PubMed Health⌕ Search

Biomedical subjects

Anton R Miller

Publications and source records attributed to Anton R Miller.

4 recordsLinked to original sources
PubMed2005

Family physicians' involvement and self-reported comfort and skill in care of children with behavioral and emotional problems: a population-based survey.

BACKGROUND: Little is known about general and family practitioners' (GP/FPs') involvement and confidence in dealing with children with common psychosocial problems and mental health conditions. The aims of this study were to ascertain GP/FPs' preferred level of involvement with, and perceived comfort and skill in dealing with children with behavioral problems, social-emotional difficulties, attention-deficit/hyperactivity disorder (ADHD), and mood disorders; and to identify factors associated with GP/FPs' involvement, comfort and skill. METHODS: Postal survey of a representative sample of 801 GP/FPs in British Columbia, Canada, which enquired about level of involvement (from primarily refer out to deal with case oneself); ratings of comfort/skill with assessment/diagnosis and management; beliefs regarding psychosocial problems in children; basic demographics; and practice information. RESULTS: Surveys were completed by 405 of 629 eligible GP/FPs (64.4%). Over 80% of respondents reported collaborative arrangements with specialists across problem and condition types, although for children with behavior problems or ADHD, more physicians primarily refer (chi2 (1) = 9.0; P < 0.005; and chi2 (1) = 103.9; P < 0.001, respectively). Comfort/skill levels (mean +/- s.d) were higher for mood disorders (4.4 +/- 1.3) than behavior problems (3.6 +/- 1.1; F [3, 1155] = 84.0, P < .0001; effect size = 0.67), but not different from social-emotional difficulties (3.8 +/- 1.1) or ADHD (3.9 +/- 1.3). Taking primary responsibility for a case was consistently related to self-reported comfort/skill with each condition type (34% to 61% of variance across condition types), while comfort/skill ratings for each condition were related to exposure to relevant continuing medical education (all P < or = 0.001), and beliefs that these problems are significant and that GP/FPs have a role to play in dealing with them (P values ranged from 0.01 to < 0.001). CONCLUSION: Supporting GP/FPs in their care for children with common psychosocial and mental health problems should include efforts to bolster their confidence and modify attitudes in relation towards these problems, especially behavior problems and ADHD, possibly within innovative continuing education programs.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Children's persistence with methylphenidate therapy: a population-based study.

OBJECTIVE: To examine persistence with methylphenidate (MPH) therapy among children and youth in the general population. METHOD: We conducted a retrospective analysis of longitudinally organized, individual-specific anonymous data from linked prescription and health databases covering the population of British Columbia for 1990 through 1996. No prescriptions being filled for 4 months indicated cessation of one bout of therapy. RESULTS: Among 16,945 identified MPH patients aged 19 years or under, overall duration of therapy was 584 days, and the average number of prescriptions received was 6.6. One-third of patients received 2 or fewer prescriptions, while 18% followed a chronic, continuous course. Among patients receiving more than 2 prescriptions, 50% of discrete therapy bouts lasted 4 months or less, and one-third of cases had multiple bouts of therapy (range 2 to 6 bouts). Younger age (that is, children aged 0 to 8 years, vs those aged 10 to 19 years), male sex, and receipt of initial prescription from a psychiatrist were associated with greater persistence. CONCLUSIONS: Enormous variability in persistence with MPH therapy and often-occurring low rates of persistence raises questions about the diligence with which MPH patients are selected, prepared, and followed in the general population. Special attention to the needs of older children and to the needs of girls is required, and discontinuities during children's therapy courses require explication.

Adolescent↗
PubMedDate not supplied

Use of medical services by methylphenidate-treated children in the general population.

OBJECTIVES: To examine selected medical services for children treated for attention-deficit/hyperactivity disorder (ADHD) in a general population setting with universal health insurance. DESIGN: Retrospective analysis of administrative prescription and health services databases spanning from 1990 to 1996. SETTING: British Columbia, Canada. PATIENTS: Children (<19 years of age) who had received the psychostimulant methylphenidate (MPH; Ritalin) on a chronic basis (chronic-MPH group), who had received MPH on any other basis (nonchronic-MPH group), and who were in a no-MPH comparison group. MAIN OUTCOME MEASURES: The number of individuals who received any of the following services based on claims submitted by qualified practitioners: 1) emergency care, 2) critical care, 3) injury-related diagnostic and treatment services, 4) complementary and alternative medical (CAM) care, and 5) other diagnostic and treatment services (audiometry and allergy testing). RESULTS: Prevalence of services users was higher among MPH-treated than nontreated children for all types of services (except critical care services in the chronic-MPH group) after adjusting for effects of age, sex, socioeconomic status, and geographic setting, with odds ratios ranging from 1.49 to 3.17. There were no differences between the 2 MPH-treated groups. CONCLUSIONS: Children treated with MPH for ADHD or presumed ADHD are more frequent users of a wide range of medical services than are other children. Findings support and extend existing evidence of increased use of medical services by this population of children. Findings have implications for service planning, including injury prevention, with these children. High utilization of audiometric, allergy, and CAM services warrants further scrutiny.

Adolescent↗