Pediatricians' attitudes and practices on ADHD before and after the development of ADHD pediatric practice guidelines.

Purpose: The study aims to assess the changes in attitudes and practices about ADHD reported by AAP fellows between 1999 and 2005 during which AAP ADHD guidelines, training, and quality improvement initiatives occurred.

Method: The study assesses AAP-initiated surveys that were conducted between 1999 and 2005 and involving a random sample of 1,000 and 1,603 pediatricians, respectively.

Results: The findings reveal that significant, although modest, increases occurred in pediatric practitioners' self-reported adherence to the guidelines.

Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder.

Objectives: Several guidelines have been published for the care of children with attention-deficit/hyperactivity disorder (ADHD); however, few data describe adoption of practice guidelines. Our study sought 1) to describe primary care diagnosis and management of ADHD, 2) to determine whether the care is in accordance with American Academy of Pediatrics (AAP) practice guidelines, and 3) to describe factors associated with guideline adherence.

Methods: We conducted a mail survey of 1374 primary care physicians in Michigan.

Receipt of asthma subspecialty care by children in a managed care organization.

Background: Although proper outpatient asthma management sometimes requires care from subspecialists, there is little information on factors affecting receipt of subspecialty care in a managed care setting.

Objective: To determine factors associated with receipt of subspecialty care for children with asthma in a managed care organization.

Methods: We conducted an analysis of the claims from 3163 children with asthma enrolled in a university-based managed care organization from January 1998 to October 2000.

Coding of pediatric behavioral and mental disorders.

Background: In response to changing reimbursement and other pressures in the health care environment, many physicians have reported the use of alternate coding to substitute for certain clinical diagnoses. However, very little information is available on how physicians who care for children approach diagnosis and coding dilemmas for behavioral and mental disorders, which often present unique additional challenges.

Objective: Our study sought to describe the frequency of alternate coding, different approaches to coding, and attitudes toward diagnosis and coding practices by physician specialty.

Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force.

Purpose: To clarify whether screening adults for depression in primary care settings improves recognition, treatment, and clinical outcomes.

Data Sources: The MEDLINE database was searched from 1994 through August 2001. Other relevant articles were located through other systematic reviews; focused searches of MEDLINE from 1966 to 1994; the Cochrane depression, anxiety, and neurosis database; hand searches of bibliographies; and extensive peer review.

Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health.

Objective: To describe the range of depressive symptoms reported by adolescents in a nationally representative U.S. sample and to examine factors associated with persistent depressive symptoms.

Implementing practice guidelines for depression: applying a new framework to an old problem.

We discuss the challenges of implementing clinical practice guidelines for depression in the primary care setting. Multiple potential barriers can limit physician guideline adherence and translation of research into improved patient outcomes. Six primary barriers relate to providers (lack of awareness, lack of familiarity, lack of agreement, lack of self efficacy, lack of outcome expectancy, and inertia of previous practice).