Reducing Stimulant Prescribing Error: A Quality Improvement Initiative in Pediatric Outpatient Setting.

OBJECTIVE: To evaluate the impact of the Songklanagarind ADHD Multidisciplinary Assessment and Care Team for Quality Improvement (SAMATI) initiative on reducing stimulant prescribing errors in a pediatric outpatient setting. METHODS: A retrospective study examined attention deficit hyperactivity disorder (ADHD) registry data from January 2017 to June 2023 to assess the impact of the SAMATI initiative, implemented in early 2020. This initiative, integrating multiple components such as audit and feedback, clinical pharmacist involvement, and Electronic Medical Record utilization, aimed to enhance ADHD medication management. Using interrupted time series and control chart analyses, the study evaluated the initiative's effect on reducing stimulant prescribing errors. Additionally, parental satisfaction was measured to gauge the initiative's overall success. RESULTS: Out of 282 patients enrolled, 267 were included in the final analysis after exclusions. Post-intervention analysis showed significant reductions in various prescribing errors per thousand prescriptions: prescribing without concern drug-condition interaction (443 to 145, p < 0.001), prescribing without adequate monitoring (115 to 14, p < 0.001), lack of regular office visits (98 to 21, p = 0.007), and inappropriate dosage (66 to 14, p = 0.05). Medication errors severity classification also showed significant changes, with notable decreases in classes C and D errors. Parental satisfaction improved from 84% to 95%. CONCLUSION: The SAMATI initiative significantly reduced stimulant prescribing errors and enhanced parental satisfaction in ADHD care management. This study demonstrates the potential of comprehensive quality improvement strategies in improving medication management in pediatric healthcare. Further research in diverse settings is warranted to confirm these findings.

Promoting Medication Adherence in Children with Attention Deficit Hyperactivity Disorder: A Mixed-Methods Systematic Review with Meta-analysis and Qualitative Comparative Analysis.

OBJECTIVE: To evaluate the efficacy of ADHD medication adherence interventions and explore the pathways to effectiveness. METHODS: A systematic review was conducted using multiple databases to identify relevant randomized controlled trials (RCTs). Pooled effect sizes were calculated for medication adherence and ADHD symptom outcomes. Qualitative Comparative Analysis (QCA) was used to identify pathways to effectiveness. RESULTS: Six RCTs were included. The interventions significantly improved medication adherence (OR = 2.39, 95% CI [1.19, 4.79]) and ADHD symptoms (Hedges' g = -0.96, 95% CI [-1.38, -0.54]). Multi-regression analysis showed a positive relationship between medication adherence and ADHD symptom reduction. QCA revealed two paths for effectiveness: (1) Presence of ADHD drug education and absence of reminder and (2) Presence of tracking and absence of reminder. CONCLUSION: ADHD medication adherence interventions have a positive impact on both medication adherence and ADHD symptoms. Interventions should consider including ADHD drug education or tracking to maximize effectiveness.

Development and diagnostic accuracy of dyslexia early identification flowchart for pediatric practice.

This study developed and evaluated the Rapid Automatized naming, Phonological Awareness, and Letter Identification (RAPALI) flowchart for early dyslexia identification in pediatric settings. Using early literacy skills at kindergarten level from the Thai emergent literacy for predicting dyslexia longitudinal study, the RAPALI flowchart effectively identified dyslexia risk at grade 3 level, boasting an AUC of 0.71, a sensitivity of 95.5%, and a negative predictive value of 99.1%. RAPALI demonstrated acceptable specificity and positive predictive value. The user-friendly flowchart aids early identification, interventions, and preventive measures for dyslexia, benefiting affected children and their families. However, further validation and adaptation are needed.