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Managing attention-deficit/hyperactivity disorder in primary care: a systematic analysis of roles and challenges.
Pediatrics. 2008 Jan; 121(1):e65-72.Ped

Abstract

OBJECTIVE

This study was designed to investigate the perceptions of primary care providers about their roles and the challenges of managing attention-deficit/hyperactivity disorder and to evaluate differences between providers who serve families primarily from urban versus suburban settings.

METHODS

The ADHD Questionnaire was developed to assess primary care provider views about the extent to which clinical activities that are involved in the management of attention-deficit/hyperactivity disorder are appropriate and feasible in primary care. Participants were asked to rate each of 24 items of the questionnaire twice: first to indicate the appropriateness of the activity given sufficient time and resources and second to indicate feasibility in their actual practice. Informants used a 4-point scale to rate each item for appropriateness and feasibility.

RESULTS

An exploratory factor analysis of primary care provider ratings of the appropriateness of clinical activities for managing attention-deficit/hyperactivity disorder identified 4 factors of clinical practice: factor 1, assessing attention-deficit/hyperactivity disorder; factor 2, providing mental health care; factor 3, recommending and monitoring approved medications; and factor 4, recommending nonapproved medications. On a 4-point scale (1 = not appropriate to 4 = very appropriate), mean ratings for items on factor 1, factor 2, and factor 3 were high, indicating that the corresponding domains of practice were viewed as highly appropriate. Feasibility challenges were identified on all factors, but particularly factors 1 and 2. A significant interaction effect, indicating differences between appropriateness and feasibility as a function of setting (urban versus suburban), was identified on factor 1. The challenges of assessing attention-deficit/hyperactivity disorder were greater for urban than for suburban primary care providers.

CONCLUSIONS

Primary care providers believe that it is highly appropriate for them to have a role in the management of attention-deficit/hyperactivity disorder. Feasibility issues were particularly salient related to assessing attention-deficit/hyperactivity disorder and providing mental health care. The findings highlight the need not only for additional training of primary care providers but also for practice-based resources to assist with school communication and collaboration with mental health agencies, especially in urban practices.

Authors+Show Affiliations

The Center for Management of ADHD, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. power@email.chop.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18166546

Citation

Power, Thomas J., et al. "Managing Attention-deficit/hyperactivity Disorder in Primary Care: a Systematic Analysis of Roles and Challenges." Pediatrics, vol. 121, no. 1, 2008, pp. e65-72.
Power TJ, Mautone JA, Manz PH, et al. Managing attention-deficit/hyperactivity disorder in primary care: a systematic analysis of roles and challenges. Pediatrics. 2008;121(1):e65-72.
Power, T. J., Mautone, J. A., Manz, P. H., Frye, L., & Blum, N. J. (2008). Managing attention-deficit/hyperactivity disorder in primary care: a systematic analysis of roles and challenges. Pediatrics, 121(1), e65-72. https://doi.org/10.1542/peds.2007-0383
Power TJ, et al. Managing Attention-deficit/hyperactivity Disorder in Primary Care: a Systematic Analysis of Roles and Challenges. Pediatrics. 2008;121(1):e65-72. PubMed PMID: 18166546.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Managing attention-deficit/hyperactivity disorder in primary care: a systematic analysis of roles and challenges. AU - Power,Thomas J, AU - Mautone,Jennifer A, AU - Manz,Patricia H, AU - Frye,Leslee, AU - Blum,Nathan J, PY - 2008/1/2/pubmed PY - 2008/2/6/medline PY - 2008/1/2/entrez SP - e65 EP - 72 JF - Pediatrics JO - Pediatrics VL - 121 IS - 1 N2 - OBJECTIVE: This study was designed to investigate the perceptions of primary care providers about their roles and the challenges of managing attention-deficit/hyperactivity disorder and to evaluate differences between providers who serve families primarily from urban versus suburban settings. METHODS: The ADHD Questionnaire was developed to assess primary care provider views about the extent to which clinical activities that are involved in the management of attention-deficit/hyperactivity disorder are appropriate and feasible in primary care. Participants were asked to rate each of 24 items of the questionnaire twice: first to indicate the appropriateness of the activity given sufficient time and resources and second to indicate feasibility in their actual practice. Informants used a 4-point scale to rate each item for appropriateness and feasibility. RESULTS: An exploratory factor analysis of primary care provider ratings of the appropriateness of clinical activities for managing attention-deficit/hyperactivity disorder identified 4 factors of clinical practice: factor 1, assessing attention-deficit/hyperactivity disorder; factor 2, providing mental health care; factor 3, recommending and monitoring approved medications; and factor 4, recommending nonapproved medications. On a 4-point scale (1 = not appropriate to 4 = very appropriate), mean ratings for items on factor 1, factor 2, and factor 3 were high, indicating that the corresponding domains of practice were viewed as highly appropriate. Feasibility challenges were identified on all factors, but particularly factors 1 and 2. A significant interaction effect, indicating differences between appropriateness and feasibility as a function of setting (urban versus suburban), was identified on factor 1. The challenges of assessing attention-deficit/hyperactivity disorder were greater for urban than for suburban primary care providers. CONCLUSIONS: Primary care providers believe that it is highly appropriate for them to have a role in the management of attention-deficit/hyperactivity disorder. Feasibility issues were particularly salient related to assessing attention-deficit/hyperactivity disorder and providing mental health care. The findings highlight the need not only for additional training of primary care providers but also for practice-based resources to assist with school communication and collaboration with mental health agencies, especially in urban practices. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/18166546/Managing_attention_deficit/hyperactivity_disorder_in_primary_care:_a_systematic_analysis_of_roles_and_challenges_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=18166546 DB - PRIME DP - Unbound Medicine ER -