Utilization of behavioral health within a Patient Centered Medical Home model for childhood Attention Deficit/Hyperactive Disorder (ADHD).



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Attention-deficit hyperactivity disorder (ADHD) is one of the most common pediatric referrals in primary care. Standard of care treatment for ADHD includes stimulant medication, behavioral therapy, and school interventions. However, traditional biomedical primary care settings often fall short in providing these services in a single setting. Instead, patients have to seek services from many providers throughout the community. Health disparities including race/ethnicity and gender are associated with limited access to primary care and behavioral health services for children with ADHD. The Patient-Centered Medical Home (PCMH) model could help underserved communities receive access to ADHD treatment. In this model, primary care physicians work collaboratively with behavioral health specialists to provide services. This study investigated ethnic and gender differences in behavioral health services as measured by the total number of outpatient visits with primary care providers, psychiatrists, psychologists, and master’s-level behavioral health specialists at a PCMH setting versus a traditional healthcare setting (comparison group). This study also investigated the likelihood of receiving ADHD medication management under a PCMH model compared to a traditional healthcare model, after controlling for gender and ethnicity. Data for this study was derived from an existing Medicaid database of patients seeking behavioral health services. A total of 2,724 cases were analyzed; 1,362 from PCMH and 1,362 from traditional fee-for-service clinics in the community. Results from this study suggest the number of encounters with behavioral health increases when psychology is integrated within primary care as opposed to a traditional setting. There was a main effect with regard to ethnicity, suggesting that those who identify as White have more encounters than Hispanic and African Americans, regardless of setting. There was also a statistically significant interaction with ethnicity and type of provider seen suggesting that the type of provider is influenced by a family’s ethnicity. Finally, the likelihood of patients receiving medication was 37.6% greater at a PCMH setting than traditional setting. The current findings suggest having psychology integrated in primary care increases access to an interdisciplinary treatment plan for ADHD. Future studies should investigate the barriers African American and Hispanic families encounter that affect the number of completed visits.



ADHD, Primary Care, PCBH, IPC, behavioral health