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

描述（由申请人提供）：停药是注意缺陷多动障碍（ADHD）儿童的一个重要但可预防的问题。这导致以前通过药物控制的ADHD症状重新出现，并增加了负面结果的可能性。干预措施可用于改善在初级保健环境中提供的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，使家庭能够积极与实践团队合作，以优化药物有效性并保持儿童药物治疗的连续性。已经确定了持续用药的异质性障碍。事实上，不同的家庭在不同的时期有不同的需要。干预将包括基于证据和理论的组件，以解决三个普遍存在的障碍：1）父母在优化药物的过程中准备不足，2）父母在设定，跟踪和实现明确的治疗目标方面表现不佳，3）父母在ADHD管理活动中的支持不足，他们的社交网络。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过程来设计和优化原型干预，使其在满足父母和医生需求以及促进富有成效的父母-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随机对照试验中进行测试，以评价干预措施（例如，增强的myADHDportal.com）与对照（例如，常规标准门户网站治疗）相比在前六个月治疗期间通过处方记录和其他更近端结局测量的调解连续性方面的总体有效性。新的多组成部分干预措施将嵌入一个名为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ADHD护理。它有助于提供者通过收集，评分和绘制家长和教师报告的ADHD症状，损伤和副作用随时间的变化来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供应商，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护理行为方面具有疗效（Epstein等人，2011），但儿童用药不连续仍然是一个问题（即，图表审计显示，只有41%的天数得到了药品）。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，以便让父母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.