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: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

PLoS One. 2021 Feb 8;16(2):e0245916. doi: 10.1371/journal.pone.0245916. eCollection 2021.

Authors

Louise A Ellis¹, Brette Blakely¹, Philip Hazell², Sue Woolfenden³, Harriet Hiscock⁴, Vanessa Sarkozy⁵, Bronwyn Gould⁶, Peter D Hibbert^{1

7

8}, Gaston Arnolda¹, Hsuen P Ting¹, Louise K Wiles^{1

7

8}, Charlotte J Molloy^{1

7

8}, Kate Churruca¹, Meagan Warwick¹, Jeffrey Braithwaite¹; CareTrack Kids Investigative Team

Affiliations

¹ Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
² Discipline of Psychiatry, School of Medicine, University of Sydney, Camperdown, New South Wales, Australia.
³ School of Women and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.
⁴ Murdoch Children's Research Institute, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁵ Tumbatin Developmental Clinic, Sydney Children's Hospital Network, School of Women and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.
⁶ General Practitioner, Paddington, New South Wales, Australia.
⁷ Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
⁸ South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity / therapy*
Australia
Child
Child, Preschool
Female
Guideline Adherence / statistics & numerical data*
Humans
Male
Medical Audit*
Medical Records / statistics & numerical data*

Grants and funding

The research was funded as an Australian National Health and Medical Research partnership grant (APP1065898) (JB), https://www.nhmrc.gov.au), with contributions by the Bupa Health Foundation (https://www.bupa.com.au), Sydney Children’s Hospital Network (https://www.schn.health.nsw.gov.au), New South Wales Kids and Families (https://www.health.nsw.gov.au/kidsfamilies), Children’s Health Queensland (https://www.childrens.health.qld.gov.au) and the South Australian Department of Health (https://www.sahealth.sa.gov.au). These funding bodies provided support in the form of salaries for authors [PH, HPT, LKW, CJM], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr Bronwyn Gould’s general practice in Paddington provided no funding to the study.