Pilot Study of Shared Care of ADHD in a Pediatric Clinic:Colocation of a Psychologist as an ADHD Care Manager
试验速览
- 阶段
- 不适用
- 入组人数
- 140
- 试验地点
- 2
- 主要终点
- A higher proportion of patients treated by the pediatric providers and psychologists than those in usual care receive doses of medication that are consistent with AAP (American Academy of Pediatrics) recommendations
研究概览
简要总结
Due to the shortage of child psychiatrists and the high prevalence of child mental health disorder, pediatricians and other pediatric primary care providers often assume responsibility for the management of various psychiatric disorders, including ADHD, Attention Deficit Hyperactivity Disorder. However, pediatricians have not been well-trained during residency to deal with the complexities of ADHD management. In addition, the system of care under which pediatricians practice do not afford the time availability that is required to properly manage a child with ADHD. On the other hand, if a pediatrician wishes to refer a patient to a child mental health specialist, many obstacles, including but not limited to stigma, insurance issues, and long waiting lists, often interfere with the patient actually receiving services for his/her ADHD. This research project seeks to examine an innovative model of care in which a child psychologist is located on the premises of a pediatric office and is available to share the care of patients with the pediatrician in order to address ADHD. We hypothesize that parents as well as pediatricians will be more satisfied with this model of care and that patients will ultimately have better outcomes. The beginning of our pilot has shown under-identification to be a barrier to care as well, and thus we propose to implement a quality improvement initiative to screen children for psychosocial issues as well. As we have had trouble with recruitment and unfortunately have had more children randomized to TAU than shared care, we propose in December 2007 a phase 2 of our study where all subjects, instead of randomization, are entered into shared care.
详细描述
Study Goals:
A. To compare patients with ADHD (Attention Deficit Hyperactivity Disorder) treated by a pediatric provider in collaboration with a co-located psychologist/ADHD care manager available for evaluation/assessment and ongoing shared-care consultation to patients with ADHD in a pediatric primary care clinic treated as usual.
-
Patients treated by the pediatricians with the added co-located services will have clinical outcomes that are superior to those that receive usual care
-
Co-located services will increase the number of ADHD patients accessing specialized mental health treatment services
-
A higher proportion of patients treated by the pediatric providers and psychologists than those in usual care receive doses of medication that are consistent with AAP (American Academy of Pediatrics) recommendations
-
Patients whose providers are offered to receive the aid of the co-located psychologists will be more likely to be co-managed by the pediatrician than referred out to the community.
-
Parents will be more satisfied with care in the shared care model than in usual care
B. Pediatricians' morale and attitudes to the treatment of ADHD will improve with the addition of a co-located psychologist.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 6 Years 至 17 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •(Patient subjects):
- •Suspected diagnosis of ADHD, inattentive type, hyperactive type, combined type, NOS
- •Living with Guardian for at least 6 months
- •English-speaking child
- •English-speaking guardian
- •Telephone Access to Guardian
- •Inclusion for Randomization or Phase 2 shared care:
- •Diagnosis of ADHD
排除标准
- •Mental Retardation
- •Co-morbid psychotic disorder
- •Homicidal
- •Dangerous behavior
- •Foster care
- •Impairing co-morbid psychiatric disorder that would make ADHD treatment in a pediatric clinic unsafe or inappropriate (in the judgment of the PI based on the case review of the findings of the clinical psychologist.)
- •Allergic or contraindication to stimulant medications
- •Inclusion Criteria (Provider subjects):
- •Provider at Cornell Campus Helmsley Tower 5/ Long Island City Campus
- •Exclusion Criteria:
- •Inclusion for screening:
- •Child is to be seen by pediatric provider at HT5
- •Parent or guardian reads English or Spanish
- •Exclusion Criteria:
- •Parent/Guardian has received screen within the year
- •Patient is too sick for parent to spend time on form
研究组 & 干预措施
TAU
Treatment as usual. These subjects and their providers were told to pursue treatment services as they normally would do.
shared care
A psychologist co-located in the pediatric primary care clinic shared care with the subject's pediatrician. The psychologist offered regular appointments and psychoeducation. On an individual basis, parent management training, behavioral management training, individual psychotherapy, educational intervention assistance, teacher communication, and medication education were provided as needed.
干预措施: Shared Care (Other)
结局指标
主要结局
A higher proportion of patients treated by the pediatric providers and psychologists than those in usual care receive doses of medication that are consistent with AAP (American Academy of Pediatrics) recommendations
时间窗: six months
次要结局
- Co-located services will increase the number of ADHD patients accessing specialized mental health treatment services(six months)
- 2. Patients whose providers are offered to receive the aid of the co-located psychologists will be more likely to be co-managed by the pediatrician than referred out to the community.(six months)
- Parents will be more satisfied with care in the shared care model than in usual care(six months)