Getting With The Guideline: Managing Pediatric ADHD in Your. Primary Care Practice

Transcription

1 Getting With The Guideline Managing Pediatric ADHD in Your Primary Care Practice Activity Evaluation Summary CME Activity: Course Director: Getting With The Guideline: Managing Pediatric ADHD in Your Primary Care Practice Saturday, April 26, 2014 Fort Lauderdale Marriott Coral Springs Hotel Coral Springs, FL Andrew Adesman, MD Date of Evaluation Summary: May 27, 2014

2 In April 2014, the Albert Einstein College of Medicine of Yeshiva University (AECOM) and National Association for Continuing Education (NACE) co-sponsored a CME activity, Getting With The Guideline: Managing Pediatric ADHD in Your Primary Care Practice, in Coral Springs, FL. This educational activity was designed to provide primary care clinicians with the background and the tools needed to provide measurement-based care for pediatric patients with ADHD which will lead to improved patient outcomes. In planning this CME activity, the AECOM and NACE performed a needs assessment. A literature search was conducted, national guidelines were reviewed, survey data was analyzed, and experts in each therapeutic area were consulted to determine gaps in practitioner knowledge, competence or performance. Eighty four healthcare practitioners registered to attend Getting With The Guideline: Managing Pediatric ADHD in Your Primary Care Practice, in Coral Springs, FL and one hundred eighty two registered to participate in the live simulcast. One hundred sixty eight healthcare practitioners actually participated in the conference: fifty nine attended the conference in Coral Springs, FL and one hundred nine participated via the live simulcast. Each attendee was asked to complete and return an activity evaluation form prior to the end of the conference. One hundred forty one completed evaluations were received. The data collected is displayed in this report. CME ACCREDITATION Albert Einstein College of Medicine of Yeshiva University is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Albert Einstein College of Medicine of Yeshiva University designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity was co-sponsored with the National Association for Continuing Education (NACE).

3 What is your professional degree? MD 90 66% DO 6 4% NP 26 19% PA 7 5% RN 2 1% Other 6 4% Total MD DO NP PA RN Other What is your specialty? Primary Care 55 39% Endocrinology 0 Rheumatology 0 Pulmonology 0 Pediatric 61 43% Gastroenterology 1 1% Other 24 17% Total % 4 35% 3 25% 2 15% 1 5%

4 How many years have you been in practice? < 5 years years 21 16% years 36 27% > 20 years 51 38% Total < 5 years 5-10 years years > 20 years After attending this activity, I should be able to: Explain current research findings regarding the apparent increases in the diagnosis of ADHD and implications for your practice; discuss new data about the genetics of ADHD and associated disorders; explain the role of diet as a potential therapy for ADHD; identify how long-term stimulant medications affect the brains of ADHD patients. Agree Disagree 0 Total Agree Disagree After attending this activity, I should be able to: Discuss new features

5 of the 2011 AAP Clinical Practice Guideline for ADHD and compare to earlier guideline; identify the special circumstances for treatment of preschoolers and adolescents with ADHD within the new guideline; explain how the use of rating scales such as the Vanderbilt Scales can provide quantitative information that can inform both the diagnosis and ongoing adequacy of the treatment response in patients with ADHD; identify best practices in the implementation of clinician performance measures and patient outcome measures for ADHD. Agree Disagree 0 Total Agree Disagree After attending this activity, I should be able to: Discuss the AAP 2011 Guideline and Process of Care algorithm to help make treatment decisions for ADHD; explain the safety and efficacy of different pharmacologic options for treating children and adolescents with ADHD; explain the importance of shared decision making and the use of a chonic care model for long-term management of ADHD; discuss methods to evaluate treatment effects by systematically measuring outcomes; explain strategies to manage adverse effects of medication treatments. Agree Disagree 0 Total Agree Disagree After attending this activity, I should be able to: Discuss the clinician's

6 respect for parental goals and treatment preferences in fostering treatment initiation and adherence; explain the importance of psychoeducation and parent behavior management training in optimizing ADHD care; discuss promising and inadvisable dietary modifications, supplements and complementary and alternative treatments for ADHD. Agree % Disagree 1 1% Total Agree Disagree After attending this activity, I should be able to: Explain how you can use an evidence-based, comprehensive web based tool to improve the quality of ADHD care in your practice; deliver and track assessment rating scales to parents and teachers using web based tools; implement a systematic follow-up plan to monitor response to treatment using web based tools; monitor and improve AAP guideline adherence in your practice; customize and improve work flow for ADHD care in your practice. Agree % Disagree 1 1% Total Agree Disagree

7 Will you make changes that will benefit patient care as a result of attending this course? Yes % No 5 4% N/A - I do not work directly with patients 16 12% Total Yes No N/A - I do not work directly with patients This activity provided information that I can use to: Increase my Competence Skills: Agree % Somewhat Agree 15 11% Somewhat Disagree 0 Disagree 0 Total Agree Somewhat Agree Somewhat Disagree Disagree This activity provided information that I can use to: Modify the way I

8 perform in Practice: Agree % Somewhat Agree 34 25% Somewhat Disagree 2 1% Disagree 1 1% Total Agree Somewhat Agree Somewhat Disagree Disagree This activity provided information that I can use to: Improve Patient Outcomes: Agree % Somewhat Agree 25 18% Somewhat Disagree 0 Disagree 0 Total Agree Somewhat Agree Somewhat Disagree Disagree What percentage of the presentations was effective in teaching you

9 something new that you will incorporate into your practice? % % % 1 2 1% Total % 3 25% 2 15% 1 5% Was this CME activity "free of commercial bias for or against any product?" Yes % No 9 7% Total Yes No In comparison to other similar activities how would you rate this

10 activity? Excellent 91 66% Good 43 31% Fair 3 2% Poor 0 Total How would you rate this activity in the quality of its organization and professional manner in which it was conducted? Excellent 99 72% Good 35 26% Fair 3 2% Poor 0 Total This program is designed to explain the 2011 AAP ADHD Guideline

11 and its use in practice Excellent % Good 34 25% Fair 1 1% Poor 0 Total Based on my participation in this CME activity, I will incorporate the following new clinical strategies: (check all that apply) Utilize the 2011 AAP Clinical Practice Guideline for ADHD % Utilize the Process of Care algorithm to help make treatment decisions for ADHD 93 24% Utilize strategies for shared decision making to foster treatment initiation and adherence 98 25% Utilize an evidence-based, comprehensive web based tool to improve the quality of ADHD care in my practice 73 19% I already do all these things 20 5% Total % 2 15% 1 5% Utilize the 2011 AAP Clinical Practice Guideline for ADHD Utilize the Process of Care algorithm to help make treatment decisions for ADHD Utilize strategies for shared decision making to foster treatment initiation and adherence Utilize an evidence- based, comprehensive web based tool to improve the quality of ADHD care in my practice I already do all these things

12 Andrew Adesman, MD: New Findings in Our Understanding of ADHD in Children and Adolescents: This Presentation addressed gaps in changing your: Competence % Performance 60 27% Patient Outcomes 59 27% Total Competence Performance Patient Outcomes Andrew Adesman, MD: New Findings in Our Understanding of ADHD in Children and Adolescents: Speakers ability to communicate: Excellent % Good 23 17% Fair 1 1% Poor 0 Total

13 Andrew Adesman, MD: New Findings in Our Understanding of ADHD in Children and Adolescents: How well topic was covered: Excellent % Good 27 21% Fair 3 2% Poor 0 Total Andrew Adesman, MD: New Findings in Our Understanding of ADHD in Children and Adolescents: Objectivity, balance, & scientific rigor: Excellent % Good 29 22% Fair 0 Poor 0 Total

14 Phil Lichtenstein, MD: Review of AAP Assessment and Treatment Guideline and Measurement-Based Care: This Presentation addressed gaps in changing your: Competence % Performance 64 28% Patient Outcomes 64 28% Total Competence Performance Patient Outcomes Phil Lichtenstein, MD: Review of AAP Assessment and Treatment Guideline and Measurement-Based Care: Speakers ability to communicate: Excellent % Good 29 22% Fair 3 2% Poor 0 Total

15 Phil Lichtenstein, MD: Review of AAP Assessment and Treatment Guideline and Measurement-Based Care: How well topic was covered: Excellent % Good 29 22% Fair 1 1% Poor 1 1% Total Phil Lichtenstein, MD: Review of AAP Assessment and Treatment Guideline and Measurement-Based Care: Objectivity, balance, & scientific rigor: Excellent % Good 31 23% Fair 1 1% Poor 0 Total

16 Phil Lichtenstein, MD: Pharmacologic Treatments for ADHD and Shared Decision Making within a Chronic Care Model: This Presentation addressed gaps in changing your: Competence % Performance 59 27% Patient Outcomes 61 27% Total Competence Performance Patient Outcomes Phil Lichtenstein, MD: Pharmacologic Treatments for ADHD and Shared Decision Making within a Chronic Care Model: Speakers ability to communicate: Excellent % Good 24 19% Fair 2 2% Poor 1 1% Total

17 Phil Lichtenstein, MD: Pharmacologic Treatments for ADHD and Shared Decision Making within a Chronic Care Model: How well topic was covered: Excellent 99 76% Good 31 24% Fair 1 1% Poor 0 Total Phil Lichtenstein, MD: Pharmacologic Treatments for ADHD and Shared Decision Making within a Chronic Care Model: Objectivity, balance, & scientific rigor: Excellent % Good 31 24% Fair 0 Poor 0 Total

18 Andrew Adesman, MD: Non-Medical Treatments for ADHD and Shared Decision Making: This Presentation addressed gaps in changing your: Competence 99 46% Performance 60 28% Patient Outcomes 54 25% Total Competence Performance Patient Outcomes Andrew Adesman, MD: Non-Medical Treatments for ADHD and Shared Decision Making: Speakers ability to communicate: Excellent % Good 26 2 Fair 2 2% Poor 0 Total Andrew Adesman, MD: Non-Medical Treatments for ADHD and Shared

19 Decision Making: How well topic was covered: Excellent 93 72% Good 34 26% Fair 3 2% Poor 0 Total Andrew Adesman, MD: Non-Medical Treatments for ADHD and Shared Decision Making: Objectivity, balance, & scientific rigor: Excellent 95 74% Good 32 25% Fair 1 1% Poor 0 Total Phil Lichtenstein, MD: Managing Office Work Flow for ADHD Care in

20 Your Practice by Using a Web Portal: This Presentation addressed gaps in changing your: Competence 88 46% Performance 58 31% Patient Outcomes 44 23% Total Competence Performance Patient Outcomes Phil Lichtenstein, MD: Managing Office Work Flow for ADHD Care in Your Practice by Using a Web Portal: Speakers ability to communicate: Excellent 81 68% Good 35 29% Fair 3 3% Poor 0 Total Phil Lichtenstein, MD: Managing Office Work Flow for ADHD Care in

21 Your Practice by Using a Web Portal: How well topic was covered: Excellent 79 66% Good 34 29% Fair 6 5% Poor 0 Total Phil Lichtenstein, MD: Managing Office Work Flow for ADHD Care in Your Practice by Using a Web Portal: Objectivity, balance, & scientific rigor: Excellent 74 62% Good 38 32% Fair 5 4% Poor 2 2% Total What is your professional degree?

22 MA What is your specialty? Retired ND Peds Med/Peds Date: 4/46/2014 Will you make changes that will benefit patient care as a result of attending this course? s: In the diagnosis and treatment Do the initial evaluation of patients in the office More involvement with school personnel Loved it. Great conference. Better than ones I pay for More Vanderbilt rating scale more frequently Implementing follow ups, Vanderbilt tests, more regularly Decrease referrals to specialty med What subject matter not presented in this activity do you think should be included in future activities? Other psychological disorders, comorbidities Possible ADHD in adult not treated in childhood When to discontinue medication More details regarding the differences in medications Case presentation to assist in medication management More details in medication treatment Comparing stimulants side by side/suggestions for where to start None Genetical causes and epidemiology of ADHD None, but a lot of material in a short amount of time More discussion of med side effects Bipolar/OCD Other portals ADHD and sleep difficulty Discussion of accommodations and working with schools (IEP's, 504 Plans, LD testing, etc.) LifePan with ADHD - approaches patient reached adult lives Meditation More case presentations Mention of teen use of drugs, selling meds Was this CME activity "free of commercial bias for or against any

23 product?" If you answered "no", please explain: List up to 3 changes in your practice that you intend to implement after you listened to the presentation. Make changes in initial assessment. Do titration as recommended. Not to perform blood testing if not needed Use of ADD scales 10 of the time. Use of medications: type, titration, etc. I am retired at this point Consider web portal. Add Omega 3's as are common Vanderbilt screening. Strict follow up. Use CAM Updating and educating parents - patient on new scientific data on medicine and brain changes. More care with ADHD assessment Increase Vanderbilt FU score. Increase FU visits Get a better history of patient's sleep/need to R/O sleep disorders. Get follow up rating scales completed by parents and teachers. Get a better history (patient and family) of cardiac signs and symptoms and document in the chart at initial visit Diagnosing. Treatment. Follow up Use Vanderbilts for all follow up evaluations. Discuss nonmedical management. Use medications in a different manner New to this activity Start more behavioral therapy. Start more Omega fatty acid Dosing time of stimulants. Use more combination (stimulant/non-stimulant) dosing. More frequent use of rating scales Use of Omega 3 supplements/eliminating food colavandi in patients with ADHD. Early use of stimulant medications Follow ups using Vanderbilts Start evaluating patients for ADHD, and refer only if needed Vanderbilt more often. Work on flowsheet of treating ADHD. Ways to evaluate side effects Team work with patient, family (parents, etc.), and teacher SDQA. Faster titration of meds with phone call fill/ s. Be more open to talking to parents about alternative therapy of ADHD Increase use of Vanderbilt for teachers and parents for initial evaluation and follow up, rather than CAP More rapid adjustment dosage meds. Phone follow up. Personal note of Vanderbilt for teachers to get them to return Vanderbilt follow ups. Use of a portal Follow up Vanderbilt scales at regular intervals. Use of SDQA Start methylphenidate in preschoolers with more confidence (resistance from insurance companies due to outdated info). Give follow up Vanderbilt screens at ADHD follow up visits. Ask about

24 driving habits and adjust meds and screening in adolescents with ADHD Data collection. Family and patient education. Connect medication with teaching process Evaluation. Medication. Improvement patient physician communication/collaboration Better follow up Titrate meds quicker More use of rating scales for initial evaluation. More use of rating scales for follow up evaluation. Consider use of web portal Certain changes - management Use rating scales. Include teenagers in medication discussion. Holidays on medication Use of Vanderbilt instead of Connors. Try to find preventing skills courses Use of diagnosing tools. More involvement of the family. Better follow up Discussion with parents and patient about medical and non-medical treatment for ADHD. Help families to get non-medical treatments for ADHD. More efficient follow up of medical treatment using forms (first follow up in less than 6 weeks) If you do not plan to incorporate the above clinical strategies, please list the factors acting as barriers: I am no longer in active clinical practice Lack of experience and time I'm part of an organization of pediatricians where all practice changes need to be authorized by management Not sure that clinical program that I work at will pay for portal Cost - I work in a community health center and I do not think this tool is in the budget. It seems like a good Q1 project though Please provide general comments regarding this activity and suggest how it might be improved: Do more often It is a very good topic, but how to incorporate or influence the law in decreasing violence and crime Participants' questions should not have been 'put off' until after web-based promotional tools Excellent presentations Excellent This is an excellent program Too much time with pre and post questions. Just do post questions to help with time management Shorter introduction so we can spend more time at the end Was very informative Wonderful, comprehensive program Too much emphasis on pre/post testing versus content Andrew Adesman, MD: New Findings in Our Understanding of ADHD

25 in Children and Adolescents: s: Dr. Adesman is excellent Dr. Adesman is outstanding Phil Lichtenstein, MD: Review of AAP Assessment and Treatment Guideline and Measurement-Based Care: s: Definitely an excellent speaker; clear Dr. Lichtenstein is outstanding Dr. Lichteinstein is superb. Excellent Phil Lichtenstein, MD: Pharmacologic Treatments for ADHD and Shared Decision Making within a Chronic Care Model: s: Too much material for the amount of time Andrew Adesman, MD: Non-Medical Treatments for ADHD and Shared Decision Making: s: Phil Lichtenstein, MD: Managing Office Work Flow for ADHD Care in Your Practice by Using a Web Portal: s: Excellent Speaker too 'slow' This talk should be given with a computer to work on while speaker is talking It is a great idea, but since it came at the end and ran over in time a lot of people left early