Attention-Deficit/Hyperactivity Disorder in 2- to 5-Year-Olds: A Primary Care Network Experience.
To assess 1) rates of primary care provider (PCP) diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children, 2) documented PCP adherence to ADHD clinical practice guidelines, and 3) patient factors influencing PCP variation in diagnosis and management. Retrospective cohort study...
| Publicado en: | Academic Pediatrics Vol. 21; no. 2; pp. 280 - 288 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Elsevier B.V.
Mar2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=148863007&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 148863007 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18762859 8NBK jtl: Academic Pediatrics issn: 18762859 maglogo: N pubinfo: dt: Mar2021 vid: 21 iid: 2 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 148863007 148863007 148863007 10.1016/j.acap.2020.04.009 148863007 ppf: 280 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Attention-Deficit/Hyperactivity Disorder in 2- to 5-Year-Olds: A Primary Care Network Experience. aug: au: Bannett, Yair Feldman, Heidi M. Gardner, Rebecca M. Blaha, Ondrej Huffman, Lynne C. affil: Division of Developmental-Behavioral Pediatrics, Stanford University School of Medicine (Y Bannett, HM Feldman, and LC Huffman), Stanford, Calif sug: subj: Attention Deficit Hyperactivity Disorder Epidemiology Physicians, Family Guideline Adherence Attention Deficit Hyperactivity Disorder Diagnosis Attention Deficit Hyperactivity Disorder Drug Therapy Human California Child, Preschool Retrospective Design Record Review Primary Health Care Community Health Centers Comorbidity Logistic Regression After Care Descriptive Statistics Odds Ratio Confidence Intervals Insurance, Health Military Family Child, Preschool: 2-5 years ab: To assess 1) rates of primary care provider (PCP) diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children, 2) documented PCP adherence to ADHD clinical practice guidelines, and 3) patient factors influencing PCP variation in diagnosis and management. Retrospective cohort study of electronic health records from all office visits of children aged 2 to 5 years, seen ≥2 times between 2015 and 2019, in 10 practices of a community-based primary health care network. Outcomes included ADHD diagnosis (symptom or disorder), and adherence to guidelines in 1) comorbidity documentation at or after ADHD diagnosis, 2) ADHD medication choice, and 3) follow-up of medicated patients. Logistic regressions assessed associations between outcomes and patient characteristics. Of 29,408 eligible children, 195 (0.7%) had ADHD diagnoses. Of those, 56% had solely symptom-level diagnoses (eg, hyperactivity); 54% had documented comorbidities. ADHD medications were prescribed only to 4- to 5-year olds (40 of 195 [21%]); 85% received stimulants as first-line medication; 48% had follow-up visits within 2 months. Likelihood of ADHD diagnosis was higher for children with public or military insurance (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.40–2.66; OR 3.17; 95% CI 1.93–4.96). Likelihood of comorbidity documentation was lower for older ADHD patients (OR 0.48; 95% CI 0.32–0.71) and higher for those with military insurance (OR 3.11; 95% CI 1.13–9.58). PCPs in this network frequently used symptom-level ADHD diagnoses in 2- to 5-year olds; ADHD diagnosis rates were below estimated population prevalence, with evidence for sociodemographic disparities. PCP comorbidity documentation and choice of stimulant medications were consistent with guidelines. Rates of timely follow-up were low. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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