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

描述（由申请人提供）：对于患有注意缺陷多动障碍（ADHD）的儿童来说，停药是一个重要但可预防的问题。这导致先前通过药物控制的ADHD症状再次出现，并增加了负面结果的可能性。干预措施可用于改善初级保健机构提供的ADHD护理，但目前没有有效的干预措施针对ADHD药物的连续性。该应用程序的总体目标是开发和测试新技术，以提供多组分干预，使家庭能够积极地与实践团队合作，以优化药物有效性并保持儿童药物的连续性。已经确定了影响药物连续性的异质性障碍。的确，不同的家庭在不同的时期有不同的需求。干预将包括以证据和理论为基础的组成部分，以解决三个普遍存在的障碍：1)父母在优化药物治疗过程中准备不足，参与不足；2)父母在设定、跟踪和实现明确的治疗目标方面参与不足；3)父母在多动症管理活动中得不到社会网络的支持。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。以用户为中心的设计过程将用于设计和优化原型干预，使其在满足父母和医生的需求以及促进有效的父母和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一项试点随机对照试验中进行测试，以评估干预措施（例如，增强myADHDportal.com）与对照组（例如，按常规标准门户进行治疗）相比的总体有效性，以及通过处方记录测量的调解连续性和治疗前六个月的其他更接近的结果。新的多成分干预措施将嵌入一个名为myADHDportal.com的基于网络的干预措施中，该干预措施目前由全国300多名临床医生和13,000个家庭使用。MyADHDportal.com使卫生保健提供者能够系统地改善初级保健实践中的ADHD护理。它通过收集、评分和绘制家长和老师关于多动症症状、损伤和副作用的报告，帮助提供者监测儿童对治疗的反应。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。尽管这种干预措施在改善提供者ADHD护理行为方面有效（Epstein et al. 2011），但儿童用药不连续性仍然是一个问题（即，图表审计显示，用药天数仅占41%）。因此，有机会通过专门设计的新功能来扩展这个成功的平台，使家长能够参与并掌握成功维持药物治疗连续性所需的知识、技能和工具。

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.