# Can a Continuing Medical Education Intervention Change Pediatricians’ Attention-Deficit/Hyperactivity Disorder Practices?

## TL;DR

A 6-month training program improved pediatricians' ADHD diagnosis and treatment practices, with extra help from care managers boosting some outcomes.

## Contribution

This study demonstrates that intensive CME programs can lead to sustained changes in ADHD care practices among primary care clinicians.

## Key findings

- Six of nine ADHD evidence-based practice variables improved significantly after the CME training.
- Care manager support added benefits for three of the nine variables but not all.
- No changes were observed in follow-up visits or medication adjustments.

## Abstract

To determine whether a 6-month continuing medical education (CME) program can increase primary care clinicians’ (PCCs) use of attention-deficit/hyperactivity disorder (ADHD) evidence-based practice (EBP) diagnostics and treatment, and to examine whether randomly assigned care manager support further facilitates practice changes.

A total of 47 PCCs attended a 3-day-long CME training, with one-half of PCCs randomly assigned to receive care manager (CM) assistance. All PCCs received continued support via 12 small group teleconference calls over 6 months, After training completion, 9 ADHD EBP variables were abstracted by chart review of 182 newly diagnosed cases seen over a 2-year period (12 months before and after the educational program).

Mixed effects regression analyses examined chart-documented practice changes as a function of pre–post effects of the training and effects of CM assistance, and their interaction. Six of 9 PCCs’ chart-abstracted practice behaviors increased significantly after training, including use of parent–teacher ADHD rating scales at initial diagnosis and over 12 months’ follow-up, as well as side effect monitoring. CM assistance demonstrated additive effects to CME training, but only on 3 of the 9 variables. No training or CM effects were found for 3 other practices: 30-day follow-up visits, total yearly visits, or medication adjustments.

Sufficiently intensive CME programs can produce objective and sustained changes in PCCs’ practices. Additional CM support facilitated some (but not all) of the same changes. Further research is required to determine which practice behavior changes require intensive educational training, CM resources, both, or other practice change interventions.

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

This study examined the impact of an intensive continuing medical education (CME) program on the use of evidence-based diagnostic and treatment practices (EBP) for attention-deficit/hyperactivity disorder (ADHD) among primary care clinicians (N = 47). The CME impact was studied by comparing providers’ charts before and after the CME intervention. Overall, results indicated that this intensive CME intervention increased utilization of EBPs over time, while adding the support of a care manager provided a modest additional benefit on practices.