Improving medication use for ADHD in primary care

改善初级保健中 ADHD 的药物使用

• 批准号: 6684443
• 负责人: JOHN V LAVIGNE
• 金额: $ 60.45万
• 依托单位: LURIE CHILDREN'S HOSPITAL OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-08-01 至 2008-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6684443
• 关键词: attention deficit disorder; behavioral /social science research tag; child behavior; child health care personnel; child mental health service; clinical research; clinical trials; community health services; computer program /software; health care professional practice; health care service evaluation; health economics; health services research tag; human subject; human therapy evaluation; mental disorder chemotherapy; middle childhood (6-11); outcomes research; patient care management; patient monitoring device; patient oriented research; primary care physician; training

DESCRIPTION (provided by applicant): Because relatively few children with mental health problems are treated in the tertiary mental health system, improving the treatment of children seen in primary care is essential, especially for conditions like attention deficit hyperactivity disorder, that respond well to medications that primary care physicians can manage. Community medical treatment of ADHD, however, is less then optimal. The proposed study examines whether the use of stimulant medication by community pediatricians can be improved. The specific aims of this study are to determine, in a randomized trial: 1) If specialized training for pediatricians in the use of stimulant medications for ADHD improves the classroom and at-home behavior of children with ADHD who are seen in primary care; 2) If specialized training and assistance in monitoring stimulant medications improves pediatrician's prescription and monitoring practices, and conformity to practice standards for managing ADHD; 3) The costs associated with training and changes in practice management procedures for managing ADHD as they relate to improvements in symptoms. This study proposes a randomized trial of treatment and monitoring procedures to improve the use of stimulants in primary care pediatric settings. In the specialized pediatric care group, pediatricians and nursing staff will be trained in the use of an algorithm-based titration and treatment protocol for stimulant medications, and in appropriate monitoring procedures. In the usual-care group, the pediatrician will be notified if the child has ADHD, with the physicians managing those patients in whatever manner the physician deems most appropriate. Assessment of patient responsiveness to treatment will be made at baseline, 4-, 9-, and 12-months after treatment initiation using teacher and parent reports of behavior change and classroom observations. Changes in practice procedure, frequency of visits and costs for training and providing specialized care will be examined. Following an intent-to-treat model, a minimum of 468 children (234 SC; 234 TAU) will be recruited and complete all evaluations in the intensive training phase.

描述（由申请人提供）：由于在三级精神卫生系统中治疗的精神健康问题儿童相对较少，因此改善初级保健中儿童的治疗至关重要，特别是对于注意缺陷多动障碍等疾病，这些疾病对初级保健医生可以管理的药物反应良好。然而，ADHD的社区医疗并不理想。这项拟议中的研究旨在探讨社区儿科医生使用兴奋剂药物的情况是否可以改善。本研究的具体目的是在一项随机试验中确定：1）对儿科医生进行使用兴奋剂治疗ADHD的专门培训是否能改善在初级保健中看到的ADHD儿童的课堂和家庭行为; 2）如果在监测兴奋剂药物方面的专门培训和援助改善了儿科医生的处方和监测实践，和符合管理ADHD的实践标准; 3）与管理ADHD的实践管理程序的培训和变化相关的成本，因为它们与症状的改善有关。本研究提出了一项随机试验的治疗和监测程序，以改善使用兴奋剂在初级保健儿科设置。在专门的儿科护理组中，儿科医生和护理人员将接受使用基于算法的兴奋剂药物滴定和治疗方案以及适当监测程序的培训。在常规护理组中，如果孩子患有ADHD，儿科医生将被告知，医生将以医生认为最合适的方式管理这些患者。将在基线、治疗开始后4个月、9个月和12个月使用教师和家长的行为变化报告和课堂观察评估患者对治疗的反应。将审查实践程序、访问频率以及培训和提供专门护理的费用方面的变化。按照意向治疗模式，将招募至少468名儿童（234名SC; 234名TAU），并在强化培训阶段完成所有评价。