Web Technology Can Improve Care for ADHD

New web-based technology is helping pediatricians manage growing case-loads of children with attention deficit hyperactivity disorder.

The web-based solution helps reduce ADHD behavioral symptoms in children receiving care at community pediatric practices by coordinating care and ensuring patients get the most effective ADHD medications.

The benefit of the software was recently validated by a multi-institutional study that found the software helped to improve the quality of ADHD care and patient outcomes.

Community-based pediatric practices are often a busy and chaotic environment with providers carrying high volume caseloads. In this setting, providers have historically had a difficult time managing medications and monitoring children, resulting in substandard care for children with ADHD.

“Our data show the software not only helped improve the quality of medication care received by children treated at community-based pediatric practices, but it also improved treatment outcomes for these children,” said Jeffery Epstein, Ph.D., the study’s principal investigator.

“As a result of the improved quality of ADHD care, children treated by pediatricians using this new technology had significantly less ADHD symptoms than children treated by pediatricians who were not given access to this web-based technology.”

The study is discussed online in the journal Pediatrics.

The ADHD care quality improvement (QI) software was developed by Epstein and research colleagues at Cincinnati Children’s Hospital. The American Academy of Pediatrics (AAP) has selected this software for use in pediatric practices that are participating in a five-state QI learning collaborative to improve care for children with ADHD.

Available through a web-based portal, the software helps community practices collect, score, and interpret reports from parents and teachers regarding children’s ADHD symptoms. This allows pediatricians to better gauge whether medications are working with their patients.

Providers at community practices can customize the schedule of collection of these ratings for each patient. When ratings are completed, automated algorithms score and interpret data.

Physicians then receive text and graphs charting patient response to medication and other related information, allowing them to determine if ADHD symptoms are improving in response to the prescribed medication and dosage.

The current study involved a randomized clinical trial coordinated through Cincinnati Children’s and Nationwide Children’s Hospital in Columbus, Ohio, where study co-author Kelly Kelleher, M.D., serves as director of the Center for Innovation in Pediatric Practice.

The trial was conducted at 50 community based pediatric practices involving 199 providers. The providers were randomized to either provide ADHD care using the technology assisted QI intervention or without the intervention.

A total of 373 children with ADHD included in study were prescribed ADHD medications for their condition (165 children at practices using the software intervention and 208 at control practices not using the software). A standard rating scale (the Vanderbilt ADHD Parent Rating Scale) was used before and following treatment to rate ADHD symptoms.

Medicated children cared for at control practices (which did not use the software) experienced an average 10.19-point reduction on the parent-rated scale of symptoms. Children at pediatric practices using the technology based intervention experienced an average symptom reduction of 13.19 points.

Use of the technology enabled significantly more treatment contacts with clinical staff and a greater number of parent and teacher ratings to monitor the effectiveness of medications. Moreover, researchers discovered treatment effectiveness and outcomes were more quickly assessed at practices using the software.

A limitation of the study is that community settings often do not have a standardized method to collect data. This made it difficult to generalize the data to all community practices and providers, according to the authors.

The study also focused only on the primary outcome of ADHD symptoms. It did not evaluate functional impairments (such as school performance), which are often why families seek treatment for ADHD.


Source: Cincinnati Children’s Hospital