Measuring Parent Preferences for ADHD Treatment to Predict Adherence

描述（由申请人提供）：本修订后的R34提案解决了儿童心理健康服务中最重要的问题之一：对循证治疗的依从性差。依从性差导致患者结果不理想，浪费了数十亿美元本可避免的医疗保健支出，并可能产生终身后果，影响儿童未来的身体健康、社会和经济福祉。传统上，重点是改善服务系统，但这未能吸引和留住个人接受治疗。需要其他方法来克服不良依从性。PI之前由nimh资助的研究建立了“概念验证”，将护理人员的护理方法与治疗依从性的不同倾向联系起来。本提案的主要创新是使用离散选择实验和潜在类别分析来确定具有相似偏好的护理人员的部分，并确定医生对这些信念的认识，因为它们与依从性有关。本研究的具体目的是：1)确定护理人员对儿童多动症最看重的治疗属性，以及在6个月的护理过程中评估的任何变化；2)评估初次就诊时照顾者对治疗的信念与医生对照顾者对治疗信念的看法的一致性；3)确定照顾者的治疗偏好和照顾者-医生对治疗信念的一致性是否能预测诊所就诊和药物使用的依从性。50名心理健康医生和300名照顾这些医生的新患者的护理人员将从马里兰州的儿童心理健康机构中招募，这些患者年龄在6-12岁，被诊断为多动症。护理者的信念和治疗偏好将在基线，3个月和6个月使用离散选择实验进行测量。医生完成一项基线调查，预测每个护理者的偏好，以及他们的实践和专业特征。离散选择实验数据将使用混合效应逻辑回归模型进行分析。潜在类别分析将用于将护理人员样本划分为偏好亚组。护理人员-医生的一致性也将被评估。依从性是通过诊所出勤率和ADHD药物使用来衡量的。照顾者偏好和照顾者-医生一致性对依从性的影响，调整儿童症状，提供者联盟和父母负担，将使用纵向数据模型进行分析。使用治疗偏好来预测依从性是解决严重而复杂的公共卫生问题的一种极具创新性的方法。多学科团队和与社区提供者的紧密联系为拟议的研究提供了良好的环境。这项工作将促进可持续儿童心理健康服务的知识转移。将其推广到初级保健机构和其他儿童心理健康状况的潜力将使该领域朝着为儿童及其家庭带来更好结果的方向发展。

DESCRIPTION (provided by applicant): This revised R34 proposal addresses one of the most significant problems in child mental health services: poor adherence to evidence-based treatment. Poor adherence leads to unsatisfactory patient outcomes, wastes billions of dollars in avoidable healthcare expenditures, and can have life-long consequences, affecting children's future physical health, social, and economic well-being. Traditionally the focus has been on improving service systems but this has failed to engage and retain individuals in treatment. Alternative approaches to overcome poor adherence are needed. The PI's previous NIMH-funded study established the "proof-of-concept" linking caregiver approaches to care with differential propensities for treatment adherence. The primary innovation in this proposal is the use of discrete choice experiments and latent class analysis to identify segments of caregivers with similar preferences and to identify physicians' awareness of these beliefs as they relate to adherence. This study specifically aims to 1) identify the treatment attributes caregivers' most value for their child's ADHD and any changes in valuation over a 6-month course of care; 2) evaluate the concordance between caregivers' beliefs about treatment and physicians' views of caregivers' beliefs about treatment at the initial visit; and 3) determine if caregiver's treatment preferences and caregiver-physician concordance on beliefs about treatment predict adherence to clinic attendance and medication use. A sample of 50 mental health physicians and 300 caregivers of the physicians' new patients 6-12 years old and diagnosed with ADHD will be recruited from child-serving mental health settings across the state of Maryland. Caregivers' beliefs and preferences for treatment will be measured at baseline, 3, and 6 months using a discrete choice experiment. Physicians complete a baseline survey of their predictions of the preferences of each caregiver and of their practice and professional characteristics. The discrete choice experiment data will be analyzed using mixed effects logistic regression models. Latent class analysis will be used to segment the caregiver sample into preference subgroups. Caregiver-physician concordance will also be assessed. Adherence is measured by clinic attendance and medication use for ADHD. The impact of caregiver preferences and caregiver-physician concordance on adherence, adjusting for child symptoms, provider alliance, and parental burden, will be analyzed using models for longitudinal data. Using treatment preferences to predict adherence is an extremely innovative approach to a serious and complex public health problem. The multidisciplinary team and the strong connection to community providers are an excellent environment for the proposed research. This work will promote knowledge transfer for sustainable child mental health services. The potential for generalizing this to primary care settings and to other child mental health conditions will move the field towards better outcomes for children and their families. PUBLIC HEALTH RELEVANCE: This research seeks to understand caregivers' most valued preferences for the treatment of their child's attention-deficit/hyperactivity disorder (ADHD), to examine the concordance between caregivers' preferences for treatment with physicians' perspectives of what they believe is important to caregivers, and to determine if caregiver preferences and caregiver/physician concordance predict adherence to treatment for the child's ADHD. The goal is to develop a tool that will help physicians implement care plans that are personalized to caregivers' preferences as a way to maximize treatment retention. Understanding caregiver preferences is an important first step towards the effective delivery of patient/family-centered mental health care that can lead to better adherence to evidence-based treatments.