Chow S-J, Sciberras E, Gillam L H, Green J, Efron D
Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Vic., Australia.
Child Care Health Dev. 2014 May;40(3):301-8. doi: 10.1111/cch.12036. Epub 2013 Feb 27.
Attention-deficit/hyperactivity disorder (ADHD) is now the most common reason for a child to present to a paediatrician in Australia. Stimulant medications are commonly prescribed for children with ADHD, to reduce symptoms and improve function. In this study we investigated the factors that influence paediatricians' decisions about prescribing stimulant medications.
In-depth, semi-structured interviews were conducted with paediatricians (n = 13) who were purposively recruited so as to sample a broad demographic of paediatricians working in diverse clinical settings. Paediatricians were recruited from public outpatient and private paediatrician clinics in Victoria, Australia. The interviews were audio-recorded and transcribed verbatim for thematic analysis. Paediatricians also completed a questionnaire describing their demographic and practice characteristics.
Our findings showed that the decision to prescribe is a dynamic process involving two key domains: (1) weighing up clinical factors; and (2) interacting with parents and the patient along the journey to prescribing. Five themes relating to this process emerged from data analysis: comprehensive assessments that include history, examination and information from others; influencing factors such as functional impairment and social inclusion; previous success; facilitating parental understanding including addressing myths and parental confusion; and decision-making model.
Paediatricians' decisions to prescribe stimulant medications are influenced by multiple factors that operate concurrently and interdependently. Paediatricians do not make decisions about prescribing in isolation; rather, they actively involve parents, teachers and patients, to arrive at a collective, well-informed decision.
注意力缺陷多动障碍（ADHD）目前是澳大利亚儿童前往儿科医生处就诊的最常见原因。兴奋剂药物常用于治疗患有ADHD的儿童，以减轻症状并改善功能。在本研究中，我们调查了影响儿科医生开具兴奋剂药物决策的因素。
对儿科医生（n = 13）进行了深入的半结构化访谈，这些儿科医生是经过有目的招募的，以便对在不同临床环境中工作的儿科医生进行广泛的人口统计学抽样。儿科医生从澳大利亚维多利亚州的公立门诊和私立儿科诊所招募。访谈进行了录音，并逐字转录以进行主题分析。儿科医生还完成了一份描述其人口统计学和执业特征的问卷。
我们的研究结果表明，开药的决定是一个动态过程，涉及两个关键领域：（1）权衡临床因素；（2）在开药过程中与家长和患者互动。数据分析得出了与该过程相关的五个主题：包括病史、检查和他人信息在内的全面评估；功能损害和社会融入等影响因素；既往成功经验；促进家长理解，包括消除误解和家长困惑；以及决策模型。
儿科医生开具兴奋剂药物的决定受到多种因素的影响，这些因素同时且相互依存地起作用。儿科医生并非孤立地做出开药决定；相反，他们积极让家长、教师和患者参与进来，以达成一个集体的、明智的决定。
