Comparison of Attention-Deficit/Hyperactivity Disorder Care Between School-Based Health Centers and a Continuity Clinic.

Abstract

BACKGROUND\nSchool-based health centers (SBHC) are in a unique position to provide guideline-driven attention-deficit/hyperactivity disorder (ADHD) care. In this study, we compared adherence to 2 components of ADHD guidelines in SBHC versus a continuity clinic.\n\n\nMETHODS\nWe compared proportions of ADHD visits that had a structured symptom report available and timely follow-up in SBHC to a continuity clinic using chart review. We used multiple logistic regression to estimate the association between guideline adherence and clinic type.\n\n\nRESULTS\nParticipants who had a medication dose change were 3.9 times more likely (relative risk [RR]\xa0=\xa03.9, 95% confidence interval [CI] 3.0-5.1) to have a structured report present and 1.7 times more likely (RR\xa0=\xa01.7, 95% CI 1.2-2.2) to have follow-up within 30\u2009days if they were seen in SBHC versus continuity clinic. Participants who were stable on their medication dose were 18 times more likely (RR\xa0=\xa018.0, 95% CI 11.3-29.0) to have a structured report present and 1.4 times more likely (RR\xa0=\xa01.4, 95% CI 1.3-1.6) to have follow-up within 100\u2009days if they were seen in SBHC versus continuity clinic.\n\n\nCONCLUSIONS\nCare provided in SBHC was associated with improved adherence to guidelines and has the potential to the improve pediatric ADHD outcomes.