Purpose

Diversion of stimulant medications for ADHD is a prevalent problem. Pediatric primary care providers (PCPs) are well-positioned to reduce diversion risk among adolescents prescribed stimulants, but little is known about their use of prevention strategies. The objectives of this study were to describe the frequency with which pediatric PCPs use diversion prevention strategies and examine potential determinants (facilitators and barriers) of strategy use.

Methods

Participants were pediatric PCPs (N = 76) participating in a randomized controlled trial of stimulant diversion prevention strategies. At baseline, before randomization, PCPs rated the frequency with which they used specific strategies in each of four categories: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes toward diversion prevention, subjective norms (i.e., implementation climate), and perceived behavioral control (i.e., knowledge/skill, resource constraints). Associations between determinants and strategy use were tested with correlational and regression analyses.

Results

PCPs used strategies for assessing mental health symptoms/functioning most frequently and patient/family education strategies least frequently. Attitudes about the effectiveness of diversion prevention, implementation climate, knowledge/skill, and resource constraints were positively correlated with the use of at least one category of strategies. In regression analysis, PCP knowledge/skill was positively associated with patient/family education, medication management, and risk assessment strategies.

Conclusions

Findings suggest that improving knowledge and skill may increase the use of diversion prevention strategies by PCPs. Identifying provider-level determinants of strategy use informs implementation efforts in pediatric primary care and can facilitate efforts to prevent stimulant diversion among adolescents.

中文翻译：

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在儿科初级保健中使用兴奋剂转移预防策略以及与提供者特征的关联

目的

多动症兴奋剂药物的转移是一个普遍的问题。儿科初级保健提供者 (PCP) 可以很好地降低青少年处方兴奋剂的转移风险，但对其预防策略的使用知之甚少。本研究的目的是描述儿科 PCP 使用转移预防策略的频率，并检查策略使用的潜在决定因素（促进因素和障碍）。

方法

参与者是 参与兴奋剂转移预防策略随机对照试验的儿科 PCP（ N = 76）。在基线时，在随机化之前，PCP 评估了他们在以下四个类别中使用特定策略的频率：患者/家庭教育、药物管理/监测、心理健康症状/功能评估以及风险行为评估。他们完成了对预防转移的态度、主观规范（即实施环境）和感知行为控制（即知识/技能、资源限制）的测量。决定因素和策略使用之间的关联通过相关和回归分析进行了测试。

结果

PCP 使用最频繁地评估心理健康症状/功能的策略和最不频繁地使用患者/家庭教育策略。关于转移预防有效性、实施环境、知识/技能和资源限制的态度与至少一类策略的使用呈正相关。在回归分析中，PCP 知识/技能与患者/家庭教育、药物管理和风险评估策略呈正相关。

结论

调查结果表明，提高知识和技能可能会增加 PCP 对转移预防策略的使用。确定策略使用的提供者级别决定因素可为儿科初级保健的实施工作提供信息，并有助于防止青少年兴奋剂转移。