No Child Left Behind: A Quality Improvement Clinical Implementation to Improve the Treatment Outcomes, Quality of Care, and Quality of Life for School-Aged Children with Attention Deficit Hyperactivity Disorder at a Rural Primary Care Practice Public Deposited

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  • March 20, 2019
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  • Dragomani, Rebecca
    • Affiliation: School of Nursing
Abstract
  • ABSTRACT Rebecca Dragomani: No Child Left Behind: A Quality Improvement Clinical Implementation to Improve Treatment Outcomes, Quality of Care, and Quality of Life and for Children with Attention Deficit Hyperactivity Disorder at a Rural Primary Care Practice (Under the direction of Dr. Victoria Soltis-Jarrett, PhD, RN, PMHCNS/NP-BC, FAAN) Background and Rationale: Children with attention deficit hyperactivity disorder (ADHD) consistently report lower quality of life than their neurotypical peers and are at substantially increased risk for development of a comorbid psychiatric disorder. Fewer than half are prescribed an initial medication that is both efficacious and tolerable. Pharmacogenomic testing identifies medications likely to cause side effects and is available for use in routine clinical practice, although its effects on the quality of life among children who are prescribed medication for ADHD has not yet been evaluated. Problem: Genetic differences contribute to the wide variability of response to ADHD medications but are not considered in treatment decisions. Quality of life, which correlates with the development of psychiatric comorbidities, is rarely assessed. Purpose: The project aimed to improve the quality of care, treatment outcomes, and quality of life for school-aged children with ADHD at a primary care practice by implementing a comprehensive bundle of practice changes that individualize treatment of ADHD. Methodology: The impact of routine pharmacogenomic testing on the incidence of ADHD medication side effects and change in behavioral symptoms was evaluated using retrospective chart review data. A convenience sample of 52 charts included 26 charts of patients who received pharmacogenomic testing (PGT) prior to being prescribed medication for ADHD and a second group of 26 patients who did not receive testing (No PGT). Quality of life was measured using cross-sectional data from 40 KINDL Quality-of-Life Questionnaires (parent-respondent). Quality of care was assessed through parent interviews. Results: All QI initiatives were fully adopted. Pharmacogenomic testing was associated with fewer moderate and severe ADHD medication side effects (PGT 1.1 vs. No PGT 2.4) and greater differences in behavioral symptom scores (PGT -32 vs. NPGT -15.8). Mean quality-of-life scores of children with ADHD (PGT - 80.3, No PGT - 75.5, History Unknown 71.2) were higher than the benchmark averages. Conclusion: The results support the continued use of pharmacogenomic testing prior to prescribing medication to children for ADHD, use of standardized assessments of response, and quality-of-life assessments to identify children at higher risk for the development of comorbid psychiatric disorders.
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Advisor
  • Davis, Amanda
  • Soltis-Jarrett, Victoria
  • Godwin, Patrick
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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