Managing attention-deficit/hyperactivity disorder in primary care: a systematic analysis of roles and challenges.

OBJECTIVE: This study was designed to investigate the perceptions of primary care providers about their roles and the challenges of managing attention-deficit/hyperactivity disorder and to evaluate differences between providers who serve families primarily from urban versus suburban settings. METHODS: The ADHD Questionnaire was developed to assess primary care provider views about the extent to which clinical activities that are involved in the management of attention-deficit/hyperactivity disorder are appropriate and feasible in primary care. Participants were asked to rate each of 24 items of the questionnaire twice: first to indicate the appropriateness of the activity given sufficient time and resources and second to indicate feasibility in their actual practice. Informants used a 4-point scale to rate each item for appropriateness and feasibility. RESULTS: An exploratory factor analysis of primary care provider ratings of the appropriateness of clinical activities for managing attention-deficit/hyperactivity disorder identified 4 factors of clinical practice: factor 1, assessing attention-deficit/hyperactivity disorder; factor 2, providing mental health care; factor 3, recommending and monitoring approved medications; and factor 4, recommending nonapproved medications. On a 4-point scale (1 = not appropriate to 4 = very appropriate), mean ratings for items on factor 1, factor 2, and factor 3 were high, indicating that the corresponding domains of practice were viewed as highly appropriate. Feasibility challenges were identified on all factors, but particularly factors 1 and 2. A significant interaction effect, indicating differences between appropriateness and feasibility as a function of setting (urban versus suburban), was identified on factor 1. The challenges of assessing attention-deficit/hyperactivity disorder were greater for urban than for suburban primary care providers. CONCLUSIONS: Primary care providers believe that it is highly appropriate for them to have a role in the management of attention-deficit/hyperactivity disorder. Feasibility issues were particularly salient related to assessing attention-deficit/hyperactivity disorder and providing mental health care. The findings highlight the need not only for additional training of primary care providers but also for practice-based resources to assist with school communication and collaboration with mental health agencies, especially in urban practices.

[Functional characteristics of pharmacy services related to home care--results from two pharmaceutical association surveys in suburban and old town areas].

In order to investigate the implementation about pharmacy services focusing on home care and to identify differences in functional characteristics in accordance with pharmacy location, questionnaire surveys were conducted on all 75 pharmacies belonging to T-City Pharmaceutical Association in a suburban area and on all 161 belonging to K-Ward Pharmaceutical Association in a central downtown district. Using data, a principal component analysis was performed. The following services were investigated: medication guidance for patients and their families; provision of drug information to patients; management of patients' drug history; dispensing; advice to physicians; inquiries; management of prescriptions for home infusion services; sales of items such as over-the-counter [OTC] drugs [commercially available drugs that do not require a physician's prescription]; display and catalogue sales of nursing items; consultation on home care; holding events such as health education programs; guidance for drug management by home visits; and information exchange with other medical professionals and social workers. The results of these surveys were as follows. (1) The following services were regularly performed in both urban and suburban areas: medication guidance for patients and their families; provision drug information to patients; management of patients' drug history; dispensing; advice to physicians; inquiries; and sales of OTC drugs. (2) The following services were not difficiently regularly performed in both areas: display and catalogue sales of nursing items; consultation on home care; holding events such as health education programs; guidance for drug management by home visits; and information exchange. (3) As to principal component analysis, pharmacy functions were divided into 3 components and the dispensing service strongly influenced the functional characteristics in T-City. Whereas, in K-Ward, pharmacy functions were divided into 4 components and consultation and information exchange were strong influences. (4) Home care-relate pharmacy services were closely associated with information exchange on both areas. This implies that enforcing information exchange among pharmacists and other health practitioners and social welfare practitioners is an essential factor to expand implementation of home-care related pharmacy services.

Effectiveness of telephone support in increasing physical activity levels in primary care patients.

BACKGROUND: Physician counseling of patients to increase physical activity has had limited success in changing behavior. Providing organizational support to primary care providers and their patients may increase effectiveness. OBJECTIVE: This study evaluates the effectiveness of a telephone-based intervention to increase physical activity among patients who exercised <15 minutes daily and wanted to increase their physical activity over a 6-month period. DESIGN: This was a randomized controlled trial, conducted from 1997 to 1998, of 316 patients aged 18 to 65 who were recruited from a mailed health risk assessment. Baseline and 6-month post-intervention telephone assessments were conducted by telephone. SETTING: One family physician's patients in a suburban community. INTERVENTION: Three sessions of telephone-delivered motivational counseling. MAIN OUTCOME MEASURES: Physical activity score (11-item Physician-Based Assessment and Counseling for Exercise [PACE]) 6 months after the intervention. RESULTS: After adjusting for baseline exercise, there was a significantly higher level of self-reported exercise among individuals randomized to the intervention at the 6-month follow-up. The mean level of activity at follow-up for the intervention group was a PACE score of 5.37, compared to 4.98 in the control group (p<0.05). In the secondary analysis, which was limited to individuals who received the intervention, the effect was stronger (PACE score of 5.58 compared to 4.94, p<0.013). CONCLUSIONS: Patients can be recruited using a health-screening questionnaire to receive a telephone-delivered behavioral intervention to successfully increase their physical activity levels.