Communication Strategies for Management of Pediatric ADHD: Do Care Managers Improve Outcomes?

Care management in addition to use of an online patient portal was not found to improve communication or outcomes among children with attention-deficit/hyperactivity disorder (ADHD) compared with use of the portal alone, according to the results of a randomized controlled trial published in Pediatrics.

A team of researchers comprising healthcare providers from 11 primary care pediatric practices (5 urban, 6 suburban) that shared an electronic health record (EHR) and an ADHD-specific patient portal (ADHD Care Assistant) conducted the study (ClinicalTrials.gov Identifier: NCT02716324) from March 2016 to April 2019.

Children aged 5 through 12 years who received care at 1 of the participating practices and had been diagnosed with ADHD within the past year were eligible unless they had a diagnosis of autism spectrum disorder, conduct disorder, psychosis, bipolar disorder, or suicidal ideation or intent in the past year. Most (91%) of the eligible children (N=303) were at least 8 years old, about two-thirds were male, and nearly half were Black.

The portal collected and shared patient and family treatment preferences and goals with a clinician; provided information about trends in ADHD symptoms, performance impairment ratings, medication side effects, and treatment receipt by using electronically submitted parent and teacher reports; stored ADHD educational materials; supported information-sharing between parents and teachers; and enabled physicians to email survey-driven ADHD rating scales to parents and teachers.

Care managers communicated information and facilitated coordination of care. They confirmed family treatment preferences and goals, provided resources and education regarding the treatment of ADHD and associated conditions, monitored attainment of parent-directed goals and emerging issues, and assisted with patient and family concerns.

The researchers used the ADHD symptom subscale of the Vanderbilt Parent Rating Scale (VPRS) to assess and score ADHD symptoms. They evaluated changes in goal attainment and patient-reported outcomes (PROs) for school performance, student engagement, peer relationships, family belonging, and teacher connectedness for the 273 participants who completed the study, 143 of whom completed care management in addition to using the portal and 130 of whom solely used the portal.

The researchers found in multivariate models that VPRS scores decreased over time (adjusted β= -.015; 95% CI, -0.023 to -0.07) in both groups, but there was no difference in intervention-by-time effects (adjusted β =.000; 95% CI, -0.011 to 0.012) between groups. Goal attainment scaling, parent proxy-reported PRO, and child-reported PRO scores (completed by children aged 8 years and older) did not change over time or differ between groups at any study visit.

Children who lived in urban areas had VPRS scores that were greater than those of children who lived in suburban areas, and children who took ADHD medications had lower VPRS scores than those who did not.

In a sensitivity analysis that adjusted for seasonality, the researchers found that participants who received at least 2 care management sessions experienced statistically significant greater decreases in VPRS scores (-4.7; 95% CI, -8.0 to -1.4) than those who had 1 care management session or no sessions.

Limitations of the study included care managers’ primary use of electronic communication, the inability to learn what teachers thought about the interventions, and the lack of a control group that did not receive any intervention.

Disclosure: Drs Fiks and Grundmeier are the inventors of the Care Assistant, which was used as the patient portal for patients with attention-deficit/hyperactivity disorder in this study.

Reference

Guevara JP, Power TJ, Bevans K, et al. Improving care management in attention-deficit/hyperactivity disorder: an RCT. Pediatrics. 2021;148(2);e2020031518. doi:10.1542/peds.2020-031518