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Collaborative consultation increases use of medication titration trials but not behaviour in children with ADHD

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Dr Jeff N Epstein

Correspondence to: Dr Jeff N Epstein, Cincinnati Children’s Hospital Medical Center, 2800 Winslow St, Room 2216, Cincinnati, OH 45206, USA; jeff.epstein@cchmc.org

QUESTION

Question:

Does a collaborative consultation service in community paediatric practices improve practice behaviours and symptoms in children with attention-deficit/hyperactivity disorder (ADHD)?

Patients:

377 children with DSM-IV ADHD who had not previously received treatment, and were registered at 12 paediatric practices which agreed to participate. 146 of these children (mean age 7.8 years; 64% male) were selected at random to be assessed for behavioural outcomes. Exclusions: practices with an on-site psychiatrist or psychologist; practices that did not use computerised billing systems.

Setting:

12 community-based paediatric practices, USA; time period not stated.

Intervention:

Practices were randomised to collaborative consultation service (6 practices, 25 healthcare professionals, 162 children with ADHD) or control (6 practices, 27 healthcare professionals, 215 children with ADHD). Collaborative consultation involved promotion of and assistance with blinded titration trials of three different weekly doses of methylphenidate hydrochloride over four weeks (weeks 1–4 …

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