Improving Charting Skills of Physicians in Monitored Practice.

INTRODUCTION: The Physician Enhancement Program (PEP) is an in-practice monitoring program for physicians with potential dyscompetency issues. One component of PEP is a monthly chart audit. The purpose of our study was to determine if physicians' charting skills improve through their participation in PEP. METHODS: The sample included physicians who participated in PEP for at least 6 months regardless of specialization, age, or gender (n = 77). PEP chart audits evaluate seven different aspects of chart and care quality, including legibility, organization, history, assessment/formulation, treatment, physical examination, and overall chart quality. Each aspect of charting is scored on a Likert-type scale from a score of 1 to 9. We conducted pair-matched t tests of the mean item scores for the 1st versus 6th, 12th, 18th, and 24th month in PEP for all chart elements except legibility. We also compared the size of the paired differences by month 1 scores for overall chart quality mean score to determine if the magnitude of change varied by starting point. RESULTS: There was significant improvement (P < .002) across the 6 chart quality elements per physician at months 6, 12, 18, and 24. Physicians who started below Q1 for overall chart quality mean showed most improvement, whereas those who started above Q3 had insignificant change as they had little room to improve. DISCUSSION: PEP participants demonstrated improved charting skills for each chart quality element evaluated. PEP is an effective form of physician education resulting in physician behavior changes, especially for those physicians who need it the most.

The diagnosis and medical treatment of ADHD in children and adolescents in primary care: a practical guide.

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood with approximately 3%-5% of children affected. ADHD is characterized by inattention, impulsivity, and hyperactivity. Many children will present to the primary care provider with concerns regarding ADHD behaviors. The approach to ADHD evaluation includes the history, physical exam, and use of ADHD rating scales. The use of medication to treat ADHD is an important part of management.