Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states
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
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| Veröffentlicht in: | PloS one 2021-02, Vol.16 (2), p.e0245916-e0245916, Article 0245916 |
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| creator | Ellis, Louise A. Blakely, Brette Hazell, Philip Woolfenden, Sue Hiscock, Harriet Sarkozy, Vanessa Gould, Bronwyn Hibbert, Peter D. Arnolda, Gaston Ting, Hsuen P. Wiles, Louise K. Molloy, Charlotte J. Churruca, Kate Warwick, Meagan Braithwaite, Jeffrey |
| description | 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 |
| doi_str_mv | 10.1371/journal.pone.0245916 |
| format | Article |
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0245916</identifier><identifier>PMID: 33556083</identifier><language>eng</language><publisher>SAN FRANCISCO: Public Library Science</publisher><subject>Attention deficit hyperactivity disorder ; Best practice ; Biology and Life Sciences ; Children ; Clinical medicine ; Comorbidity ; Demographic aspects ; Diagnosis ; Disease management ; Editing ; Guidelines ; Health aspects ; Health care ; Human performance ; Hyperactivity ; Innovations ; Management ; Medical records ; Medical research ; Medicine and Health Sciences ; Multidisciplinary Sciences ; Pediatrics ; People and Places ; Physical Sciences ; Psychiatry ; Psychological aspects ; Resilience ; Science & Technology ; Science & Technology - Other Topics</subject><ispartof>PloS one, 2021-02, Vol.16 (2), p.e0245916-e0245916, Article 0245916</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Ellis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Ellis et al 2021 Ellis et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>5</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000617379900021</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c692t-da7bbd499a1dc3fdd28e3904248c47207c793eff64afdf837b0404b35c4c25603</citedby><cites>FETCH-LOGICAL-c692t-da7bbd499a1dc3fdd28e3904248c47207c793eff64afdf837b0404b35c4c25603</cites><orcidid>0000-0001-8337-2181 ; 0000-0001-7451-9751 ; 0000-0003-3017-2770 ; 0000-0003-4948-7633 ; 0000-0002-8420-7396 ; 0000-0002-6557-6196 ; 0000-0002-6954-5071 ; 0000-0002-9923-3116 ; 0000-0003-0296-4957 ; 0000-0001-7865-343X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869992/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869992/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2104,2116,2930,23873,27931,27932,39264,39265,53798,53800</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33556083$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Doering, Stephan</contributor><creatorcontrib>Ellis, Louise A.</creatorcontrib><creatorcontrib>Blakely, Brette</creatorcontrib><creatorcontrib>Hazell, Philip</creatorcontrib><creatorcontrib>Woolfenden, Sue</creatorcontrib><creatorcontrib>Hiscock, Harriet</creatorcontrib><creatorcontrib>Sarkozy, Vanessa</creatorcontrib><creatorcontrib>Gould, Bronwyn</creatorcontrib><creatorcontrib>Hibbert, Peter D.</creatorcontrib><creatorcontrib>Arnolda, Gaston</creatorcontrib><creatorcontrib>Ting, Hsuen P.</creatorcontrib><creatorcontrib>Wiles, Louise K.</creatorcontrib><creatorcontrib>Molloy, Charlotte J.</creatorcontrib><creatorcontrib>Churruca, Kate</creatorcontrib><creatorcontrib>Warwick, Meagan</creatorcontrib><creatorcontrib>Braithwaite, Jeffrey</creatorcontrib><creatorcontrib>CareTrack Kids Invest Team</creatorcontrib><creatorcontrib>CareTrack Kids Investigative Team</creatorcontrib><creatorcontrib>on behalf of the CareTrack Kids Investigative Team</creatorcontrib><title>Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states</title><title>PloS one</title><addtitle>PLOS ONE</addtitle><addtitle>PLoS One</addtitle><description>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.</description><subject>Attention deficit hyperactivity disorder</subject><subject>Best practice</subject><subject>Biology and Life Sciences</subject><subject>Children</subject><subject>Clinical medicine</subject><subject>Comorbidity</subject><subject>Demographic aspects</subject><subject>Diagnosis</subject><subject>Disease management</subject><subject>Editing</subject><subject>Guidelines</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Human performance</subject><subject>Hyperactivity</subject><subject>Innovations</subject><subject>Management</subject><subject>Medical records</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Multidisciplinary Sciences</subject><subject>Pediatrics</subject><subject>People and Places</subject><subject>Physical Sciences</subject><subject>Psychiatry</subject><subject>Psychological aspects</subject><subject>Resilience</subject><subject>Science & Technology</subject><subject>Science & Technology - Other 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adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states</title><author>Ellis, Louise A. ; Blakely, Brette ; Hazell, Philip ; Woolfenden, Sue ; Hiscock, Harriet ; Sarkozy, Vanessa ; Gould, Bronwyn ; Hibbert, Peter D. ; Arnolda, Gaston ; Ting, Hsuen P. ; Wiles, Louise K. ; Molloy, Charlotte J. ; Churruca, Kate ; Warwick, Meagan ; Braithwaite, Jeffrey</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-da7bbd499a1dc3fdd28e3904248c47207c793eff64afdf837b0404b35c4c25603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Attention deficit hyperactivity disorder</topic><topic>Best practice</topic><topic>Biology and Life Sciences</topic><topic>Children</topic><topic>Clinical medicine</topic><topic>Comorbidity</topic><topic>Demographic aspects</topic><topic>Diagnosis</topic><topic>Disease management</topic><topic>Editing</topic><topic>Guidelines</topic><topic>Health aspects</topic><topic>Health care</topic><topic>Human performance</topic><topic>Hyperactivity</topic><topic>Innovations</topic><topic>Management</topic><topic>Medical records</topic><topic>Medical research</topic><topic>Medicine and Health Sciences</topic><topic>Multidisciplinary Sciences</topic><topic>Pediatrics</topic><topic>People and Places</topic><topic>Physical Sciences</topic><topic>Psychiatry</topic><topic>Psychological aspects</topic><topic>Resilience</topic><topic>Science & Technology</topic><topic>Science & Technology - Other Topics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ellis, Louise A.</creatorcontrib><creatorcontrib>Blakely, Brette</creatorcontrib><creatorcontrib>Hazell, Philip</creatorcontrib><creatorcontrib>Woolfenden, Sue</creatorcontrib><creatorcontrib>Hiscock, Harriet</creatorcontrib><creatorcontrib>Sarkozy, 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Meagan</au><au>Braithwaite, Jeffrey</au><au>Doering, Stephan</au><aucorp>CareTrack Kids Invest Team</aucorp><aucorp>CareTrack Kids Investigative Team</aucorp><aucorp>on behalf of the CareTrack Kids Investigative Team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states</atitle><jtitle>PloS one</jtitle><stitle>PLOS ONE</stitle><addtitle>PLoS One</addtitle><date>2021-02-08</date><risdate>2021</risdate><volume>16</volume><issue>2</issue><spage>e0245916</spage><epage>e0245916</epage><pages>e0245916-e0245916</pages><artnum>0245916</artnum><issn>1932-6203</issn><eissn>1932-6203</eissn><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.</abstract><cop>SAN FRANCISCO</cop><pub>Public Library Science</pub><pmid>33556083</pmid><doi>10.1371/journal.pone.0245916</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0001-8337-2181</orcidid><orcidid>https://orcid.org/0000-0001-7451-9751</orcidid><orcidid>https://orcid.org/0000-0003-3017-2770</orcidid><orcidid>https://orcid.org/0000-0003-4948-7633</orcidid><orcidid>https://orcid.org/0000-0002-8420-7396</orcidid><orcidid>https://orcid.org/0000-0002-6557-6196</orcidid><orcidid>https://orcid.org/0000-0002-6954-5071</orcidid><orcidid>https://orcid.org/0000-0002-9923-3116</orcidid><orcidid>https://orcid.org/0000-0003-0296-4957</orcidid><orcidid>https://orcid.org/0000-0001-7865-343X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-02, Vol.16 (2), p.e0245916-e0245916, Article 0245916 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_webofscience_primary_000617379900021 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; PubMed Central; Web of Science - Social Sciences Citation Index – 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Free Full-Text Journals in Chemistry |
| subjects | Attention deficit hyperactivity disorder Best practice Biology and Life Sciences Children Clinical medicine Comorbidity Demographic aspects Diagnosis Disease management Editing Guidelines Health aspects Health care Human performance Hyperactivity Innovations Management Medical records Medical research Medicine and Health Sciences Multidisciplinary Sciences Pediatrics People and Places Physical Sciences Psychiatry Psychological aspects Resilience Science & Technology Science & Technology - Other Topics |
| title | Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states |
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