Educating and Supporting Primary Care Providers in the Implementation of Evidence-based Practices for ADHD

Although numerous studies have demonstrated that a high percentage of primary care providers (PCPs) are knowledgeable about the American Academy of Pediatrics' guidelines for managing ADHD, many fail to implement these guidelines correctly. The goal of this project is to increase the use of evidence-based practices (EBP) for assessing and treating children with ADHD between 5 and 12 years in the context of primary care practice. This randomized controlled trial will evaluate the whether a 3-part intervention (education about ADHD management and communication training, collaborative consultation, and performance feedback regarding use of EBPs) is effective in improving EBP use among primary care providers.

Study Overview

• Status: Completed
• Conditions: Attention Deficit Hyperactivity Disorder
• Intervention / Treatment: Behavioral: Supporting Practice for ADHD (SPA)

• Study Type: Interventional
• Enrollment (Actual): 895
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19103
      • Children's Hospital of Philadelphia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 5 years to 12 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Primary Subjects: Clinicians

Inclusion Criteria:

• Non-resident clinician (physician or nurse practitioner) at participating site

Exclusion Criteria:

• Residents

Secondary Subjects: Families

Inclusion Criteria:

• Children aged 5-12 years receiving care from a clinician enrolled in the study for ADHD and their parents

Exclusion Criteria:

• Autism spectrum disorder

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Clinicians in the intervention arm will receive the three-part intervention (Supporting Practice for ADHD, or SPA) which includes: education about ADHD management and communication training, collaborative consultation, and performance feedback, for the first 8 months of the study.	Behavioral: Supporting Practice for ADHD (SPA); The SPA intervention will last for 8 months for each study arm (first 8 months of the study for the intervention group, last 8 months for the control group). The intervention includes 3 components: 1) a series of web-based educational presentations to provide education to providers about evidence-based practice for managing ADHD and strategies for promoting effective communication with families 2) Collaborative consultation designed to address clinical issues arising in practice will be provided by members of the study team. 3) Providers will be given systematic performance feedback with regard to their use of evidence-based practices for ADHD every 2 months during the 8-month intervention period.
Other: Control; Clinicians in the control arm will receive no intervention for the first 8 months of the study, then will receive the full SPA intervention for the last 8 months of the study.	Behavioral: Supporting Practice for ADHD (SPA); The SPA intervention will last for 8 months for each study arm (first 8 months of the study for the intervention group, last 8 months for the control group). The intervention includes 3 components: 1) a series of web-based educational presentations to provide education to providers about evidence-based practice for managing ADHD and strategies for promoting effective communication with families 2) Collaborative consultation designed to address clinical issues arising in practice will be provided by members of the study team. 3) Providers will be given systematic performance feedback with regard to their use of evidence-based practices for ADHD every 2 months during the 8-month intervention period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Patients Who Were Sent the Parents Rating Scale	This measure is based on chart review of patients of clinicians in each study arm (up to 4 patients per clinician) and reflects whether there is evidence that a parent rating scale was sent out during the baseline interval	Baseline Period (8 months)
Number of Patients Whose Parent Rating Scale Was Returned	This measure is based on chart review of patients of clinicians in each study arm (up to 4 patients per clinician) and reflects whether there is evidence that a parent rating scale was received by the clinician during the baseline interval	Baseline Period (8 months)
Number of Patients Who Were Sent the Teacher Rating Scale	This measure is based on chart review of patients of clinicians in each study arm (up to 4 patients per clinician) and reflects whether there is evidence that a teacher rating scale was sent out during the baseline interval	Baseline Period (8 months)
Number of Patients Whose Teacher Rating Scale Was Returned	This measure is based on chart review of patients of clinicians in each study arm (up to 4 patients per clinician) and reflects whether there is evidence that a teacher rating scale was received by the clinician during the baseline interval	Baseline Period (8 months)
Number of Patients Who Were Sent the Parents Rating Scale	This measure is based on chart review of patients of clinicians in each study arm (up to 4 patients per clinician) and reflects whether there is evidence that a parent rating scale was sent out during the intervention interval	Intervention Period (8 months)
Number of Patients Whose Parent Rating Scale Was Returned	This measure is based on chart review of patients of clinicians in each study arm (up to 4 patients per clinician) and reflects whether there is evidence that a parent rating scale was received by the clinician during the intervention interval	Intervention Period (8 months)
Number of Patients Who Were Sent the Teacher Rating Scale	This measure is based on chart review of patients of clinicians in each study arm (up to 4 patients per clinician) and reflects whether there is evidence that a teacher rating scale was sent out during the intervention interval	Intervention Period (8 months)
Number of Patients Whose Teacher Rating Scale Was Returned	This measure is based on chart review of patients of clinicians in each study arm (up to 4 patients per clinician) and reflects whether there is evidence that a teacher rating scale was received by the clinician during the intervention interval	Intervention Period (8 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Patients Who Were Sent the Parent Rating Scale - by MOC Status	We calculated the percent of patient charts with evidence that a parent rating scale was sent out during the baseline period, separately for intervention clinicians who did and did not complete Maintenance of Certification (MOC) attestation.	Baseline Period (8 months)
Number of Patients Whose Parent Rating Scale Was Returned- by MOC Status	We calculated the percent of patient charts with evidence that a parent rating scale was received by the clinician/practice during the baseline period, separately for intervention clinicians who did and did not complete Maintenance of Certification (MOC) attestation.	Baseline Period (8 months)
Number of Patients Who Were Sent the Teacher Rating Scale- by MOC Status	We calculated the percent of patient charts with evidence that a teacher rating scale was sent out during the baseline period, separately for intervention clinicians who did and did not complete Maintenance of Certification (MOC) attestation.	Baseline Period (8 months)
Number of Patients Whose Teacher Rating Scale Was Returned- by MOC Status	We calculated the percent of patient charts with evidence that a teacher rating scale was received by the clinician/practice during the baseline period, separately for intervention clinicians who did and did not complete Maintenance of Certification (MOC) attestation.	Baseline Period (8 months)
Number of Patients Who Were Sent the Parent Rating Scale- by MOC Status	We calculated the percent of patient charts with evidence that a parent rating scale was sent out during the intervention period, separately for intervention clinicians who did and did not complete Maintenance of Certification (MOC) attestation.	Intervention Period (8 months)
Number of Patients Whose Parent Rating Scale Was Returned- by MOC Status	We calculated the percent of patient charts with evidence that a parent rating scale was received by the clinician/practice during the intervention period, separately for intervention clinicians who did and did not complete Maintenance of Certification (MOC) attestation.	Intervention Period (8 months)
Number of Patients Who Were Sent the Teacher Rating Scale- by MOC Status	We calculated the percent of patient charts with evidence that a teacher rating scale was sent out during the intervention period, separately for intervention clinicians who did and did not complete Maintenance of Certification (MOC) attestation.	Intervention Period (8 months)
Number of Patients Whose Teacher Rating Scale Was Returned- by MOC Status	We calculated the percent of patient charts with evidence that a teacher rating scale was received by the clinician/practice during the intervention period, separately for intervention clinicians who did and did not complete Maintenance of Certification (MOC) attestation.	Intervention Period (8 months)
Number of Patients Who Were Sent the Parent Rating Scale- by Feedback Call Participation	We calculated the percent of patient charts with evidence that a parent rating scale was sent out during the baseline period, separately for intervention clinicians who did and did not participate in at least one performance feedback call.	Baseline Period (8 months)
Number of Patients Whose Parent Rating Scale Was Returned- by Feedback Call Participation	We calculated the percent of patient charts with evidence that a parent rating scale was received by the clinician/practice during the baseline period, separately for intervention clinicians who did and did not participate in at least one performance feedback call.	Baseline Period (8 months)
Number of Patients Who Were Sent the Teacher Rating Scale- by Feedback Call Participation	We calculated the percent of patient charts with evidence that a teacher rating scale was sent out during the baseline period, separately for intervention clinicians who did and did not participate in at least one performance feedback call.	Baseline Period (8 months)
Number of Patients Whose Teacher Rating Scale Was Returned- by Feedback Call Participation	We calculated the percent of patient charts with evidence that a teacher rating scale was received by the clinician/practice during the baseline period, separately for intervention clinicians who did and did not participate in at least one performance feedback call.	Baseline Period (8 months)
Number of Patients Who Were Sent the Parent Rating Scale- by Feedback Call Participation	We calculated the percent of patient charts with evidence that a parent rating scale was sent out during the intervention period, separately for intervention clinicians who did and did not participate in at least one performance feedback call.	Intervention Period (8 months)
Number of Patients Whose Parent Rating Scale Was Returned- by Feedback Call Participation	We calculated the percent of patient charts with evidence that a parent rating scale was received by the clinician/practice during the intervention period, separately for intervention clinicians who did and did not participate in at least one performance feedback call.	Intervention Period (8 months)
Number of Patients Who Were Sent the Teacher Rating Scale- by Feedback Call Participation	We calculated the percent of patient charts with evidence that a teacher rating scale was sent out during the intervention period, separately for intervention clinicians who did and did not participate in at least one performance feedback call.	Intervention Period (8 months)
Number of Patients Whose Teacher Rating Scale Was Returned- by Feedback Call Participation	We calculated the percent of patient charts with evidence that a teacher rating scale was received by the clinician/practice during the intervention period, separately for intervention clinicians who did and did not participate in at least one performance feedback call.	Intervention Period (8 months)
Implementation Outcome: Number of Clinicians Who Completed All 3 Educational Presentations	We assessed the proportion of clinicians randomized to the intervention group that completed all 3 educational presentations.	Intervention Period (8 months)
Implementation Outcome: Number of Clinicians Who Used the Collaborative Consultation Component	We calculated the proportion of clinicians in the intervention group that posted in the online networking site which was used to facilitate collaborative consultation.	Intervention Period (8 months)
Implementation Outcome: Number of Clinicians Who Participated in at Least One Performance Feedback Call	We calculated the proportion of clinicians in the intervention group who participated in at least one of the four performance feedback calls that were held during the study period.	Intervention Period (8 months)
Implementation Outcome: Number of Clinicians Who Participated in All Intervention Components and Attested to Fulfilling MOC Requirements	We calculated the proportion of clinicians in the intervention group who completed all components of the intervention and attested to fulfilling MOC requirements.	Intervention Period (8 months)

Collaborators and Investigators

• Sponsor: Children's Hospital of Philadelphia
• Investigators: Principal Investigator: Thomas Power, PhD, Children's Hospital of Philadelphia; Principal Investigator: Alexander G Fiks, MD, MSCE, Children's Hospital of Philadelphia

Study record dates

Study Major Dates

• Study Start: November 1, 2014
• Primary Completion (Actual): July 31, 2016
• Study Completion (Actual): July 31, 2016

Study Registration Dates

• First Submitted: October 13, 2014
• First Submitted That Met QC Criteria: October 20, 2014
• First Posted (Estimate): October 22, 2014

Study Record Updates

• Last Update Posted (Actual): March 18, 2019
• Last Update Submitted That Met QC Criteria: March 15, 2019
• Last Verified: March 1, 2019

More Information

Terms related to this study

• Keywords: Evidence-Based Practice; Provider Education
• Additional Relevant MeSH Terms: Mental Disorders; Attention Deficit and Disruptive Behavior Disorders; Neurodevelopmental Disorders; Attention Deficit Disorder with Hyperactivity
• Other Study ID Numbers: 14-011189