Louise A Ellis1, Brette Blakely1, Philip Hazell2, Sue Woolfenden3, Harriet Hiscock4, Vanessa Sarkozy5, Bronwyn Gould6, Peter D Hibbert1,7,8, Gaston Arnolda1, Hsuen P Ting1, Louise K Wiles1,7,8, Charlotte J Molloy1,7,8, Kate Churruca1, Meagan Warwick1, Jeffrey Braithwaite1. 1. Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia. 2. Discipline of Psychiatry, School of Medicine, University of Sydney, Camperdown, New South Wales, Australia. 3. School of Women and Children's Health, University of New South Wales, Randwick, New South Wales, Australia. 4. Murdoch Children's Research Institute, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia. 5. Tumbatin Developmental Clinic, Sydney Children's Hospital Network, School of Women and Children's Health, University of New South Wales, Randwick, New South Wales, Australia. 6. General Practitioner, Paddington, New South Wales, Australia. 7. Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia. 8. South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
Abstract
OBJECTIVE: To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). METHOD: Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with 'Yes' or 'No' responses for adherence, which were scored 'Yes'. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes. RESULTS: Adherence with guidelines was high at 83.6% (95% CI: 77.7-88.5) with pediatricians (90.1%; 95% CI: 73.0-98.1) higher than GPs (68.3%; 95% CI: 46.0-85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6-99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6-91.4) and GPs (18.7%; 95% CI: 4.1-45.5). CONCLUSION: Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement.
OBJECTIVE: To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). METHOD: Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with 'Yes' or 'No' responses for adherence, which were scored 'Yes'. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes. RESULTS: Adherence with guidelines was high at 83.6% (95% CI: 77.7-88.5) with pediatricians (90.1%; 95% CI: 73.0-98.1) higher than GPs (68.3%; 95% CI: 46.0-85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6-99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6-91.4) and GPs (18.7%; 95% CI: 4.1-45.5). CONCLUSION: Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement.
Authors: R C Wasserman; K J Kelleher; A Bocian; A Baker; G E Childs; F Indacochea; C Stulp; W P Gardner Journal: Pediatrics Date: 1999-03 Impact factor: 7.124
Authors: Aaron E Carroll; Nerissa S Bauer; Tamara M Dugan; Vibha Anand; Chandan Saha; Stephen M Downs Journal: Pediatrics Date: 2013-08-19 Impact factor: 7.124
Authors: Tamara D Hooper; Peter D Hibbert; Nicole Mealing; Louise K Wiles; Adam Jaffe; Les White; Christopher T Cowell; Mark F Harris; William B Runciman; Stan Goldstein; Andrew R Hallahan; John G Wakefield; Elisabeth Murphy; Annie Lau; Gavin Wheaton; Helena M Williams; Clifford Hughes; Jeffrey Braithwaite Journal: BMJ Open Date: 2015-04-08 Impact factor: 2.692