discussions about pregnancy and adolescents, attitudes toward pregnancy. The Journal of Adolescent Health. 33(2), 84-87.
38. Love AL, Jensen PS, Khan-Kapadia LA, Brandt TW, Jaccard J, for the PPP Steering Committee: The basic science of behavior change and its application to pediatric providers. Child and Adolescent Psychiatric Clinics. 26:851-874, 2017. doi: 10.1016/j.chc.2017.06.011.
39. Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Mainwaring, B. A., Luzader, C. P., & Stark, L. J. Community-wide intervention to improve the attention-deficit/hyperactivity disorder assessment and treatment practices of community physicians. Pediatrics;2008:122:19-27.
40. Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Kolb, R., Altaye, M., & Simon, J. O. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics;2011:128:e1201-1208.
41. Rushton, J.L., Fant, K.E. & Clark, S.J. Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder. Pediatrics;2004:114:e23-8.
42. Olson B.G., Rosenbaum P.F., Dosa N.P., & Roizen N.J. Improving guideline adherence for the diagnosis of ADHD in an ambulatory pediatric setting. Ambul Pediatr;2005:5:138-142.
43. Epstein, J.N., et al. Improving Attention-Deficit/Hyperactivity Disorder treatment outcomes through use of a collaborative consultation treatment service by community-based pediatricians: A cluster randomized trial. Arch Pediatr Adolesc Med;2007:161:835-840.
44. Epstein, J.N., Langberg, J.M., Lichtenstein, P.K., Kolb, R., & Simon, J.O. (2013). The myADHDportal.com Improvement Program: An inovative quality improvement intervetnion for improving the quality of ADHD care among community-based pediatricians. Clin Pract Pediatr Psychol;2013:1:55
45. Schlesinger A, Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M; AACAP Committee on Quality Issues (CQI), Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry. 2022 Jun 6:S0890-8567(22)00291-X. doi: 10.1016/j.jaac.2022.06.001. Online ahead of print.
46. Xiao L, Qi H, Zheng W, Xiang Y-T, Carmody TJ, Mayes TL, Trivedi MH, Wang G. The effectiveness of enhanced evidence-based care for depressive disorders: a meta-analysis of randomized controlled trials. Transl Psychiatry. 2021; 11: 531. Published online 2021 Oct 16. doi: 10.1038/s41398-021-01638-7
47. Gillies D, Buykx P, Parker AG, Hetrick SE. Consultation liaison in primary care for people with mental disorders. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD007193. DOI: 10.1002/14651858.CD007193.pub2.
48. Yonek J, Lee C-M, Harrison A, Mangurian C, Tolou-Shams M. Key components of effective pediatric integrated mental health models. JAMA Pediatr 174:487-498, 2020, doi: 10.1001/jamapediatrics.2020.0023.