One in 7 children with constipation in this commercially insured population received ED care for constipation, many without an outpatient visit in the month before or after. Efforts to improve primary care utilization for this condition should be encouraged.

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BACKGROUND: School-based health centers (SBHC) are in a unique position to provide guideline-driven attention-deficit/hyperactivity disorder (ADHD) care. In this study, we compared adherence to 2 components of ADHD guidelines in SBHC versus a continuity clinic. METHODS:We compared proportions of ADHD visits that had a structured symptom report available and timely follow-up in SBHC to a continuity clinic using chart review. We used multiple logistic regression to estimate the association between guideline adherence and clinic type. RESULTS:Participants who had a medication dose change were 3.9 times more likely (relative risk [RR] = 3.9, 95% confidence interval [CI] 3.0-5.1) to have a structured report present and 1.7 times more likely (RR = 1.7, 95% CI 1.2-2.2) to have follow-up within 30 days if they were seen in SBHC versus continuity clinic. Participants who were stable on their medication dose were 18 times more likely (RR = 18.0, 95% CI 11.3-29.0) to have a structured report present and 1.4 times more likely (RR = 1.4, 95% CI 1.3-1.6) to have follow-up within 100 days if they were seen in SBHC versus continuity clinic. CONCLUSIONS:Care provided in SBHC was associated with improved adherence to guidelines and has the potential to the improve pediatric ADHD outcomes. Citation: MacGeorge CA, King KL, Simpson AN, Abramson EL, Bundy DG, McElligott JT. Comparison of attention-deficit/hyperactivity disorder care between school-based health centers and a continuity clinic. J Sch Health. 2019; 89: 953-958.A ttention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, with a prevalence of 7% in school-aged children. 1 ADHD is known to cause impairment in a wide range of contexts, including relationships with families and peers, academic performance, school behavior, and social and emotional functioning. 2,3 This leads to increased risk-taking behavior, motor vehicle a Assistant Professor, (macgeorg@musc.edu), Medical

Objectives Many children with constipation who are evaluated in emergency departments (EDs) receive an abdominal radiograph (AR) despite evidence-based guidelines discouraging imaging. The objectives of this study were to identify predictors associated with obtaining an AR and to determine if ARs were associated with a longer length of stay (LOS) among children with constipation evaluated in the ED. Methods A review of billing and electronic health records was conducted in an academic pediatric ED for children ages 0 to 17 years who had a primary discharge diagnosis of constipation from July 2013 to June 2014. Logistic regression was used to identify predictors for obtaining an AR. Differences in mean LOS were analyzed using linear regression. Results In total, 326 children met inclusion criteria, and 60% of the children received an AR. In logistic regression, significant predictors included age (odds ratio [OR] = 1.1/year of age, P = 0.004), presenting with abdominal pain as chief complaint compared with constipation (OR = 4.4, P < 0.0001), and history of emesis (OR = 2.8, P = 0.001) after controlling for provider type and previous constipation medication use. In linear regression, the adjusted mean LOS for those with an AR was 163 minutes compared with 117 minutes for those without after controlling for age, provider type, and history of constipation medication use (P < 0.0001). Conclusions Abdominal radiographs were used frequently in the ED diagnosis and management of constipation, particularly in older children and those with abdominal pain and emesis. Abdominal radiographs were associated with increased LOS.

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