The assessment of attention-deficit/hyperactivity disorder in rural primary care: The portability of the American Academy of Pediatrics guidelines to the "real world"
The assessment of attention-deficit/hyperactivity disorder in rural primary care: The portability of the American Academy of Pediatrics guidelines to the "real world"
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DOI：
10.1542/peds.2004-1521
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发表时间：
2005-02-01
期刊：
影响因子：
8
通讯作者：
Kratochvil, CJ
中科院分区：
文献类型：
--
作者：
Polaha, J;Cooper, SL;Kratochvil, CJ
Objective.研究在农村儿科实践中评估注意力缺陷/多动障碍（ADHD）的方案的实施情况。该方案旨在为儿科医生提供一种有效的手段来学习和使用美国儿科学会（AAP）提出的ADHD指南。来自2个农村儿科诊所的初级保健人员（医生、护士等）接受了使用ADHD评估方案的培训。在引入方案前1 - 2年审查了101例患者的病历，在随后的2 - 3年审查了86例患者的病历，以评估对AAP指南的依从性。此外，34%的量表评分的工作人员进行了重新评分，以检查评分的准确性。在AAP指南可用和评估方案实施之前，两个初级保健中心都没有始终如一地收集现在建议用于ADHD评估的全面信息。家长和/或教师的评分量表，收集只有0%至21%的评估跨网站。当提供简短的培训和支持材料时，医疗记录反映了在确定临床必要的ADHD信息方面的显着改善，父母和教师的评分量表在88%至100%的时间内存在。工作人员表现出能够高度准确地对评级表进行评分。培训后2 ~ 3年，方案收集和管理的完整性得以保持。一个有效的系统进行ADHD评估，根据AAP指南在农村儿科诊所可以启动和维护完整性。需要进一步的研究来确定该系统是否改善了诊断决策和患者结局。
Objective. To examine the implementation of a protocol for the assessment of attention-deficit/ hyperactivity disorder (ADHD) in rural pediatric practices. The protocol was designed to provide an efficient means for pediatricians to learn and use the ADHD guidelines put forth by the American Academy of Pediatrics (AAP).Methods. Primary care staff ( physicians, nurses, etc) from 2 rural pediatric practices were trained to use the ADHD-assessment protocol. Medical records for 101 patients were reviewed from 1 to 2 years before the introduction of the protocol and for 86 patients during the subsequent 2 to 3 years to assess compliance with the AAP guidelines. In addition, 34% of the scales scored by the staff were rescored to check for scoring accuracy.Results. Before the availability of the AAP guidelines and the implementation of the assessment protocol, neither primary care site was consistently collecting the comprehensive information that is now recommended for an ADHD assessment. Parent and/or teacher rating scales were collected for only 0% to 21% of assessments across sites. When provided with brief training and supporting materials, medical records reflected significant improvement in the ascertainment of clinically necessary ADHD information, with parent and teacher rating scales present 88% to 100% of the time. Staff demonstrated an ability to score rating scales with a high degree of accuracy. The integrity of protocol collection and management was maintained 2 to 3 years after training.Conclusions. An efficient system for conducting ADHD assessments according to AAP guidelines in rural pediatrics clinics can be initiated and maintained with integrity. Additional research is needed to determine if this system improves diagnostic decision-making and patient outcomes.