一项潜在类别分析，以确定照顾者对其子女注意力缺陷多动障碍治疗偏好的差异：陈述的偏好与当前治疗是否匹配？
A Latent Class Analysis to Identify Variation in Caregivers' Preferences for their Child's Attention-Deficit/Hyperactivity Disorder Treatment: Do Stated Preferences Match Current Treatment?
作者信息
Ng Xinyi, Bridges John F P, Ross Melissa M, Frosch Emily, Reeves Gloria, Cunningham Charles E, dosReis Susan
机构信息
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
Patient. 2017 Apr;10(2):251-262. doi: 10.1007/s40271-016-0202-z.
OBJECTIVES
To investigate variation in caregiver preferences for their child's attention-deficit/hyperactivity disorder (ADHD) care and to determine if their stated preferences align with current care management.
METHODS
Caregivers of a child aged 4-14 years and in care for ADHD were recruited from pediatric outpatient clinics and advocacy groups across the state of Maryland. Participants completed a survey collecting demographics, the child's treatment, and caregiver preferences-elicited using a best-worst scaling experiment (case 2). Latent class analysis was used to identify distinct preference segments and bivariate analyses were used to compare the association between segment membership with what the child was currently receiving for their ADHD.
RESULTS
Participants (n = 184) were predominantly White (68%) and the child's mother (84%). Most children had ADHD for 2 or more years (79%). Caregiver preferences were distinguished by two segments: continuous medication (36%) and minimal medication (64%). The two groups had very different preferences for when medication was administered (p < 0.001), but they had similar preferences for provider-oriented and non-medication interventions (p > 0.05 for the caregiver behavior training, provider communication, provider specialty, and out-of-pocket costs). One third of the sample did not receive the preferred individualized education program and 42% of the minimal medication group reported using medication 7 days a week all year round.
CONCLUSIONS
Although behavior management training and school accommodations aspects of an ADHD care plan are more important to caregivers than evidence-based medication, fewer families had access to educational accommodations. Further research is needed to clarify how stated preferences for care align with treatments used in actual practice settings.
目的
调查照顾者对其孩子注意力缺陷多动障碍（ADHD）护理的偏好差异，并确定他们所陈述的偏好是否与当前的护理管理一致。
方法
从马里兰州各地的儿科门诊诊所和倡导团体中招募4至14岁患有ADHD的儿童的照顾者。参与者完成了一项调查，收集人口统计学信息、孩子的治疗情况以及使用最佳-最差尺度实验（案例2）得出的照顾者偏好。使用潜在类别分析来识别不同的偏好细分，并使用双变量分析来比较细分成员资格与孩子目前接受的ADHD治疗之间的关联。
结果
参与者（n = 184）主要为白人（68%），且大多是孩子的母亲（84%）。大多数孩子患有ADHD两年或更长时间（79%）。照顾者的偏好分为两个细分：持续用药（36%）和最少用药（64%）。两组在给药时间上有非常不同的偏好（p < 0.001），但在以提供者为导向的干预和非药物干预方面有相似的偏好（照顾者行为训练、提供者沟通、提供者专业和自付费用方面p > 0.05）。三分之一的样本没有得到首选的个性化教育计划，42%的最少用药组报告全年每周7天都在用药。
结论
尽管ADHD护理计划中的行为管理培训和学校适应措施对照顾者来说比循证用药更重要，但获得教育适应措施的家庭较少。需要进一步研究以阐明所陈述的护理偏好与实际临床环境中使用的治疗方法如何一致。
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