McGuier Elizabeth A, Kolko David J, Joseph Heather M, Kipp Heidi L, Lindstrom Rachel A, Pedersen Sarah L, Subramaniam Geetha A, Molina Brooke S G
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Adolesc Health. 2021 Apr;68(4):808-815. doi: 10.1016/j.jadohealth.2020.12.006. Epub 2021 Jan 11.
Diversion of stimulant medications for ADHD is a prevalent problem. Pediatric primary care providers (PCPs) are well-positioned to reduce diversion risk among adolescents prescribed stimulants, but little is known about their use of prevention strategies. The objectives of this study were to describe the frequency with which pediatric PCPs use diversion prevention strategies and examine potential determinants (facilitators and barriers) of strategy use.
Participants were pediatric PCPs (N = 76) participating in a randomized controlled trial of stimulant diversion prevention strategies. At baseline, before randomization, PCPs rated the frequency with which they used specific strategies in each of four categories: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes toward diversion prevention, subjective norms (i.e., implementation climate), and perceived behavioral control (i.e., knowledge/skill, resource constraints). Associations between determinants and strategy use were tested with correlational and regression analyses.
PCPs used strategies for assessing mental health symptoms/functioning most frequently and patient/family education strategies least frequently. Attitudes about the effectiveness of diversion prevention, implementation climate, knowledge/skill, and resource constraints were positively correlated with the use of at least one category of strategies. In regression analysis, PCP knowledge/skill was positively associated with patient/family education, medication management, and risk assessment strategies.
Findings suggest that improving knowledge and skill may increase the use of diversion prevention strategies by PCPs. Identifying provider-level determinants of strategy use informs implementation efforts in pediatric primary care and can facilitate efforts to prevent stimulant diversion among adolescents.
用于治疗注意力缺陷多动障碍（ADHD）的刺激性药物被挪用是一个普遍存在的问题。儿科初级保健提供者（PCP）处于降低开具刺激性药物的青少年中药物被挪用风险的有利位置，但对于他们使用预防策略的情况却知之甚少。本研究的目的是描述儿科PCP使用药物挪用预防策略的频率，并检查策略使用的潜在决定因素（促进因素和障碍）。
参与者是参与刺激性药物挪用预防策略随机对照试验的儿科PCP（N = 76）。在基线时，即在随机分组之前，PCP对他们在四个类别中每个类别使用特定策略的频率进行评分：患者/家庭教育、药物管理/监测、心理健康症状/功能评估以及危险行为评估。他们完成了对药物挪用预防态度、主观规范（即实施氛围）以及感知行为控制（即知识/技能、资源限制）的测量。通过相关性分析和回归分析测试决定因素与策略使用之间的关联。
PCP最常使用评估心理健康症状/功能的策略，最少使用患者/家庭教育策略。对药物挪用预防有效性的态度、实施氛围、知识/技能和资源限制与至少一类策略的使用呈正相关。在回归分析中，PCP的知识/技能与患者/家庭教育、药物管理和风险评估策略呈正相关。
研究结果表明，提高知识和技能可能会增加PCP对药物挪用预防策略的使用。确定策略使用的提供者层面决定因素有助于儿科初级保健中的实施工作，并可促进预防青少年中刺激性药物挪用的努力。
