title: Improving attention-deficit/hyperactivity disorder treatment outcomes through use of a collaborative consultation treatment service by community-based pediatricians: a cluster randomized trial.
abstract: OBJECTIVE
  To test whether adoption of a collaborative consultative service model results in improved patient outcomes.
  
  
  METHODS
  Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group.
  
  
  METHODS
  Community-based pediatric offices.
  
  
  METHODS
  Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder (ADHD). Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance. Main Outcome Measure Physician practice behaviors and child ADHD symptomatology.
  
  
  RESULTS
  Using self-report of pediatricians, the collaborative consultative service increased the use of evidence-based practices by pediatricians, but no difference in children's ADHD symptomatology was observed between the groups. However, many pediatricians did not fully use the collaborative consultative services. Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services.
  
  
  CONCLUSIONS
  When actually implemented by pediatricians, the collaborative consultative service appears to be an effective method for facilitating evidence-based treatment procedures for ADHD and use of these procedures appear to improve children's outcomes. Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45206, USA. jeff.epstein@cchmc.org
authors.forename: Jeffery N
authors.initials: JN
authors.lastname: Epstein
authors.forename: David
authors.initials: D
authors.lastname: Rabiner
authors.forename: Diane E
authors.initials: DE
authors.lastname: Johnson
authors.forename: David P
authors.initials: DP
authors.lastname: Fitzgerald
authors.forename: Allan
authors.initials: A
authors.lastname: Chrisman
authors.forename: Alaattin
authors.initials: A
authors.lastname: Erkanli
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Sullivan
authors.forename: John S
authors.initials: JS
authors.lastname: March
authors.forename: Peter
authors.initials: P
authors.lastname: Margolis
authors.forename: Edward C
authors.initials: EC
authors.lastname: Norton
authors.forename: C Keith
authors.initials: CK
authors.lastname: Conners
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards*; D003299:Cooperative Behavior; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D012017:Referral and Consultation / Q000458:organization & administration*