Military Children with Attention Deficit Hyperactivity Disorder (ADHD): Maximizing Adherence to Clinical Practice Guidelines

Introduction: Despite almost two decades of clear clinical practice guidelines (CPG) for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD), provider adherence to the guidelines continues to vary greatly. While variable adherence to the CPG in non-military settings is widely reported in the literature, adherence in military settings has yet to be established, and recent clinical observations suggest that military children with ADHD may not be receiving evidence based care.
Project Purpose: This project evaluates the current status of provider adherence to the ADHD CPG in a military primary care pediatric clinic 24 months after a targeted educational intervention. In keeping with the quality improvement framework of “Plan-Do-Study-Act” (PDSA) this project additionally incorporates a session for providers to evaluate performance, identify existing barriers that impede guideline adherence, and address areas for improvement through the using evidence-based interventions.
Methods: A retrospective chart review was conducted to determine the rates of guideline adherence. Records from a convenience sample of 50 patients during 62 encounters conducted by 4 providers in a military pediatric clinic from January through December, 2016 were reviewed. A goal-oriented meeting was held with the providers, nurses, and clinic staff to disseminate findings and assist in the process of identifying barriers and solutions to guideline adherence using the “Plan-Do-Study-Act” model.
Results: Providers in the selected military clinic adhered to 2/6 of the key guideline components. Of 85 total variables, the providers have an overall mean adherence rate of 28.6% (0-100%, SD 33.8%). During the PDSA session, provides and nurses identified interventions to implement for further improvement.