Yair Bannett

All Publications

• Attention-Deficit/Hyperactivity Disorder in 2- to 5-Year-Olds: A Primary Care Network Experience. Academic pediatrics Bannett, Y., Feldman, H. M., Gardner, R. M., Blaha, O., Huffman, L. C. 2020

  Abstract

  To assess (1) rates of primary care provider (PCP) diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children, (2) documented PCP adherence to ADHD clinical practice guidelines, and (3) patient factors influencing PCP variation in diagnosis and management.Retrospective cohort study of electronic health records from all office visits of children aged 2-5 years, seen ?2 times between 2015 and 2019, in 10 practices of a community-based primary healthcare network. Outcomes included ADHD diagnosis (symptom or disorder), and adherence to guidelines in (1) comorbidity documentation at or after ADHD diagnosis, (2) ADHD medication choice, and (3) follow-up of medicated patients. Logistic regressions assessed associations between outcomes and patient characteristics.Of 29,408 eligible children, 195 (0.7%) had ADHD diagnoses. Of those, 56% had solely symptom-level diagnoses (e.g., hyperactivity); 54% had documented comorbidities. ADHD medications were prescribed only to 4-5-year-olds (40/195 (21%)); 85% received stimulants as first-line medication; 48% had follow-up visits within 2 months. Likelihood of ADHD diagnosis was higher for children with public or military insurance (OR 1.94; 95% CI 1.40-2.66; OR 3.17; 95% CI 1.93-4.96). Likelihood of comorbidity documentation was lower for older ADHD patients (OR 0.48; 95% CI 0.32-0.71) and higher for those with military insurance (OR 3.11; 95% CI 1.13-9.58).PCPs in this network frequently used symptom-level ADHD diagnoses in 2-5-year-olds; ADHD diagnosis rates were below estimated population prevalence, with evidence for sociodemographic disparities. PCP comorbidity documentation and choice of stimulant medications were consistent with guidelines. Rates of timely follow-up were low.

  View details for DOI 10.1016/j.acap.2020.04.009

  View details for PubMedID 32360494

• Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers. Academic pediatrics Bannett, Y., Feldman, H. M., Bentley, J. P., Ansel, D. A., Wang, C. J., Huffman, L. C. 2019

  Abstract

  To describe variation in rates of attention-deficit/hyperactivity disorder (ADHD) management by pediatrics primary care providers (PCPs) and to assess influence of clinician characteristics on variation.Retrospective cohort study of electronic health records (EHR) from all office visits of patients aged 4-17 years seen at least twice between 2015 and 2017 by 73 clinicians in 9 pediatrics practices of a community-based primary healthcare network in California. Outcomes per clinician: (1) % patients seen for ADHD management; (2) % ADHD patients with diagnosed comorbid conditions. Logistic random-effects regression models examined practice- and clinician-level variation.Of 40,323 patients in the cohort, 2,039 (5.1%) carried an ADHD diagnosis, of which 1,142 (56%) received ADHD medication. Percent of patients seen for ADHD management varied by clinician from 0.0 to 8.3% (median 3.0%). After accounting for practice-level variation and patient characteristics (i.e., sex, age, insurance), clinician characteristics explained 28% of clinician variation in ADHD management. ADHD management rate was associated with high percent Full Time Equivalent (OR 1.17; 95% CI 1.07-1.27). Percent of ADHD patients with diagnoses of comorbidities varied by clinician from 0.0 to 100% (median 35%). Association between ADHD management rate and comorbidity diagnosis was minimal (R=0.10).Objective EHR measures showed that PCPs in this network varied widely in their involvement in ADHD management. For most PCPs, % of patients with ADHD and diagnosis of comorbidities was lower than estimated prevalence rates. Exploration of modifiable factors associated with PCP variation is needed to inform strategies for implementation of evidence-based practices.

  View details for DOI 10.1016/j.acap.2019.11.016

  View details for PubMedID 31794864

• Amnesia for traumatic events among recent survivors: a pilot study. CNS spectrums Yovell, Y., Bannett, Y., Shalev, A. Y. 2003; 8 (9): 676?80, 683?85

  Abstract

  Traumatic amnesia has been amply documented in the psychoanalytic literature but inconsistently in the research literature.Six trauma were followed prospectively. Survivors were interviewed 7, 30, and 120 days following the traumatic event. Each interview documented in detail their recollections of the day of their trauma.In four subjects who did not develop posttraumatic stress disorder (PTSD), we found brief, stable, and persistent memory gaps, which coincided with the moment of greatest emotional intensity. In two subjects who developed PTSD, we found, in addition to the previous form of amnesia, longer, progressive, and unstable memory gaps.Neurobiological research offers two explanatory mechanisms for the observations: A failure of acquisition of episodic memories may account for the stable deficits seen in all subjects. This could coincide with stress-induced malfunction of the hippocampal declarative memory system. A failure of spontaneous recall may account for the more extended traumatic amnesia that was observed in PTSD patients. This resembles the psychoanalytic description of repression.These preliminary findings suggest that brief, irreversible memory gaps are common in trauma survivors, whereas longer, progressive, and potentially reversible amnesia occurs among survivors who develop PTSD.

  View details for DOI 10.1017/s1092852900008865

  View details for PubMedID 15079141