Objective: 

Despite efficacious treatments, evidence-based guidelines, and increased availability of integrated behavioral health care, youth coping with attention-deficit/hyperactivity disorder (ADHD) receive suboptimal care. More research is needed to understand and address care gaps, particularly within rural health systems that face unique challenges. We conducted a qualitative study within a predominantly rural health system with a pediatric-integrated behavioral health care program to address research gaps and prepare for quality improvement initiatives, including primary care clinician (PCC) trainings and clinical decision support tools in the electronic health record (EHR).

Method: 

Semistructured interviews were conducted with 26 PCCs representing clinics within the health system. Interview guides were based on the Practical Robust Implementation and Sustainability Model to elicit PCC views regarding determinants of current practices and suggestions to guide quality improvement efforts. We used thematic analysis to identify patterns of responding that were common across participants.

Results: 

PCCs identified several internal and external contextual factors as determinants of current practices. Of note, PCCs recommended increased access to continuing education trainings held in clinic over lunch and delivered in less than 30 minutes. Suggested improvements to the EHR included incorporating parent and teacher versions of the Vanderbilt Rating Scale into the EHR, documentation templates aligned with evidence-based guidelines, and alerts and suggestions to aid medication management during appointments.

Conclusion: 

Future research to identify implementation strategies to help rural PCCs adopt innovations are needed given the increased responsibility for managing ADHD care and intractable gaps in access to behavioral health care in rural regions.

中文翻译：

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农村初级保健临床医生对儿科注意力缺陷/多动障碍护理的看法

客观的： 

尽管有有效的治疗方法、基于证据的指南以及综合行为保健的可用性不断增加，但患有注意力缺陷/多动症（ADHD）的青少年所获得的护理效果并不理想。需要更多的研究来了解和解决护理差距，特别是在面临独特挑战的农村卫生系统内。我们在主要是农村的卫生系统中进行了一项定性研究，其中包括儿科综合行为卫生保健计划，以弥补研究差距并为质量改进举措做好准备，包括初级保健临床医生（PCC）培训和电子健康记录中的临床决策支持工具（电子病历）。

方法： 

对代表卫生系统内诊所的 26 个 PCC 进行了半结构化访谈。访谈指南以实用的稳健实施和可持续性模型为基础，旨在引出 PCC 关于当前实践决定因素的看法以及指导质量改进工作的建议。我们使用主题分析来识别参与者常见的响应模式。

结果： 

PCC 确定了一些内部和外部背景因素作为当前实践的决定因素。值得注意的是，PCC 建议增加在诊所午餐时参加持续教育培训的机会，培训时间不超过 30 分钟。对 EHR 的改进建议包括将家长和教师版本的范德比尔特评级量表纳入 EHR、与循证指南一致的文档模板以及在预约期间帮助药物管理的警报和建议。

结论： 

鉴于管理多动症护理的责任越来越大，并且农村地区在获得行为健康护理方面存在棘手的差距，未来需要开展研究来确定帮助农村 PCC 采用创新的实施策略。