Improving the Diagnosis, Treatment, and Follow-Up of Adult Attention Deficit/Hyperactivity Disorder (ADHD) Patients in Primary Care Utilizing a Performance Improvement Continuing Medical Education (PI CME) Activity

Harvey C. Parker, Anne Teeter Ellison, Gregg Sherman, Michelle E. Frisch, Cheryl Kay, B. Stephen Burton, Wendy Cerenzia

Abstract


Background: Attention deficit/hyperactivity disorder (ADHD) is a debilitating condition in adults that is often underdiagnosed and undertreated. This article describes gaps in healthcare providers’ (HCPs) assessment and management of adult ADHD, the implementation of a performance improvement continuing medical education (PI CME) activity designed to improve the performance of HCPs who care for adult patients with ADHD, and results of the assessment of the educational effectiveness of the PI CME activity.

Methods: The target audience was HCPs in primary care. The activity followed the American Medical Association’s 3-stage methodology for PI CME. In Stages A and C, the pre-assessment stage and post-assessment stage, participants evaluated their practices with respect to performance measures to diagnose and treat adults with ADHD. They completed a self-assessment survey, answered questions from chart reviews of adult patients with ADHD in their practice, and selected one or more Quality Improvement Plans (QIPs) to implement in their practice to improve care given to adults with ADHD. In Stage B, the action stage, participants were supplied with educational material (National Association of Continuing Education Adult ADHD Toolkit) designed to inform them about caring for adults with ADHD and to help them implement their chosen QIP(s). Performance change was measured by comparing data sets from their self-assessment surveys and patient chart reviews obtained at Stages A and C.

Results: A total of 92 participants completed the self-assessment surveys and 926 chart reviews prior to and after Stage B. Analysis of the self-assessment survey data gathered indicated that participants more frequently used the performance measures and that they reported feeling more confident in evaluating and treating adults with ADHD at Stage C than they did in Stage A. As a result of the PI CME intervention, medium to large positive effect sizes were found in participants’ utilization of the measures and their confidence in applying the measures with study patients. With respect to practice behavior as indicated in the chart reviews, compared to Stage A, participants who completed the PI CME activity were significantly more likely (P < .001) to execute comprehensive initial assessments (91% vs. 97%) and use rating scales (71% vs. 90%) to evaluate adults with ADHD in their practice during Stage C. Also, more participants confirmed symptom severity using corroborating evidence, recommended pharmacologic and psychosocial treatments, and provided follow-up after establishing a treatment plan.

Conclusions: This study showed that the participants of the PI CME activity often selected more than one QIP to implement in their practice, made improvements across key performance measures that would serve to enhance their practice and improve clinical outcomes for their adult patients with ADHD, and reported increased confidence in providing care to adults with ADHD. The data derived from the activity, combined with participants’ comments about the value of the educational materials and the instructional format used, validated the educational effectiveness of this 3-stage performance improvement mode of instruction.


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