Developing New Technologies to Improve ADHD Medication Continuity For PAR 12-279

开发新技术以改善 ADHD 药物连续性 PAR 12-279

• 批准号: 9038444
• 负责人: William Bernard Brinkman
• 金额: $ 19.5万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9038444
• 关键词: Address; Adverse effects; Affect; Age; Attention deficit hyperactivity disorder; Behavior; Behavior Therapy; Caring; Child; Childhood; Chronic; Chronic Care; Collection; Communication; Disease Management; Effectiveness; Effectiveness of Interventions; Equilibrium; Failure; Family; Foundations; Goals; Graph; Health; Health Care Costs; Health Personnel; Impairment; Injury; Intervention; Joints; Knowledge; Measures; Mediation; Medicine; Monitor; Newly Diagnosed; Online Systems; Outcome; Parents; Patients; Pharmaceutical Preparations; Physicians; Primary Health Care; Process; Provider; Public Health; Randomized Controlled Trials; Records; Reporting; Review Literature; Role; School-Age Population; Schools; Secure; Social Network; Structure; Symptoms; Testing; Time; Training; Treatment Efficacy; Work; base; cost; design; dosage; efficacy testing; family management; health related quality of life; improved; innovation; juvenile justice system; man; meetings; multi-component intervention; new technology; primary care setting; prototype; skills; social; teacher; theories; tool; treatment as usual; treatment response; usability; user centered design

DESCRIPTION (provided by applicant): Discontinuation of medication is a significant but preventable problem for children with attention deficit hyperactivity disorder (ADHD). This leads to the re-emergence of ADHD symptoms previously controlled by medication and increases the likelihood of negative outcomes. Interventions are available to improve ADHD care delivered in primary care settings, but no current intervention effectively targets ADHD medication continuity. The overall objective of this application is to develop and test new technologies to deliver a multi- component intervention to enable families to actively partner with practice teams to optimize medication effectiveness and maintain child medication continuity. Heterogeneous barriers to medication continuity have been identified. Indeed, different families have different needs at different times. The intervention will include evidence- and theory-based components to address three pervasive barriers: 1) Parents are poorly prepared for and involved in the process of optimizing medication, 2) Parents are poorly engaged in setting, tracking, and achieving explicit treatment goals, and 3) Parents are poorly supported in ADHD management activities by their social networks. These targets constitute a core foundation of family-management behaviors that are common to many chronic conditions. A user centered design process will be employed to design and optimize the prototype intervention to be highly usable, acceptable, and valuable in meeting parent and physician needs and promoting productive parent-physician interactions. The optimized intervention will be tested in a pilot cluster randomized controlled trial to evaluate the general effectiveness of the intervention (e.g. enhanced myADHDportal.com), compared to control (e.g. treatment as usual standard portal), on mediation continuity as measured by prescription records and other more proximal outcomes during the first six months of treatment. The new multi-component intervention will be embedded in a web-based intervention entitled myADHDportal.com which is currently used by over 300 clinicians and 13,000 families nationwide. MyADHDportal.com enables health care providers to systematically improve ADHD care in primary care practices. It facilitates provider monitoring of child response to treatment through collection, scoring, and graphing of parent and teacher reports of ADHD symptoms, impairment, and side effects over time. It also promotes productive communication between providers, parents, and teachers through a secure messaging function. Despite this intervention's efficacy at improving provider ADHD care behaviors (Epstein et al. 2011), child medication discontinuity continues to be a problem (i.e., chart audits revealed coverage of only 41% of days with medicine). Thus, there is an opportunity to expand this successful platform with new features specifically designed to engage and equip parents with the knowledge, skills, and tools needed to be successful maintaining continuity of medication treatment.

描述（由申请人提供）：对于患有注意力缺陷多动障碍（ADHD）的儿童来说，停药是一个重要但可以预防的问题。这导致以前通过药物控制的多动症症状重新出现，并增加了负面结果的可能性。可以采取干预措施来改善初级保健机构提供的多动症护理，但目前没有干预措施有效地针对多动症药物治疗的连续性。该应用程序的总体目标是开发和测试新技术以提供多成分干预，使家庭能够积极与实践团队合作，以优化药物有效性并保持儿童用药连续性。已经确定了药物连续性的异质障碍。确实，不同的家庭在不同的时期有不同的需求。干预措施将包括基于证据和理论的组成部分，以解决三个普遍存在的障碍：1) 家长对优化药物治疗过程的准备和参与不足，2) 家长在制定、跟踪和实现明确治疗目标方面参与度较低，3) 家长在 ADHD 管理活动中得不到社交网络的支持。这些目标构成了许多慢性病常见的家庭管理行为的核心基础。将采用以用户为中心的设计流程来设计和优化原型干预，使其在满足家长和医生的需求以及促进富有成效的家长与医生互动方面具有高度可用性、可接受性和价值。优化的干预措施将在试点集群随机对照试验中进行测试，以评估干预措施（例如增强型 myADHDportal.com）与对照（例如照常标准门户网站治疗）相比的总体有效性，以及治疗前六个月期间通过处方记录和其他更近端结果衡量的调解连续性。新的多成分干预措施将嵌入名为 myADHDportal.com 的网络干预措施中，目前全国有 300 多名临床医生和 13,000 个家庭在使用该干预措施。 MyADHDportal.com 使医疗保健提供者能够系统地改善初级保健实践中的多动症护理。它通过收集、评分和绘制家长和老师关于 ADHD 症状、障碍和副作用的报告，帮助提供者监控儿童对治疗的反应。它还通过安全的消息传递功能促进提供者、家长和教师之间的有效沟通。尽管这种干预措施可以有效改善提供者的 ADHD 护理行为（Epstein 等人，2011 年），但儿童用药不连续仍然是一个问题（即图表审计显示用药天数的覆盖率仅为 41%）。因此，我们有机会通过专门设计的新功能来扩展这个成功的平台，让家长获得成功维持药物治疗连续性所需的知识、技能和工具。