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; Browyn  Gould; Peter D. Hibbert; Gaston Arnolda; Hsuen P. Ting; Louise K. Wiles; Charlotte Molloy; Kate Churruca; Meagan Warwick; Jeffrey Braithwaite; CareTrack Kids Investigative Team

doi:10.1371/journal.pone.0245916

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, Browyn Gould, Peter D. Hibbert, Gaston Arnolda, Hsuen P. Ting, Louise K. Wiles, Charlotte Molloy, Kate Churruca, Meagan Warwick, Jeffrey Braithwaite^*, CareTrack Kids Investigative Team

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective
To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD).

Method
Medical 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.

Results
Adherence 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).

Conclusion
Adherence 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.

Original language	English
Article number	e0245916
Pages (from-to)	1-16
Number of pages	16
Journal	PLoS ONE
Volume	16
Issue number	2
DOIs	https://doi.org/10.1371/journal.pone.0245916
Publication status	Published - 8 Feb 2021

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Access to Document

10.1371/journal.pone.0245916Licence: CC BY

Publisher version (open access)Final published version, 1.06 MBLicence: CC BY

Cite this

Ellis, L. A., Blakely, B., Hazell, P., Woolfenden, S., Hiscock, H., Sarkozy, V., Gould, B., Hibbert, P. D., Arnolda, G., Ting, H. P., Wiles, L. K., Molloy, C., Churruca, K., Warwick, M., Braithwaite, J., & CareTrack Kids Investigative Team (2021). Guideline adherence in the management of attention deficit hyperactivity disorder in children: an audit of selected medical records in three Australian states. PLoS ONE, 16(2), 1-16. Article e0245916. https://doi.org/10.1371/journal.pone.0245916

@article{2d32772a82b5433bb2d528edeb89d437,

title = "Guideline adherence in the management of attention deficit hyperactivity disorder in children: an audit of selected medical records in three Australian states",

abstract = "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 {\textquoteleft}Yes{\textquoteright} or {\textquoteleft}No{\textquoteright} responses for adherence, which were scored {\textquoteleft}Yes{\textquoteright}. 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.",

author = "Ellis, {Louise A.} and Brette Blakely and Philip Hazell and Sue Woolfenden and Harriet Hiscock and Vanessa Sarkozy and Browyn Gould and Hibbert, {Peter D.} and Gaston Arnolda and Ting, {Hsuen P.} and Wiles, {Louise K.} and Charlotte Molloy and Kate Churruca and Meagan Warwick and Jeffrey Braithwaite and {CareTrack Kids Investigative Team}",

note = "Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2021",

month = feb,

day = "8",

doi = "10.1371/journal.pone.0245916",

language = "English",

volume = "16",

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Ellis, LA , Blakely, B, Hazell, P, Woolfenden, S, Hiscock, H, Sarkozy, V, Gould, B, Hibbert, PD , Arnolda, G, Ting, HP, Wiles, LK, Molloy, C , Churruca, K, Warwick, M, Braithwaite, J & CareTrack Kids Investigative Team 2021, 'Guideline adherence in the management of attention deficit hyperactivity disorder in children: an audit of selected medical records in three Australian states', PLoS ONE, vol. 16, no. 2, e0245916, pp. 1-16. https://doi.org/10.1371/journal.pone.0245916

TY - JOUR

T1 - Guideline adherence in the management of attention deficit hyperactivity disorder in children

T2 - an audit of selected medical records in three Australian states

AU - Ellis, Louise A.

AU - Blakely, Brette

AU - Hazell, Philip

AU - Woolfenden, Sue

AU - Hiscock, Harriet

AU - Sarkozy, Vanessa

AU - Gould, Browyn

AU - Hibbert, Peter D.

AU - Arnolda, Gaston

AU - Ting, Hsuen P.

AU - Wiles, Louise K.

AU - Molloy, Charlotte

AU - Churruca, Kate

AU - Warwick, Meagan

AU - Braithwaite, Jeffrey

AU - CareTrack Kids Investigative Team

N1 - Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2021/2/8

Y1 - 2021/2/8

N2 - 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.

AB - 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.

UR - http://purl.org/au-research/grants/nhmrc/1065898

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U2 - 10.1371/journal.pone.0245916

DO - 10.1371/journal.pone.0245916

M3 - Article

C2 - 33556083

SN - 1932-6203

VL - 16

SP - 1

EP - 16

JO - PLoS ONE

JF - PLoS ONE

IS - 2

M1 - e0245916

ER -

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

Abstract

Bibliographical note

Access to Document

Other files and links

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The appropriateness of healthcare delivered to Australian children: CareTrack Kids

Cite this

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

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Projects

The appropriateness of healthcare delivered to Australian children: CareTrack Kids

Cite this