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The effects of patient characteristics on ADHD diagnosis and treatment: a factorial study of family physicians

机译：患者特征对多动症诊断和治疗的影响：家庭医生的析因研究

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Background Attention Deficit Hyperactivity Disorder (ADHD) is a costly and prevalent disorder in the U.S., especially among youth. However, significant disparities in diagnosis and treatment appear to be predicted by the race and insurance status of patients. Methods This study employed a web-based factorial survey with four ADHD cases derived from an ADHD clinic, two diagnosed with ADHD in actual evaluation, and two not. Randomized measures included race and insurance status of the patients. Participants N = (187) included clinician members of regional and national practice-based research networks and the U.S. clinical membership of the Society of Teachers of Family Medicine. The main outcomes were decisions to 1) diagnose and 2) treat the cases, based upon the information presented, analyzed via binary logistic regression of the randomized factors and case indicators on diagnosis and treatment. Results ADHD-positive cases were 8 times more likely to be diagnosed and 12 times more likely to be treated, and the male ADHD positive case was more likely to be diagnosed and treated than the female ADHD positive case. Uninsured cases were significantly more likely to be treated overall, but male cases that were uninsured were about half as likely to be diagnosed and treated with ADHD. Additionally, African-American race appears to increase the likelihood of medicinal treatment for ADHD and being both African-American and uninsured appears to cut the odds of medicinal treatment in half, but not significantly. Conclusions Family physicians were competent at discerning between near-threshold ADHD-negative and ADHD positive cases. However, insurance status and race, as well as gender, appear to affect the likelihood of diagnosis and treatment for ADHD in Family Medicine settings.
机译：背景注意缺陷多动障碍（ADHD）在美国是一种代价高昂且普遍的疾病，尤其是在年轻人中。但是，根据患者的种族和保险状况，可以预见在诊断和治疗上的巨大差异。方法：本研究采用基于网络的析因调查，对4例来自ADHD诊所的ADHD病例进行了调查，其中2例在实际评估中被诊断为ADHD，而2例没有。随机测量包括患者的种族和保险状况。参与者N =（187）包括区域和国家基于实践的研究网络的临床医生成员以及家庭医学教师学会的美国临床成员。主要结果是根据以下信息做出决策：1）诊断和2）治疗病例，并根据所提供的信息，通过对随机因素和病例指标进行诊断和治疗的二元逻辑回归分析。结果ADHD阳性病例被诊断的几率是8倍，被治疗的可能性是12倍，男性ADHD阳性病例比女性ADHD阳性病例更有可能被诊断和治疗。未投保的病例总体上更有可能得到治疗，但未投保的男性病例被诊断和治疗多动症的可能性约为一半。此外，非洲裔美国人的种族似乎增加了对多动症进行药物治疗的可能性，而非洲裔美国人和未投保的人看来都将药物治疗的几率降低了一半，但幅度并不大。结论家庭医生擅长区分接近阈值的ADHD阴性病例和ADHD阳性病例。但是，保险状况，种族以及性别似乎会影响家庭医学环境中多动症的诊断和治疗的可能性。

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