How QbTest is reducing wait time and increasing clinician confidence in the US
1-minute summary: Feedback from medical professionals and academic research indicates that QbTest can help to reduce wait time, increase clinician confidence, and improve the patient experience.
Clinicians in the United States have improved their diagnostic confidence and reduced wait times by integrating QbTest and QbCheck, objective ADHD evaluation tools, into their ADHD care pathway.
Dr. Wiley, Dr. Dodini, Mandy Yount, and Andrea Beckstrom are U.S. healthcare professionals experienced in the ADHD landscape and have found that, they now:
- Have a streamlined ADHD evaluation process which has saved them valuable time and helped reduce waiting lists
- Make more confident diagnostic decisions for ADHD
- Have the ability to measure patient reaction to ADHD medication and titrate
- Have patients receiving a higher level of care due to accurate diagnoses and optimized treatment plans
1. Gaining evidence-based insights
Parents are often extremely concerned and reluctant to seek an ADHD evaluation, says Dr. Wiley, pediatrician at Focus-MD in Mobile, Alabama. The clinic is part of a network of primary care providers committed to providing evidence-based care for children and adults with ADHD and associated conditions.
He commented: “The traditional route of testing for ADHD is to test for intelligence and learning disabilities. And what I found with my own children is that the process backs into a diagnosis of ADHD, if those things are not found to be a problem.
“As a parent, I found myself very much in that same situation…when we backed into a diagnosis of ADHD without even looking at the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or doing any objective testing of ADHD core symptoms, it really let me know that the standard of care was not adequate for my children and therefore I couldn’t make it the standard of care for my patients.”
Clinicians are concerned that subjective data isn’t consistent and doesn’t always match up with a patient’s symptoms. Dr. Wiley integrated QbTest into his clinic to make evidence-based decisions using an objective evaluation while also listening to patient experience for a rounded assessment.
Dr. Wiley said: “There’s no question that QbTest adds confidence to my assessment…how do you distinguish the clinical pattern of dyslexia in a school age of primary age, child from that of ADHD? Every dyslexic child will meet the DSM-5 criteria for the diagnosis of ADHD.
“When I see a dyslexic child on medication, I can’t wait to stop their medicine, do a QbTest, and see if it’s 100% normal. Because if it is, we can stop the medicine…I have parents of dyslexic kids come back and say, you know what, I’m so glad he doesn’t have to take that medicine and we can just do the dyslexia interventions.”
2. Clinicians are making more confident diagnostic decisions
Mandy Yount is a board certified Psychiatric Mental Health Nurse Practitioner at Downtown Psychiatric Services in Memphis, Tennessee.
Before introducing QbTest to her clinic, making a diagnosis was more difficult and typical psychological evaluations took a total of three days, costing around $1500 – $2000. Waitlists in the area were as long as 10 months and many clients were leaving jobs and failing classes while waiting for evaluation. Patients often present at the clinic with comorbidities and on existing medication with no clear distinction on how much of their inattention is due to ADHD.
Mandy notes that another benefit of implementing QbTest in the clinic has been in supporting decision-making. The test has helped with a diagnosis where a patient has ADHD, but also helped to identify where patients reported symptoms may not match test results.
“With QbTest, the majority of our patients are going to follow a certain pattern. When they do not, it’s always a red flag to me as a provider that I may not be on the right track diagnostically. I feel that is just an added layer of protection.”
“Because there can be so many reasons for distraction, procrastination, and poor focus, sometimes ADHD is not an easy diagnosis. So many people assume ADHD to be the diagnosis anytime someone struggles with inattention and that’s simply not the case. I can’t tell you how many clients came to me on stimulants, riddled with anxiety and the stimulants were making them more anxious.”
Dr. Aaron Dodini is a licensed clinical psychologist, and he runs the Dodini Behavioral Health clinic in the Washington metropolitan area. He commented that he’s able to avoid any false positives and gives a more conservative approach to ADHD evaluation and managing medication, which is what he needs for confident diagnoses.
The clinic integrated QbCheck into its pathway because they needed more confidence in their ADHD evaluations with objective data. Previously, they relied on a battery of tools including cognitive ability, psychological inventory, and IQ tests. While they can be helpful, they don’t measure a patient objectively on the three core symptoms of ADHD.
Andrea Beckstrom is a Board-Certified Psychiatric Nurse Practitioner and Medical Director at ASPIRE medical in Utah. Prior to introducing QbTest, wait times for ADHD evaluations were around 3-6 months.
She agrees that QbTest helps clinicians make timely, confident diagnoses, noting: “QbTest has had an impact on clinical decision making because it provides us with additional information to support our clinical ADHD evaluations. This additional information provides us with data points to reference and assists with difficult conversations when clients are adamant that their symptoms are from ADHD.
“The additional data also influences our ability to make timely diagnoses, and get an earlier start on the correct path of treatment.”
3. Quicker, more accurate evaluations
Since adding QbTest to her clinic, Mandy has noted that making a diagnosis is much easier. Patients often present at the clinic with comorbidities and on existing medication with no clear distinction on how much of their inattention is due to ADHD.
Mandy commented: “Because QbTest takes less than an hour and is significantly more cost-effective, we have been able to offer a more precise diagnosis and get the patients on a treatment plan faster than ever before.
“We spent a lot of valuable time ‘chasing our tail’ so to speak, trying to determine how much of the patient’s inattention was ADHD and how much was anxiety. Prior to QbTest, we were doing what most other clinics were likely doing… Administering screeners and obtaining clinical history. Requiring a full-scale psychological assessment is not only time consuming, but also not cost-considerate for most of our clients.”
“Not only does QbTest make diagnosis easier and lead to faster treatment response times, but it also helps delineate between the patients who do not have a focus disorder so that we can continue seeking answers for those patients as well.”
Andrea explains how QbTest has helped her clinic streamline their pathway. She commented: “Introducing QbTest has helped our clinic and providers have more information when diagnosing ADHD because we have objective data to go along with our assessment and subjective information from the client and Vanderbilt assessment…One key component is that having the QbTest in house has helped patients avoid the long wait times for psychological testing that is typically seen in the field. Wait times are usually around 3-6 months, and the testing can be very expensive. By shortening this wait time, getting the QbTest results in a matter of weeks, you as a provider can move forward confidently with treatment.”
Dr. Dodini stated that physicians love to see the QbCheck results because it gives them confidence that medicines are working. It allows them to prescribe medication confidently, knowing that they can titrate as they need, quickly and efficiently, by using the tool. This saves physicians and patients a tremendous amount of time.
4. An improved patient experience
Before introducing QbTest to Mandy’s clinic, making a diagnosis was more difficult and typical psychological evaluations took a total of three days, costing around $1500 – $2000. Waitlists in the area were as long as 10 months and many clients were leaving jobs and failing classes while waiting for evaluation. Patients often present at the clinic with comorbidities and on existing medication with no clear distinction on how much of their inattention is due to ADHD.
Over the years, Dr. Dodini used several different evaluation tools. One of the key reasons he integrated QbCheck opposed to other ADHD evaluations is because his patients want to see the visual report to help them understand their symptoms. He commented: “My patients love it…Oh my gosh, this is how my brain works. For adults, it’s a bittersweet experience. They’re thrilled to finally get some answers and also at times think, if only I had known this ten years earlier.”
Dr. Dodini said: “As we are part of the consortium, the ADHD expert consortium, one of our goals is to help create a pathway way for care that is more standardized…we believe that having the data, using the technology that’s available to us, not only helps us develop a standard of care for assessment, but also for treatment.
“QbCheck is cheaper than doing a huge battery of two days’ worth of testing. And frankly, in my opinion, a more valid assessment – a more pinpointed assessment.”
QbCheck also gives clinicians a greater reach. Patients in areas where there aren’t as many psychologists or healthcare workers qualified to do ADHD evaluations now have reach to the entire country. During and since the pandemic, the clinic can assess patients across the United States who were eager to find services in an affordable way.
Now, following the implementation of QbCheck, Dr. Dodini’s clinic is contacted by patients and they are given a series of self-report scales and questionnaires on ADHD symptoms. Afterward, they provide patients with a QbCheck voucher code, allowing them to conveniently carry out the ADHD evaluation at home.
The ADHD Expert Consortium
The ADHD Expert Consortium, the group that Dr. Dodini is part of, is currently pushing for objective testing to standardize the diagnostic and treatment process for those with the disorder. ADHD has been a poorly recognized condition that is misunderstood and underdiagnosed – because of this, there is a lack of evidence-based objective testing and treatment monitoring.
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References
[1] National Institute for Clinical Excellence (NICE) (2023, March 7). QbTest for the assessment of attention deficit hyperactivity disorder (ADHD). Nice.org. Retrieved June 14, 2023, from https://www.nice.org.uk/advice/mib318
[2] Bullock R, Ford S (2022) A nurse-led model of care for attention-deficit hyperactivity disorder. Nursing Times [online]; 118: 10.
[3] Hollis C, Hall CL, Guo B, James M, Boadu J, Groom MJ, Brown N, Kaylor-Hughes C, Moldavsky M, Valentine AZ, Walker GM, Daley D, Sayal K, Morriss R; the AQUA Trial Group. The impact of a computerised test of attention and activity (QbTest) on diagnostic decision making in children and young people with suspected attention deficit hyperactivity disorder: single-blind randomised controlled trial. J Child Psychol Psychiatry. 2018 Dec;59(12):1298-1308. doi: 10.1111/jcpp.12921. Epub 2018 Apr 26.