Mental health is an area where a lot of evidence-based guidelines now exist. A lack of evidence isn’t always the problem. In some cases, one of the key issues is that clinicians don’t adhere to the guidelines. The reasons for this can be many and varied: because they don’t know about the guidelines, because it’s hard to change entrenched practice, because the new systems and procedures are culturally different to what they’re used to, because they don’t have the right training etc.
This randomised controlled trial (available in full-text on the Pediatrics journal website) conducted by researchers in Cincinnati, Ohio, looks at the effectiveness of a website quality improvement programme to improve paediatricians’ adherence to ADHD guidelines.
Forty-nine community-based paediatricians from 8 practices across Kentucky were included in the study. Each practice was given access to a web portal and trained in how to use the system (2 hour-long web-based sessions) which enables parents, teachers, and paediatricians to input information (e.g. rating scales) about the target child during initial ADHD assessment and treatment.
The paediatricians were told to use the system to assess and monitor patients and communicate with parents and teachers. They were followed up at 3-monthly intervals for a year.
The trial used a cluster randomisation design, whereby practices were matched into pairs according to their size and types of patients. The two practices in each pair were randomly assigned to either the intervention or a control group that received the intervention after 6 months.
Here’s what they found:
Paediatricians who used the web portal adhered much better to the guidelines than those in the control group:
- Collection of parent rating scales for assessment of children with ADHD (Cohen’s d = 0.69)
- Collection of teacher rating scales for assessment of children with ADHD (d = 0.68)
- Use of DSM-IV criteria (d = 0.85)
- Use of teacher rating scales to monitor treatment responses (d = 1.01)
The researchers concluded:
A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based paediatric settings.
Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics. 2011 Nov;128(5):e1201-8. Epub 2011 Oct 17.