Attention-Deficit/Hyperactivity Disorder in 2- to 5-Year-Olds: A Primary Care Network Experience
| Autor: | Ondrej Blaha, Heidi M. Feldman, Lynne C. Huffman, Rebecca M. Gardner, Yair Bannett |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pediatrics
medicine.medical_specialty medicine.medical_treatment Population Comorbidity Logistic regression 03 medical and health sciences 0302 clinical medicine 030225 pediatrics mental disorders medicine Attention deficit hyperactivity disorder Humans 030212 general & internal medicine Medical diagnosis education Child Retrospective Studies education.field_of_study Primary Health Care business.industry Health services research Retrospective cohort study medicine.disease Stimulant Attention Deficit Disorder with Hyperactivity Child Preschool Pediatrics Perinatology and Child Health Central Nervous System Stimulants business |
| Zdroj: | Academic pediatrics. 21(2) |
| ISSN: | 1876-2867 |
| Popis: | Objectives 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. Methods Retrospective cohort study of electronic health records from all office visits of children aged 2-5 years, seen ≥2 times between 2015 and 2019, in 10 practices of a community-based primary healthcare 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. Results Of 29,408 eligible children, 195 (0.7%) had ADHD diagnoses. Of those, 56% had solely symptom-level diagnoses (e.g., hyperactivity); 54% had documented comorbidities. ADHD medications were prescribed only to 4-5-year-olds (40/195 (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 (OR 1.94; 95% 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). Conclusion PCPs in this network frequently used symptom-level ADHD diagnoses in 2-5-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. |
| Databáze: | OpenAIRE |
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