The challenges of implementing ADHD clinical guidelines and research best evidence in routine clinical care settings: Delphi survey and mixed-methods study.
The challenges of implementing ADHD clinical guidelines and research best evidence in routine clinical care settings: Delphi survey and mixed-methods study.
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DOI：
10.1192/bjpo.bp.115.002386
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发表时间：
2016-01
期刊：
影响因子：
5.4
通讯作者：
Hollis C
中科院分区：
文献类型：
--
作者：
Hall CL;Taylor JA;Newell K;Baldwin L;Sayal K;Hollis C
具有里程碑意义的美国ADHD多模式治疗（MTA）研究确立了个性化药物滴定和优化策略的益处，以改善注意力缺陷多动障碍（ADHD）的短期至中期结局。这种个性化的药物管理方法随后被纳入国家健康与护理卓越研究所（NICE）ADHD临床指南（NICE CG 78）。然而，很少有人知道临床医生对实施这些药物管理策略的ADHD在常规护理的态度。研究国家卫生服务（NHS）医疗保健专业人员对ADHD药物管理策略的共识。使用德尔菲法，我们检查的重要性和可行性实施103 ADHD治疗声明的来源，包括英国NICE ADHD指南和美国药物管理算法的看法。ADHD药物管理的某些建议被认为是重要和可行的，包括逐步滴定兴奋剂药物。其他建议被认为是重要的，但在常规实践中实施不可行，如滴定期间每周与家人进行临床随访和收集随访症状问卷。临床医生认为ADHD药物管理的许多关键指南建议是重要和可行的。然而，一些建议提出了重大的实施挑战的背景下，在英格兰的常规NHS临床护理。C.H.和K.S.是NICE ADHD临床指南（NICE CG 78）的指南开发组成员。© 2016皇家精神病学家学院。这是一篇开放获取的文章，根据知识共享非商业性，无衍生品（CC BY-NC-ND）许可证的条款分发。
The landmark US Multimodal Treatment of ADHD (MTA) study established the benefits of individualised medication titration and optimisation strategies to improve short- to medium-term outcomes in attention-deficit hyperactivity disorder (ADHD). This individualised medication management approach was subsequently incorporated into the National Institute for Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78). However, little is known about clinicians’ attitudes towards implementing these medication management strategies for ADHD in routine care. To examine National Health Service (NHS) healthcare professionals’ consensus on ADHD medication management strategies. Using the Delphi method, we examined perceptions on the importance and feasibility of implementing 103 ADHD treatment statements from sources including the UK NICE ADHD guidelines and US medication management algorithms. Certain recommendations for ADHD medication management were judged as important and feasible to implement, including a stepwise titration of stimulant medication. Other recommendations were perceived as important but not feasible to implement in routine practice, such as weekly clinic follow-up with the family during titration and collection of follow-up symptom questionnaires. Many of the key guideline recommendations for ADHD medication management are viewed by clinicians as important and feasible to implement. However, some recommendations present significant implementation challenges within the context of routine NHS clinical care in England. C.H. and K.S. were members of the Guideline Development Group for the NICE ADHD Clinical Guideline (NICE CG78). © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.