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A Cluster Randomized Trial

Jeffery N. Epstein, PhD; David Rabiner, PhD; Diane E. Johnson, PhD; David P. FitzGerald, PhD; Allan Chrisman, MD; Alaattin Erkanli, PhD; Kevin K. Sullivan, BS; John S. March, MD; Peter Margolis, MD, PhD; Edward C. Norton, PhD; C. Keith Conners, PhD

Arch Pediatr Adolesc Med. 2007;161(9):835-840.

Objective  To test whether adoption of a collaborative consultative service model results in improved patient outcomes.

Design  Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group.

Setting  Community-based pediatric offices.

Participants  Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder (ADHD).

Intervention  A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance.

Main Outcome Measure  Physician practice behaviors and child ADHD symptomatology.

Results  Using self-report of pediatricians, the collaborative consultative service increased the use of evidence-based practices by pediatricians, but no difference in children's ADHD symptomatology was observed between the groups. However, many pediatricians did not fully use the collaborative consultative services. Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services.

Conclusions  When actually implemented by pediatricians, the collaborative consultative service appears to be an effective method for facilitating evidence-based treatment procedures for ADHD and use of these procedures appear to improve children's outcomes. Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood.

Author Affiliations: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Drs Epstein and Margolis); Department of Public Policy, Duke University, Durham, North Carolina (Dr Rabiner); Departments of Psychiatry (Drs Johnson, FitzGerald, Chrisman, March, and Conners, and Mr Sullivan) and Biostatistics and Bioinformatics (Dr Erkanli), Duke University Medical Center, Durham, North Carolina; and Department of Health Policy and Administration, University of North Carolina, Chapel Hill (Dr Norton).