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Carolina Pediatrics, PACarolina Pediatrics, PA

CHIPRA Grant/Summer Learning 2011

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QTIP – ADHD INDICATORSQTIP – ADHD INDICATORSFollow Up Care for Children Prescribed ADHD MedicationFollow Up Care for Children Prescribed ADHD Medication

Project Minimum Requirements: 10-chart audit (5 monthly audits). Charts on new patients prescribed

stimulants between 6 and 12 years of age:

1. If a follow-up visit was performed within 45 days of beginning a new stimulant.

2. Was a standardized instrument (such as the Vanderbilt) used, and scored.

3. What medications were prescribed?

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What We Did ? PDSA - 1What We Did ? PDSA - 1

P : To find how we were doing so far

in all the three indicators .

D : Did 10 Chart audit for each of the

three providers and collected data on

the three indicators.

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AnalysisAnalysis S : Analyze the collected dataProvider: FOLLOW-UP

w/in 45 days:STANDARDIZED INSTRUMENT USED

What MedicationsRx:

Provider 1 0% 100% Vyvanse 70%Concerta 20%No Medication 10%

Provider 2 20% 100% Concerta 30%Adderall XR 50%No Medication 20%

Provider 3 50% 100% Adderall XR 50%Vyvanse 40%Metadate 10%Strattera Rx 1xFocalin RX 1x

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A: Need to improve on the follow up rates.

Will provide all ADHD patients with a new policy update.

Staff to make extra effort in contacting ADHD patients to remind them about follow up appointments.

Side NoteAudits are still being performed monthly. Data collected to date.

PDSA CYCLE -2PDSA CYCLE -2P: To improve patient compliance with

ADHD follow up.

D: We gave a handout to all ADHD patients explaining the office policy.

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ADHD Policy HandoutADHD Policy HandoutCarolina Pediatrics - ADHD Consult Follow-Up

Policy1.      Your child’s provider will need to see your child within 30-45 days

after starting ADHD medication(s). It is essential to make your child’s follow-up appointment. This applies to newly diagnosed patients and to patients who have received a medication change.

2.      Patients will be followed-up every 3 months thereafter. 3.      ADHD medications cannot be changed without being seen by your

child’s provider. 4.      Prescriptions will need to be picked up, because ADHD medications

cannot be “called in”. Do not wait until your child’s medications run out. We DO NOT guarantee prescription refills on same day requests.

Please make your next appointment at check out in _________ days/months/as needed.

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22ndnd PDSA Cycle Data PDSA Cycle Data

S: Analyze the collected dataFOLLOW-UP w/in 45 days

Standardized Instrument:(Vanderbilt unless otherwise notated)

What Medications Rx:

Providers 1, 2, 3, and 4

70% 100% Adderall XR 60%

Vyvanse 20%

Concerta 10%

Ritalin 10%

WHAT’S NEXT ?WHAT’S NEXT ?A : The follow up rates improved

significantly across the office.

Continue to focus on patient education and office staff participation in improving ADHD follow up.

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DATA FROM 3DATA FROM 3RDRD MONTH MONTH

FOLLOW UPW/IN 45 DAYS

STANDARDIZED INSTRUMENT

MEDICATION

PROVIDERS 1,23 AND 4.

80% 100% CONCERTA- 30%

ADERRALLXR-70%

VYVANSE- 10%

RITALIN – 10%

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OTHER INDICATORSOTHER INDICATORSFuture PDSA cycles would focus on the

proper use of standardized instruments and appropriate use of ADHD medications.

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AnalysisAnalysis

Strengths• Once the PDSA cycles were implemented the office made the adjustments seamlessly.• Parent participation.

Weaknesses

Relying heavily on parent participation - presuming parent will take initiative.

Strengths• Once the PDSA cycles were implemented the office made the adjustments seamlessly.• Parent participation.

Weaknesses

Relying heavily on parent participation - presuming parent will take initiative.

WE DID IT !WE DID IT !

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