(1046) Influence of a Pre-visit ADHD Video/question Prompt List Intervention on Youth Question-asking and Provider Education During Medical Visits

Objectives: Prior work conducted internationally has found that youth often are not involved and do not ask questions during medical or pharmacy visits. The objective of this study was to conduct a randomized controlled trial to test the effectiveness of an Attention-Deficit/Hyperactivity Disorder (ADHD) pre-visit video/question prompt list intervention to increase youth question-asking and provider education about ADHD during pediatric medical visits.

Methods: Youth were eligible if they were: ages 11 to 17 years; spoke and read English; had an ADHD diagnosis; were present for an ADHD visit; and screened as having predominantly inattentive subtype, hyperactive/impulsive subtype, or combined inattention/hyperactivity on the Vanderbilt parent assessment scale. Youth were recruited from two pediatric clinics and randomized. Intervention youth watched an 11-minute video with 6 themes that encouraged them to ask questions about ADHD and its treatment. They then checked questions that they wanted to ask their provider on a one-page ADHD patient questions prompt list for use during visits. ADHD visits were audio-taped, transcribed, and coded. Multivariate regression was used to analyze the data.

Results: One hundred and two youth participated; 52 were randomized to the intervention group. Thirty-two were Black, 13% were Native American, 1% were Hispanic. Thirty-six percent were female. Youth in the intervention group were significantly more likely to ask their providers one or more questions about ADHD and its treatment than youth in the usual care group (40% compared to 12.5%, Pearson chi-square=9.8, p=0.002). In the multivariable regression, youth were significantly more likely to ask one or more questions if they were in the intervention group versus usual care (odds ratio=5.4,95% confidence interval=1.8, 15.9). Providers educated about ADHD medications during 54% of visits, non-medication strategies for ADHD during 35% of visits, school performance during 11% of visits, and out of school relationships during only one visit. Providers were significantly more likely to educate youth in the intervention group about more non-medication treatments than youth in the usual care group (t-test=2.32, p=0.02). The intervention did not significantly increase visit length (14.7 minutes compared to 11.7 minutes, t-test=1.57, p=0.12). Providers were not significantly more likely to educate youth in the intervention group about school, relationships, or medications than youth in the usual care group. Providers were significantly more likely to educate youth in the intervention about more non-medications strategies for ADHD than youth in usual care (unstandardized beta=0.35, 95% confidence interval=0.20, 0.67). When whether the youth asked one or more questions about ADHD was added to the regression model, providers were significantly more likely to educate youth who asked one or more questions about more non-medication strategies for ADHD than youth in the usual care group (unstandardized beta=0.50, 95% confidence interval=0.13 to 0.88). Providers were significantly more likely to educate youth about more ADHD medication areas if youth asked one or more questions about ADHD (unstandardized beta= 0.98, 95% confidence interval=0.31, 1.64).

Conclusions: The intervention did significantly increase youth question-asking and provider education about non-medication strategies for ADHD; youth are being followed for 6 months to examine how the intervention impacts school performance and ADHD symptoms. The intervention has the potential to improve youth self-management of ADHD. The developed ADHD videos and question prompt list are on a website the team developed for youth titled "Information for the Evolving Teenager" (iuveo. org). The website also includes 12 additional topics for youth including asthma, vaping, substance use, and mental health topics. The materials could be used by youth in pharmacy settings to prompt them to engage more with their pharmacists. Future research should examine the impact of youth using ADHD question prompt lists in pharmacy settings on patient question-asking, pharmacist education, and youth outcomes.