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Research ArticleOriginal Research

Evaluating a Web-Based Adult ADHD Toolkit for Primary Care Clinicians

Natalia Y. Loskutova, Cory B. Lutgen, Elisabeth F. Callen, Melissa K. Filippi and Elise A. Robertson
The Journal of the American Board of Family Medicine July 2021, 34 (4) 741-752; DOI: https://doi.org/10.3122/jabfm.2021.04.200606
Natalia Y. Loskutova
From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (NYL, CBL, EC, MKF, EAR).
MD, PhD
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Cory B. Lutgen
From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (NYL, CBL, EC, MKF, EAR).
BS
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Elisabeth F. Callen
From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (NYL, CBL, EC, MKF, EAR).
PhD, GStat
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Melissa K. Filippi
From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (NYL, CBL, EC, MKF, EAR).
PhD, MPH
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Elise A. Robertson
From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (NYL, CBL, EC, MKF, EAR).
MA
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Article Figures & Data

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    Figure 1.

    AAFP Adult ADHD Toolkit Content Overview: Sections and Sub-sections.

Tables

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    Table 1.

    Baseline Demographic Characteristics of 97 Participating Providers

    Age (Mean± SD)35.4 ± 11.4
    Age range, yn (%)
        <3048 (49.5)
        31 to 4027 (27.8)
        41 to 509 (9.3)
        51 to 607 (7.3)
        61 to 706 (6.2)
    Gender
        Male47 (48.5)
        Female48 (49.5)
        Prefer not to answer2 (2.1)
    Race
        American Indian or Alaskan Native0
        Native Hawaiian or Other Pacific Islander0
        Asian20 (20.6)
        Black or African American9 (9.3)
        White58 (59.8)
        Multiracial0
        Other4 (4.1)
        Prefer not to answer6 (6.2)
    Ethnicity
        Hispanic or Latinx7 (7.2)
        Not Hispanic or Latinx86 (88.7)
        Prefer not to answer4 (4.1)
    • SD, standard deviation.

    • View popup
    Table 2.

    Adult Attention Deficit Hyperactivity Disorder (ADHD) Toolkit Web Usage Data

    Page Views of Section WebpagesDownloads of Toolkit Resources
    Sectionn (%)Resourcen (%)
    Toolkit Home Page186 (47.2)Adult ADHD Assessment and Diagnosis Approach Algorithm30 (19.0)
    ADHD Screeners & Quality of Life Assessments23 (14.6)
    Section 2: Adult ADHD Assessment & Diagnosis72 (18.3)Patient Handout: Managing Adult ADHD14 (8.9)
    FDA Approved Stimulant Medications for Adult ADHD11 (7.0)
    Physician Handout: Adult ADHD Treatment11 (7.0)
    Section 3: Treatment and Management of ADHD in Adults52 (13.2)Current Behavior Scale - Partner Report11 (7.0)
    DSM-5 Diagnostic Criteria for ADHD9 (5.7)
    Overview of Treatment Recommendations for Adult ADHD9 (5.7)
    Section 1: About Adult ADHD40 (10.2)Overview of Possible Causes for Presenting Symptoms Similar to ADHD8 (5.1)
    Differential Diagnosis of ADHD in Adults7 (4.4)
    Child Behavior Scale - Parent Report6 (3.8)
    Section 4: Risk Reduction15 (3.8)Symptoms of ADHD in Adults4 (2.5)
    FDA Approved Non-Stimulant Medications for Adult ADHD3 (1.9)
    Section 5: Adult ADHD in Specific Patient Groups15 (3.8)National Resource Center on ADHD (CHADD): Diagnosis of ADHD in Adults*3 (1.9)
    ADHD Risk Reduction Checklist3 (1.9)
    Section 6: FAQ13 (3.3)Adverse Effects of Selected Medications used in the Treatment of ADHD in Adults3 (1.9)
    Physician Handout: Adult ADHD Overview1 (0.6)
    Acknowledgments1 (0.3)Interventions for Minimizing Drug Misuse based on Patient Risk1 (0.6)
    Universal precautions to reduce stimulant misuse in treating adult ADHD*1 (0.6)
    Total394Total158
    • ↵* Non-AAFP, external document used with permission; Date Range: 11/1/2019 - 3/31/2020.

    • FDA, Food and Drug Administration; FAQ, Frequently Asked Questions.

    • View popup
    Table 3.

    Logistic Regression Results of an Association of Residency Status, Number of Patients with Adult Attention Deficit Hyperactivity Disorder (ADHD), and Having Patients with ADHD on the Use of the AAFP Adult ADHD Toolkit.

    Exp(B)WaldP value
    Residency status (resident vs non-resident)0.561.06.30
    Number of adult patients with ADHD: 0 patients1.080.006.94
    Number of adult patients with ADHD: 1 to 3 patients0.490.59.44
    Number of adult patients with ADHD: 4 to 6 patients5.541.35.25
    Saw patients with ADHD during the 17 weeks49.5321.87<.001
    • View popup
    Table 4.

    Impact of Toolkit on Knowledge and Confidence among Toolkit Users and Non-Users

    Knowledge
    Users (Used Toolkit)Non-Users (Did Not Used Toolkit)F for TimeF for Time * Use
    nMean±SDnMean±SD
    Nature of ADHD
        Baseline423.1±0.8262.9±0.524.67*0.20
        Midpoint3.1±0.83.0±0.8
        Final3.6±0.73.5±0.7
    Effects of ADHD on quality of life and risk associated with untreated ADHD
        Baseline433.2±0.9253.0±0.816.52*0.92
        Midpoint3.2±0.93.2±0.7
        Final3.7±0.73.5±0.7
    ADHD diagnostic process in adults
        Baseline432.7±0.8242.6±0.724.00*1.13
        Midpoint3.0±0.92.8±0.6
        Final3.4±0.83.2±0.8
    Management of ADHD in adults
        Baseline432.9±0.8232.8±0.910.73*1.65
        Midpoint3.3±0.82.9±0.6
        Final3.5±0.83.2±0.8
    Management of ADHD in young adults
        Baseline423.1±0.8253.0±0.720.20*1.32
        Midpoint3.4±0.73.0±0.8
        Final3.7±0.73.4±0.8
    Management of ADHD in women
        Baseline433.0±0.8252.9±0.615.02*1.03
        Midpoint3.3±0.83.0±0.8
        Final3.6±0.73.4±0.8
    Management of ADHD in patients with co-morbid conditions
        Baseline422.7±0.7262.8±0.77.98*3.87*
        Midpoint3.2±0.72.7±0.6
        Final3.4±0.72.9±0.7
    Management of ADHD in older adults
        Baseline432.5±0.6262.4±0.824.60*0.97
        Midpoint3.0±0.82.7±0.7
        Final3.2±0.63.0±0.7
    Monitoring for treatment effects, side effects and outcomes
        Baseline413.1±0.8263.1±0.78.15*5.08*
        Midpoint3.6±0.83.0±0.7
        Final3.5±0.73.4±0.9
    Patient safety with the use of stimulants in adults
        Baseline433.1±0.7262.9±0.912.46*0.15
        Midpoint3.3±0.83.0±0.7
        Final3.6±0.73.4±0.8
    Prevention of non-medical use of stimulants in adults
        Baseline432.8±0.8262.9±0.811.08*2.49
        Midpoint3.1±0.72.8±0.9
        Final3.5±0.73.2±0.9
    Understanding of potential for abuse of immediate-release stimulants
        Baseline423.1±0.8243.2±0.89.44*2.03
        Midpoint3.4±0.93.1±0.8
        Final3.8±0.93.4±0.9
    Federal prescribing requirements for stimulants as controlled substance
        Baseline423.0±0.9263.0±1.013.61*1.54
        Midpoint3.5±0.93.2±0.9
        Final3.7±0.83.5±0.7
    State prescribing requirements for stimulants as controlled substance
        Baseline423.1±1.0263.0±1.115.17*0.67
        Midpoint3.4±0.93.1±0.9
        Final3.6±0.83.6±0.6
    Existing resources for patients and clinicians about adult ADHD
        Baseline422.5±0.8262.6±0.828.09*3.50*
        Midpoint3.3±0.92.9±0.7
        Final3.4±0.93.3±0.8
    Communication with patients about any aspect of ADHD including the nature of ADHD, the medication treatment options, the non-pharmacological treatment options, patient's role in ADHD management, locating support services, training options and self-education resources, etc.
        Baseline433.0±0.8252.7±2.520.41*0.10
        Midpoint3.1±0.82.8±0.6
        Final3.6±0.83.3±0.8
    Confidence
    Used ToolkitDid Not Used ToolkitF for TimeF for Time * Use
    nMean±SDnMean±SD
    Diagnosing and treating ADHD in adults
        Baseline452.6±0.9262.4±0.925.99*1.33
        Midpoint3.3±0.82.8±1.0
        Final3.3±1.03.2±0.7
    Recognizing and screening for ADHD in adults
        Baseline442.4±0.9262.4±1.132.20*1.76
        Midpoint3.2±0.92.8±0.9
        Final3.4±0.93.0±0.7
    Making a diagnosis in patients who do not display classic childhood symptoms of hyperactivity and impulsivity
        Baseline452.0±1.0261.8±1.020.49*0.58
        Midpoint2.8±1.02.4±1.0
        Final3.0±1.02.5±1.0
    Full evaluation of ADHD symptoms and coexisting disorders
        Baseline442.3±1.0262.2±1.024.99*2.07
        Midpoint3.0±1.02.5±0.9
        Final3.2±1.12.9±0.9
    Use of rating scales as an initial screening step
        Baseline432.6±1.0262.4±1.211.96*0.14
        Midpoint3.1±0.92.7±1.3
        Final3.3±1.13.0±1.0
    Mental health interview techniques and life history interview
        Baseline442.8±0.9263.0±1.05.02*4.22*
        Midpoint3.3±1.03.2±1.0
        Final3.5±0.93.0±0.8
    Choosing treatment options for uncomplicated ADHD in adults
        Baseline442.8±1.0262.7±1.222.21*0.97
        Midpoint3.5±0.83.2±1.1
        Final3.6±1.03.2±0.8
    Choosing treatment options for ADHD with co-morbid mental health disorders
        Baseline442.5±0.9262.2±0.911.28*5.39*
        Midpoint3.1±0.92.4±0.8
        Final3.2±1.02.3±0.8
    Choosing treatment options for ADHD with co-existing substance use disorder
        Baseline452.0±1.0261.9±1.017.21*3.79*
        Midpoint2.8±1.12.1±0.9
        Final3.0±1.02.3±1.0
    Follow up care practices
        Baseline452.8±1.0262.7±1.018.78*1.91
        Midpoint3.5±0.93.0±1.0
        Final3.5±0.93.0±0.9
    Providing patient education related to any aspect of ADHD in adults
        Baseline452.6±1.0262.4±1.028.61*2.41
        Midpoint3.4±1.02.8±0.8
        Final3.6±0.93.0±0.9
    Identifying and managing patients at risk for stimulant misuse, abuse and diversion
        Baseline452.6±1.0262.5±0.910.94*0.98
        Midpoint3.3±0.92.8±1.0
        Final3.2±1.02.9±1.0
    • ADHD, Attention Deficient Hyperactivity Disorder; SD, standard deviation.

    • ↵* P value < 0.05.

    • View popup
    Table 5.

    Needs Related to Adult Attention Deficit Hyperactivity Disorder (ADHD) Reported by Study Participants.

    Needsn (%)
    Better understanding for non-medication management options, effectiveness and side effects42 (51.9)
    Better understanding diagnostic criteria and diagnostic process for adults33 (40.7)
    Differentiating adult ADHD from co-morbid disorders32 (39.5)
    How to appropriately screen for ADHD in adults30 (37.0)
    Understanding the presentation in an adult patient30 (37.0)
    Better understanding of treatment options for those with a history of substance abuse30 (37.0)
    Better understanding of medication management options and effectiveness30 (37.0)
    Prevention of stimulant abuse/misuse/ diversion29 (35.8)
    More information about validated diagnostic and screening tools for adult ADHD28 (34.6)
    More patient education resources on management of adult ADHD symptoms besides taking medication27 (33.3)
    Tapering off medications24 (29.6)
    Understanding health risks of long-term stimulant use in adults24 (29.6)
    Understanding what resources are available in the local area for people who deal with ADHD22 (27.2)
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Evaluating a Web-Based Adult ADHD Toolkit for Primary Care Clinicians
Natalia Y. Loskutova, Cory B. Lutgen, Elisabeth F. Callen, Melissa K. Filippi, Elise A. Robertson
The Journal of the American Board of Family Medicine Jul 2021, 34 (4) 741-752; DOI: 10.3122/jabfm.2021.04.200606

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Evaluating a Web-Based Adult ADHD Toolkit for Primary Care Clinicians
Natalia Y. Loskutova, Cory B. Lutgen, Elisabeth F. Callen, Melissa K. Filippi, Elise A. Robertson
The Journal of the American Board of Family Medicine Jul 2021, 34 (4) 741-752; DOI: 10.3122/jabfm.2021.04.200606
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Keywords

  • Adult ADHD
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