Atheoretical Versus Theory-Based Approaches in Promoting Safer ADHD-Medication Prescribing for Adults

Gaps between treatment guidelines and medical decisions persist despite interventions with physicians, which are mostly atheoretical. The purpose of this retrospective cross-sectional study was to compare atheoretical and theory-based logistic regression models of a binary outcome: potentially unsafe prescribing of attention-deficit hyperactivity disorder (ADHD) medications to adults. Social cognitive theory and self-determination theory provided the framework for the study. Predictors were framed as social cognitive theoretical constructs: knowledge (e.g., physician specialty) and environmental influence (e.g., interventions). Atheoretical hypotheses were based on legislation mandating meaningful use of electronic health records and computerized decision support (CDS). Theory-based hypotheses were derived from literature on cognition in medicine and on the controlled motivation construct in self-determination theory. Research questions addressed associations of CDS and meaningful use with the outcome and fit of competing models. The sample included office-based physician visits made by patients aged \u3e 17 years with ADHD (n = 810) or potentially unsafe medical conditions (n = 9,101), recorded in a U.S. database in 2014–2016. Findings for the atheoretical model were reduced odds of the outcome with CDS, and nonsignificant improvement in model fit using theory. Supporting the self-determination theory-based hypothesis, odds were increased with meaningful use. This study adds to research suggesting autonomy as a core issue in medicine. Positive social change may result from psychology-based strategies to empower physicians through participation in developing clinically relevant information systems