UCLA Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA 90024, USA.
Pediatrics. 2013 Mar;131 Suppl 1:S50-9. doi: 10.1542/peds.2012-1427f.
To examine whether parent perceptions about care (barriers, disorder knowledge, treatment willingness) vary among children who drop out of or stay in publicly funded care for attention-deficit/hyperactivity disorder (ADHD) and to explore whether parent perceptions are predictive of staying in care over time.
A longitudinal cohort study of 529 children ages 5 to 11 years receiving care for ADHD in primary care or specialty mental health clinics in a large, countrywide, managed-care Medicaid program. Multiple logistic regression analyses were performed to identify parent perceptions associated with the likelihood of staying in care across three 6-month time intervals, controlling for child and parent demographic characteristics, parental distress, clinical need, and recent special education use.
At least three-fourths of children had at least 1 contact for any mental health care during a 6-month time interval (75%, 85%, 76%). Parent-perceived barriers, ADHD knowledge, and counseling willingness did not predict staying in care, whereas willingness for medication treatment was predictive at baseline. Minority status, nonmarried parent, parental distress, clinical need, and special education use were predictive of staying in care, but mostly during only one 6-month time interval, and their influence varied over time.
Parent willingness for medication treatment along with several demographic and need factors predicted staying in care but not consistently over time. Future research is needed to develop practical tools for clinicians to elicit parent priorities about ADHD treatment and to integrate them into quality-improvement interventions targeted to improving shared decision-making for longer term ADHD care.
考察在因注意力缺陷多动障碍（ADHD）而退出或留在公共资助的照护中的儿童中，父母对护理的看法（障碍、疾病知识、治疗意愿）是否存在差异，并探讨父母的看法是否能预测随时间的护理保留率。
这是一项针对 529 名 5 至 11 岁儿童的纵向队列研究，这些儿童在大型全国性管理式医疗 Medicaid 计划中的初级保健或专业心理健康诊所接受 ADHD 治疗。采用多项逻辑回归分析，确定与在三个 6 个月时间间隔内保留护理的可能性相关的父母看法，控制儿童和父母人口统计学特征、父母痛苦、临床需求和最近特殊教育使用情况。
至少有四分之三的儿童在 6 个月的时间间隔内至少有一次任何心理健康护理的接触（75%、85%、76%）。父母感知到的障碍、ADHD 知识和咨询意愿并不能预测保留护理，而药物治疗意愿在基线时是预测因素。少数族裔地位、非婚父母、父母痛苦、临床需求和特殊教育使用情况均预测了保留护理，但大多只在一个 6 个月时间间隔内，而且它们的影响随时间而变化。
父母对药物治疗的意愿以及一些人口统计学和需求因素预测了护理保留率，但并非始终如此。未来的研究需要开发实用工具，让临床医生了解父母对 ADHD 治疗的优先事项，并将其纳入针对改善长期 ADHD 护理的共享决策的质量改进干预措施中。
