title: Management of ADHD in children and adolescents: clinical audit in a South African setting.
abstract: OBJECTIVE
  Attention deficit hyperactivity disorder (ADHD) is common, yet under-recognised and undertreated, particularly in low socio-economic settings. Little is known about compliance to evidence- based guidelines in low- and middle-income countries, and no clinical audits have been published in Africa. We undertook to measure compliance in a South African setting using the National Institute for Clinical Excellence (NICE) guidelines for ADHD as the gold standard to compare compliance and socio-demographic characteristics between two treatment locations in Cape Town and to generate an audit checklist for standardising care.
  
  
  METHODS
  The study used a sample of 100 randomly selected cases of school-age patients diagnosed with ADHD, at the Division of Child & Adolescent Psychiatry, Red Cross War Memorial Children's Hospital and University of Cape Town, South Africa. Fifty cases each from a central and a peripheral clinic location were reviewed retrospectively using audit tools, including 17 audit standards derived from NICE guidelines. We defined compliance as "good" with ≥80%, "fair" with 50-79%, and "poor" with <50% adherence.
  
  
  RESULTS
  Compliance was low, with only four audit standards rated as "good". Physical monitoring was especially poor. The central group received more treatment options and relatively safer monitoring.
  
  
  CONCLUSIONS
  We recommend introducing structured protocols followed by re-auditing to improve service delivery, and present a checklist for use in future audit cycles.
authors.affiliation: a Division of Child & Adolescent Psychiatry , Red Cross War Memorial Children's Hospital and University of Cape Town , South Africa.
authors.forename: Kim
authors.initials: K
authors.lastname: Vrba
authors.affiliation: a Division of Child & Adolescent Psychiatry , Red Cross War Memorial Children's Hospital and University of Cape Town , South Africa.
authors.forename: Wendy
authors.initials: W
authors.lastname: Vogel
authors.affiliation: a Division of Child & Adolescent Psychiatry , Red Cross War Memorial Children's Hospital and University of Cape Town , South Africa.
authors.forename: Petrus J
authors.initials: PJ
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D057189:Checklist; D002648:Child; D054869:Clinical Audit; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D012574:Schools; D013019:South Africa