Effectiveness of Home Visits and Telemedicine for Attention Deficit Hyperactivity Disorder (ADHD) Children Patients in the Community who Loss to Follow-Up to Return to Continuity of Treatment: Pilot Randomized Controlled Trial
Article Sidebar
Main Article Content
Abstract
Objective: To compare the effectiveness of home visits combined with telemedicine consultation in re-engaging pediatric patients with attention-deficit/hyperactivity disorder (ADHD) who were lost to follow-up back into continuous care at Vachira Phuket Hospital.
Methods: This pilot randomized controlled trial was conducted among children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who had been lost to follow-up. Eligible participants whose parents or legal guardians provided informed consent were randomly assigned to either the intervention group or the control group using a computer-generated randomization sequence. The allocation assignments were kept in sealed envelopes, which were opened only after informed consent had been obtained. Owing to the nature of the intervention, blinding was not performed. Participants in the intervention group received one home visit combined with a telemedicine consultation, whereas those in the control group received one routine telephone follow-up. The primary outcome was re-engagement in care with continued treatment attendance over a 3-month period.
Results: A total of 38 participants were enrolled, including 18 in the control group and 20 in the intervention group. Baseline characteristics were comparable between the two groups. The intervention group showed a higher rate of re-engagement in continuous treatment within 3 months than the control group (80.0% vs. 50.0%; RR = 1.60, 95% CI 0.96 – 2.67; p = 0.052), although the difference did not reach statistical significance. In addition, after adjustment for baseline SNAP-IV scores using analysis of covariance (ANCOVA), the intervention group demonstrated significantly lower post-intervention scores for Inattention, Hyperactivity, and Oppositional symptoms than the control group (p < 0.05 for all comparisons).
Conclusion: A home visit combined with telemedicine consultation showed a favorable trend toward improving re-engagement in continuous treatment among children with ADHD who had been lost to follow-up compared with routine telephone follow-up. Although the primary outcome did not reach statistical significance, participants in the intervention group demonstrated significantly greater improvement in ADHD symptom severity than those in the control group. These findings support the potential value of proactive community-based follow-up, and larger randomized controlled trials are warranted to confirm its long-term effectiveness.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles submitted for consideration must not have been previously published or accepted for publication in any other journal, and must not be under review by any other journal.
References
Charach A, Dashti B, Carson P, Booker L, Lim CG, Lillie E, et al. Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 [cited 2024 May 5]. (AHRQ Comparative Effectiveness Reviews). Available from: http://www.ncbi.nlm.nih.gov/books/NBK82368/
Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007 Jun;164(6):942–8.
ADHD comorbidities : handbook for ADHD complications in children and adults - NLM Catalog - NCBI [Internet]. [cited 2024 May 5]. Available from: https://www.ncbi.nlm.nih.gov/nlmcatalog?cmd=PureSearch&term=101482616%5Bnlmid%5D
Scopus preview - Scopus - Document details - Developments and challenges in the diagnosis and treatment of ADHD [Internet]. [cited 2024 May 5]. Available from: https://www.scopus.com/record/display.uri?eid=2-s2.0-84889672025&origin=inward&txGid=06712505c3a9cc5a7f2b22dc2c0126b3
Wu EQ, Hodgkins P, Ben-Hamadi R, Setyawan J, Xie J, Sikirica V, et al. Cost effectiveness of pharmacotherapies for attention-deficit hyperactivity disorder: a systematic literature review. CNS Drugs 2012 Jul 1;26(7):581–600.
Gajria K, Lu M, Sikirica V, Greven P, Zhong Y, Qin P, et al. Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder - a systematic literature review. Neuropsychiatr Dis Treat 2014;10:1543–69.
Zetterqvist J, Asherson P, Halldner L, Långström N, Larsson H. Stimulant and non-stimulant attention deficit/hyperactivity disorder drug use: total population study of trends and discontinuation patterns 2006-2009. Acta Psychiatr Scand 2013;128(1):70–7.
Adler LD, Nierenberg AA. Review of medication adherence in children and adults with ADHD. Postgrad Med 2010;122(1):184–91.
Dorsey ER, Topol EJ. State of Telehealth. N Engl J Med 2016;375(14):1400.
Digital Health Bureau, Ministry of Public Health. Telemedicine services [Internet]. [cited 2023 Feb 13]. Available from: https://bdh.moph.go.th/site/wp-content/uploads/2023/08/3.1.3-telemedicine.pdf
Dorsey ER, Topol EJ. State of Telehealth. N Engl J Med 2016;375(2):154–61.
Gajria K, Lu M, Sikirica V, Greven P, Zhong Y, Qin P, et al. Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder - a systematic literature review. Neuropsychiatr Dis Treat 2014;10:1543–69.
Myers K, Vander Stoep A, Zhou C, McCarty CA, Katon W. Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: a community-based randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2015;54(4):263–74.
Rockhill CM, Tse YJ, Fesinmeyer MD, Garcia J, Myers K. Telepsychiatrists’ Medication Treatment Strategies in the Children’s Attention-Deficit/Hyperactivity Disorder Telemental Health Treatment Study. J Child Adolesc Psychopharmacol 2016;26(8):662–71.
