Quality of care for childhood attention-deficit/hyperactivity disorder in a managed care medicaid program.
Bonnie T. Zima,Bonnie T. Zima,Regina Bussing,Regina Bussing,Lingqi Tang,Lingqi Tang,Lily Zhang,Lily Zhang,Susan L. Ettner,Thomas R. Belin,Kenneth B. Wells +10 more
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TLDR
Areas for quality improvement are alignment of clinical severity with provider type, follow-up visits, stimulant use in specialty mental health, agency data infrastructure to document delivery of evidence-based psychosocial treatment, and stimulant medication refill prescription persistence.Abstract:
Objective To examine whether clinical severity is greater among children receiving attention-deficit/hyperactivity disorder (ADHD) care in primary care compared with those in specialty mental health clinics, and to examine how care processes and clinical outcomes vary by sector across three 6-month time intervals. Method This was a longitudinal cohort study of 530 children aged 5 to 11 years receiving ADHD care in primary care or specialty mental health clinics from November 2004 through September 2006 in a large, countywide managed care Medicaid program. Results Clinical severity at study entry did not differ between children who received ADHD care in solely primary or specialty mental health care clinics. At three 6-month intervals, receipt of no care ranged from 34% to 44%, and unmet need for mental health services ranged from 13% to 20%. In primary care, 80% to 85% of children had at least one stimulant prescription filled and averaged one to two follow-up visits per year. Less than one-third of children in specialty mental health clinics received any stimulant medication, but all received psychosocial interventions averaging more than five visits per month. In both sectors, stimulant medication refill prescription persistence was poor (31%–49%). With few exceptions, ADHD diagnosis, impairment, academic achievement, parent distress, and parent-reported treatment satisfaction, perceived benefit, and improved family functioning did not differ between children who remained in care and those who received no care. Conclusion Areas for quality improvement are alignment of clinical severity with provider type, follow-up visits, stimulant use in specialty mental health, agency data infrastructure to document delivery of evidence-based psychosocial treatment, and stimulant medication refill prescription persistence.read more
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National trends in the mental health care of children, adolescents, and adults by office-based physicians.
TL;DR: Compared with adultmental health care, the mental health care of young people has increased more rapidly and has coincided with increased psychotropic medication use.
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Special Education Implications of Point and Cumulative Prevalence for Children with Emotional or Behavioral Disorders.
TL;DR: In this article, the authors present a review of both point prevalence and cumulative prevalence of children with emotional or behavioral disorders, highlighting the service gap that exists between prevalence estimates and special education identification.
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Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions.
TL;DR: PCPs appear to be sole physician managers for care of 4 in 10 US children with ADHD, and one-third with mental health conditions overall, according to the Medical Expenditure Panel Survey.
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Attention-deficit/hyperactivity disorder: are we helping or harming?
TL;DR: Prevalence and prescribing rates for attention-deficit/hyperactivity disorder (ADHD) have risen steeply over the past decade, partly in response to concerns about underdiagnosis and undertreatment.
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ADHD Knowledge, Perceptions, and Information Sources: Perspectives From a Community Sample of Adolescents and Their Parents
Regina Bussing,Bonnie T. Zima,Dana M. Mason,Johanna M. Meyer,Kimberly G. White,Cynthia Garvan +5 more
TL;DR: Culturally appropriate psychoeducational strategies are needed that combine doctor-provided ADHD information with reputable Internet sources despite time limitations during patient visits, both parents and teens place high priority on receiving information from their doctor.
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