Pediatrician Adherence with the AAP ADHD Guidelines: Understanding the Contributions of Individual and Practice-Level Characteristics

Abstract

The present study examined physician adherence with clinical practice guidelines (CPG's). CPG's represent a synthesis of the research literature designed to guide clinical practice. Successful implementation of CPG’s may increase the quality of services delivered. Because youth often present in primary care settings with emotional and behavioral problems, CPG's can help physicians make appropriate decisions about the diagnosis and treatment of mental health problems. Building on prior research, this study examined the relationship between pediatrician and practice-level knowledge and attitudes and pediatrician adherence with the American Academy of Pediatrics guidelines for the evaluation, diagnosis and treatment of children with Attention Deficit Hyperactivity Disorder. Data were analyzed taking into account the individual pediatrician and practice levels. Wave of data collection, youth, pediatrician and practice-level demographic variables, and youth diagnostic variables were also examined as potential predictors. Although results did not support the relationship between knowledge and adherence, practice level perceived barriers to providing better ADHD care was predictive of adherence with treatment guidelines. In addition, youth age and diagnosis were significant predictors of adherence. This study highlights the importance of examining the context within which physicians practice when attempting to understand physician behavior, given the significance of youth and practice-level variables as predictors of adherence.