Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers.

Abstract

OBJECTIVES\nTo describe variation in rates of attention-deficit/hyperactivity disorder (ADHD) management by pediatrics primary care providers (PCPs) and to assess influence of clinician characteristics on variation.\n\n\nMETHODS\nRetrospective cohort study of electronic health records (EHR) from all office visits of patients aged 4-17 years seen at least twice between 2015 and 2017 by 73 clinicians in 9 pediatrics practices of a community-based primary healthcare network in California. Outcomes per clinician: (1) % patients seen for ADHD management; (2) % ADHD patients with diagnosed comorbid conditions. Logistic random-effects regression models examined practice- and clinician-level variation.\n\n\nRESULTS\nOf 40,323 patients in the cohort, 2,039 (5.1%) carried an ADHD diagnosis, of which 1,142 (56%) received ADHD medication. Percent of patients seen for ADHD management varied by clinician from 0.0 to 8.3% (median 3.0%). After accounting for practice-level variation and patient characteristics (i.e., sex, age, insurance), clinician characteristics explained 28% of clinician variation in ADHD management. ADHD management rate was associated with high percent Full Time Equivalent (OR 1.17; 95% CI 1.07-1.27). Percent of ADHD patients with diagnoses of comorbidities varied by clinician from 0.0 to 100% (median 35%). Association between ADHD management rate and comorbidity diagnosis was minimal (R=0.10).\n\n\nCONCLUSIONS\nObjective EHR measures showed that PCPs in this network varied widely in their involvement in ADHD management. For most PCPs, % of patients with ADHD and diagnosis of comorbidities was lower than estimated prevalence rates. Exploration of modifiable factors associated with PCP variation is needed to inform strategies for implementation of evidence-based practices.