Abstract
Purpose
Diversion of stimulant medications for ADHD is a prevalent problem. Pediatric primary
care providers (PCPs) are well-positioned to reduce diversion risk among adolescents
prescribed stimulants, but little is known about their use of prevention strategies.
The objectives of this study were to describe the frequency with which pediatric PCPs
use diversion prevention strategies and examine potential determinants (facilitators
and barriers) of strategy use.
Methods
Participants were pediatric PCPs (N = 76) participating in a randomized controlled trial of stimulant diversion prevention
strategies. At baseline, before randomization, PCPs rated the frequency with which
they used specific strategies in each of four categories: patient/family education,
medication management/monitoring, assessment of mental health symptoms/functioning,
and assessment of risky behaviors. They completed measures of attitudes toward diversion
prevention, subjective norms (i.e., implementation climate), and perceived behavioral
control (i.e., knowledge/skill, resource constraints). Associations between determinants
and strategy use were tested with correlational and regression analyses.
Results
PCPs used strategies for assessing mental health symptoms/functioning most frequently
and patient/family education strategies least frequently. Attitudes about the effectiveness
of diversion prevention, implementation climate, knowledge/skill, and resource constraints
were positively correlated with the use of at least one category of strategies. In
regression analysis, PCP knowledge/skill was positively associated with patient/family
education, medication management, and risk assessment strategies.
Conclusions
Findings suggest that improving knowledge and skill may increase the use of diversion
prevention strategies by PCPs. Identifying provider-level determinants of strategy
use informs implementation efforts in pediatric primary care and can facilitate efforts
to prevent stimulant diversion among adolescents.
Keywords
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Article info
Publication history
Published online: January 11, 2021
Accepted:
December 4,
2020
Received:
September 17,
2020
Footnotes
Conflicts of interest: The authors declare no conflicts of interest.
ClinicalTrials.gov Identifier: NCT03080259.
Identification
Copyright
© 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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- Pediatric Primary Care Providers Play a Central Role in Reducing Stimulant DiversionJournal of Adolescent HealthVol. 68Issue 4
- PreviewWhen used as prescribed, stimulant medications such as methylphenidate and amphetamine salts are safe, effective, and Food and Drug Administration approved for attention deficit hyperactivity disorder (ADHD) treatment [1]. At the same time, stimulant medications are also increasingly being used nonmedically. Recent epidemiological data suggesting that one in 20 high school seniors reports past-year nonmedical use (NMU) of a stimulant [2]. Unlike college student motives for perceived academic performance enhancement, motives for high school student stimulant NMU are more aligned with classic substance abuse motives (e.g., “get high”) and substance abuse correlates (e.g., binge drinking, cannabis use) [2].
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