ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting.

BACKGROUND: COVID-19 impacted all students, especially those with attention deficit hyperactivity disorder (ADHD), putting them at risk for disruption to their medication regimen and school performance. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refills and if telehealth management demonstrated a higher rate of adherence. METHODS: A total of 396 patients from the General Academic Pediatrics (GAP) clinic at Children's Hospital of The King's Daughters (CHKD) were included in the study. Patients were between the ages of 8-18 with a history of ADHD for three or more years that was medically managed with four or more prescription refills between January 2019 and May 2022. A retrospective chart review collected age, sex, race, refill schedule, appointment schedule, and number of telehealth appointments. Data analysis compared the variables and defined "pre-pandemic months" as January 2019 through March 2020 and "pandemic months" as April 2020 through June 2022. RESULTS: The total percentage of patients who had their ADHD medications during pre-pandemic months ranged from 40 to 66% versus 31-44% during pandemic months. Additionally, the total percentage of patients who had quarterly ADHD management appointments during pre-pandemic months ranged between 59 and 70% versus 33-50% during pandemic months. The number of months with ADHD prescription refills over the last three years was significantly higher among those who had both virtual and in-person visits than those who had just in-person visits, p < 0.001. Regarding race, Black patients had a lower number of medication refills compared to White patients when controlled for appointment type. They also had a lower number of total appointments, but there was not a significant difference in the number of virtual appointments. CONCLUSIONS: Since the start of the pandemic, ADHD patients have both refilled their prescriptions and returned to clinic less frequently. This data suggests a need to re-evaluate the ADHD symptoms of GAP patients periodically and return them to a more consistent medication regimen. Telehealth appointments are a potential solution to increase adherence. However, racial inequities found in this study need to be addressed.

Navigating quality and safety in your health system: understanding the alphabet soup.

Entering any new healthcare system today requires thorough knowledge about its quality and safety structure and culture. Learning that language is generally the first step in gaining a better understanding of how systems function. This overview of common mnemonics in the quality and safety world will provide the reader with better comprehension of their quality systems within their institutions. Healthcare providers should understand how patient safety organizations were established and the importance of our safety event classification system, along with the ability to recognize gaps in care that highlight opportunities for improvement. In addition, this review provides explanations of error prevention tools used every day to help new colleagues communicate better and share situational awareness to keep patients safe. Lastly, utilization of standard quality improvement tools can facilitate quality improvement projects and assist all healthcare systems to become highly reliable organizations.

Integrated pediatric urgent care: A perfect fit into patient-centered medical home and meeting the needs of population health and our profession.

General Pediatricians have been constrained into a narrower band of primary care practice with the advent of hospitalists, advanced practice professionals and pediatric specific urgent cares. This new patient care structure will require electronic medical records and institutional systems to decrease interfaces and increase integration, thereby allowing a free flow of information that will provide more efficient and safe care. Pediatric specific urgent cares that are integrated will be able to utilize both efficient system level 1 thinking and deeper more thoughtful system level 2 thinking, which will benefit the pediatric patient by decreasing diagnostic errors. If done appropriately, everywhere a pediatric patient contacts the healthcare system, including pediatric specific urgent cares, the patient should be provided a longitudinal, seamless and specific high quality of care that fits the venue they contact.

Parental Perception and Participation in Genetic Testing Among Children With Autism Spectrum Disorders.

The purpose of this study was to determine the factors associated with genetic testing in children with autism spectrum disorders (ASDs) and understand parental involvement in the decision to test using survey data of parents of children with ASD. Evaluation by a geneticist was associated with genetic testing by more than 39 times compared to evaluation by a nongeneticist (95% CI = 9.15-168.81). Those offered testing by the physicians were more than 6 times more likely to be tested than those not offered testing (95% CI = 1.66-24.61). Financial concerns, not being offered testing, and lack of awareness were the most consistent reasons for not testing given by participants. A physician's recommendation for testing and an evaluation by a geneticist were the most important factors associated with genetic testing in children with ASD. Educating primary care physicians and nongenetic specialists can potentially improve genetic testing among children with ASD.

Parental Self-Assessment of Behavioral Effectiveness in Young Children and Views on Corporal Punishment in an Academic Pediatric Practice.

This article assesses parental confidence and current behavioral techniques used by mostly African American caregivers of young children in an urban Southeastern setting, including their use and attitudes toward corporal punishment (CP). Two hundred and fifty parental participants of children aged 18 months to 5 years completed a survey on factors affecting their behavioral management and views on CP. Statistical analysis included χ2 test and logistic regression with confidence interval significance determined at P <.05. Significant associations of CP usage were found in parents who were themselves exposed to CP and parental level of frustration with child disobedience. A total of 40.2% of respondents answered that they had not received any discipline strategies from pediatricians and 47.6% were interested in receiving more behavioral strategies. Clear opportunities exist for pediatricians to provide information on evidence-based disciplinary techniques, and these discussions may be facilitated through the creation of a No Hit Zone program in the pediatric practice.

A Feasibility Study of Autism Behavioral Markers in Spontaneous Facial, Visual, and Hand Movement Response Data.

Autism spectrum disorder (ASD) is a neurodevelopmental disability with atypical traits in behavioral and physiological responses. These atypical traits in individuals with ASD may be too subtle and subjective to measure visually using tedious methods of scoring. Alternatively, the use of intrusive sensors in the measurement of psychophysical responses in individuals with ASD may likely cause inhibition and bias. This paper proposes a novel experimental protocol for non-intrusive sensing and analysis of facial expression, visual scanning, and eye-hand coordination to investigate behavioral markers for ASD. An institutional review board approved pilot study is conducted to collect the response data from two groups of subjects (ASD and control) while they engage in the tasks of visualization, recognition, and manipulation. For the first time in the ASD literature, the facial action coding system is used to classify spontaneous facial responses. Statistical analyses reveal significantly (p <0.01) higher prevalence of smile expression for the group with ASD with the eye-gaze significantly averted (p<0.05) from viewing the face in the visual stimuli. This uncontrolled manifestation of smile without proper visual engagement suggests impairment in reciprocal social communication, e.g., social smile. The group with ASD also reveals poor correlation in eye-gaze and hand movement data suggesting deficits in motor coordination while performing a dynamic manipulation task. The simultaneous sensing and analysis of multimodal response data may provide useful quantitative insights into ASD to facilitate early detection of symptoms for effective intervention planning.

Sexual harassment in middle and high school children and effects on physical and mental health.

Sexual harassment can be physical interaction and touching, as well as, psychological, environmental, or via Internet and text messaging. An online survey in an urban clinic asked children, aged 12 to 18 years the following: demographic data, height and weight, chronic medical conditions, healthcare use, questions concerning sexual harassment-witnessed and exposure, and finally questions from the Pediatric Symptom Checklist (PSC-35). Overall, 124 of 210 (59%) of the 12- to 18-year-olds surveyed had experienced sexual harassment, with the predominance being female 69% (80/116) versus 48% (49/92) male. Participants who had experienced sexual harassment were significantly more likely to score positive for psychological impairment than those who had not experienced sexual harassment (chi-square test P < .001; odds ratio: 4.7 (95% confidence interval, 1.9-11.8). There was a borderline significant association between elevated body mass index and having experienced sexual harassment (2-sample t test P = .08). Sexual harassment has a direct correlation to psychological impairment in adolescents, especially females.