Improving medication use for ADHD in primary care

改善初级保健中 ADHD 的药物使用

• 批准号: 6776414
• 负责人: JOHN V LAVIGNE
• 金额: $ 63.39万
• 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/6776414
• 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接受治疗的患有精神健康问题的儿童相对较少，因此改善初级保健儿童的治疗至关重要，特别是对于注意力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，多动症的社区医疗治疗并不理想。拟议的研究探讨了社区儿科医生对兴奋剂药物的使用是否可以得到改善。本研究的具体目的是在一项随机试验中确定：1）对儿科医生使用兴奋剂药物治疗 ADHD 进行专门培训是否可以改善初级保健机构就诊的 ADHD 儿童的课堂和家庭行为； 2) 监测兴奋剂药物方面的专门培训和协助是否改善了儿科医生的处方和监测实践，并符合治疗多动症的实践标准； 3) 与管理多动症的培训和实践管理程序的改变相关的成本，因为它们与症状的改善有关。本研究提出了一项治疗和监测程序的随机试验，以改善初级保健儿科环境中兴奋剂的使用。在专门的儿科护理小组中，儿科医生和护理人员将接受培训，了解如何使用基于算法的滴定和兴奋剂药物治疗方案以及适当的监测程序。在常规护理组中，如果孩子患有多动症，儿科医生将收到通知，医生会以医生认为最合适的方式管理这些患者。将根据教师和家长的行为变化报告和课堂观察，在基线、治疗开始后 4、9 和 12 个月对患者对治疗的反应进行评估。将审查执业程序、就诊频率以及培训和提供专门护理的费用的变化。按照意向治疗模式，将招募至少 468 名儿童（234 名 SC；234 名 TAU），并在强化训练阶段完成所有评估。