title: Attention-deficit/hyperactivity disorder outcomes for children treated in community-based pediatric settings.
abstract: OBJECTIVE
  To determine if children treated by community physicians who participated in an attention-deficit/hyperactivity disorder (ADHD) quality improvement intervention demonstrate symptom and impairment improvements comparable with those achieved in university-based clinical trials.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Rural, suburban, and urban practices, with 28% of the 47 practices serving primarily (>50% of patients) Medicaid-receiving populations.
  
  
  METHODS
  A total of 785 children aged between 7 and 11 years were treated for ADHD by community physicians participating in the study. Intervention A total of 158 community physicians from 47 separate practices participated in a quality improvement intervention, the ADHD Collaborative, designed to improve physician adherence to evidence-based ADHD treatment guidelines. The intervention included mapping and redesign of practice office flow to facilitate adherence to American Academy of Pediatrics ADHD guidelines as well as didactic sessions related to diagnosis and treatment of ADHD. Medical record reviews were completed at the initial assessment and every 3 months for 1 year to evaluate treatment outcome.
  
  
  METHODS
  Improvement in parent- and teacher-rated ADHD symptoms and functional impairment.
  
  
  RESULTS
  Children showed large improvements in parent- and teacher-rated ADHD symptoms, similar to some clinical trials, but made no significant improvements in functional impairment.
  
  
  CONCLUSIONS
  Large improvements in ADHD symptoms can be achieved in primary care settings when physicians provide evidence-based ADHD care using medication. Because many children with ADHD continued to have significant functional impairment despite symptom improvement, collaboration with other mental health or educational services in additional to medication appears warranted.
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. jeff.epstein@cchmc.org
authors.forename: Jeffery N
authors.initials: JN
authors.lastname: Epstein
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Langberg
authors.forename: Philip K
authors.initials: PK
authors.lastname: Lichtenstein
authors.forename: Mekibib
authors.initials: M
authors.lastname: Altaye
authors.forename: William B
authors.initials: WB
authors.lastname: Brinkman
authors.forename: Katherine
authors.initials: K
authors.lastname: House
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Stark
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D016022:Case-Control Studies; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000697:Central Nervous System Stimulants