PLoS ONE (Jan 2021)

Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states.

  • Louise A Ellis,
  • Brette Blakely,
  • Philip Hazell,
  • Sue Woolfenden,
  • Harriet Hiscock,
  • Vanessa Sarkozy,
  • Bronwyn Gould,
  • Peter D Hibbert,
  • Gaston Arnolda,
  • Hsuen P Ting,
  • Louise K Wiles,
  • Charlotte J Molloy,
  • Kate Churruca,
  • Meagan Warwick,
  • Jeffrey Braithwaite,
  • CareTrack Kids Investigative Team

DOI
https://doi.org/10.1371/journal.pone.0245916
Journal volume & issue
Vol. 16, no. 2
p. e0245916

Abstract

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ObjectiveTo assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD).MethodMedical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with 'Yes' or 'No' responses for adherence, which were scored 'Yes'. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes.ResultsAdherence with guidelines was high at 83.6% (95% CI: 77.7-88.5) with pediatricians (90.1%; 95% CI: 73.0-98.1) higher than GPs (68.3%; 95% CI: 46.0-85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6-99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6-91.4) and GPs (18.7%; 95% CI: 4.1-45.5).ConclusionAdherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement.