Clinicians' Adherence to Guidelines When Initiating Methylphenidate Treatment.

Abstract

<b><i>Aims:</i></b> Between 2008 and 2012, the number of children and adolescents in the Netherlands who received methylphenidate prescriptions increased by 35.6%. We determined guideline adherence regarding the assessment of attention-deficit/hyperactivity disorder (ADHD) and rates of off-label use in those 2 years. We also compared adherence to guidelines between mental health and pediatrics settings. <b><i>Methods:</i></b> We conducted a medical file audit of 506 children or adolescents who had received a first methylphenidate prescription in 2008 (<i>n</i> = 208) or 2012 (<i>n</i> = 298) across mental health (<i>n</i> = 333) and pediatrics outpatient clinics (<i>n</i> = 173) in the Netherlands and assessed adherence to seven guideline recommendations. <b><i>Results:</i></b> We did not find significant differences between 2008 and 2012 regarding the mean adherence to the seven recommendations (43% vs. 45%) or the percentage of off-label use (35% vs. 30%). Best adherence rates (over the years 2008 and 2012 combined) concerned the assessment of comorbidities (89%) and the involvement of teachers in the diagnostic process (75%). Least frequently adhered to were assessing ADHD severity (1%), the use of a (semi-)structured parent interview (16%), and providing psycho-education to parents (42%) or teachers (1%). Mental health settings showed better adherence than pediatrics settings (over the years 2008 and 2012 combined) concerning the use of (semi-)structured parent interviews (22% vs. 3.1%), having a separate diagnostic session directed at the child (81% vs. 63%), assessment of comorbidities (95% vs. 76%), and providing psycho-education to parents (51% vs. 24%). <b><i>Conclusions:</i></b> There was neither a decrease in adherence to guidelines nor an increase in off-label use between 2008 and 2012. However, there is ample room for improvement regarding guideline adherence.