Empowering general practitioners to diagnose and treat attention-deficit/hyperactivity disorder: Insights from an Australian pilot program

IF 1.6 4区 医学 Q2 PEDIATRICS Journal of paediatrics and child health Pub Date : 2024-10-04 DOI:10.1111/jpc.16684
Alison Poulton, Simone Heiler, Jessica Bedford, Lujing Liu, Marilyn Dyson, Habib Bhurawala
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Abstract

As the number of Australians seeking treatment for attention-deficit/hyperactivity disorder (ADHD) has been steadily increasing,1 this has put increasing strain on the pathways to treatment. In 2023, the Australian Senate published a report on Assessment and support services for people with ADHD, noting the barriers to accessing assessment and treatment for ADHD.2 The government has yet to respond. A particular issue was the limited capacity and high costs of specialist treatment. These findings are consistent with the 2019 Henry Review,3 which identified a serious problem with access to ADHD services for young people in New South Wales.

The difficulties with accessing specialist treatment for ADHD are putting increased pressure on general practitioners (GPs). A recent survey of Australian GPs found that 92% had identified ADHD in one or more of their patients within the previous year,4 but inadequate access to specialists for diagnosis and treatment was a major concern.

In order to address this bottleneck, we are piloting a model of integrated care with upskilled GPs. Our model differs from the pilot study of integrated GP-paediatrician care by Hiscock and colleagues in Victoria.5 In that study, the paediatricians attended the individual practices to support the GPs with paediatric consultations. Our study relates solely to ADHD in individuals aged 4–25 years, diagnosed in childhood. With this particular cohort of patients, it is more time-efficient to train GPs in a specialised ADHD clinic. The GPs work at the weekly ADHD clinic for 3 months under supervision and are delivered a four-module course on ADHD. After an assessment of competence, they are authorised to diagnose and treat children and adolescents with ADHD independently in general practice.

Three GPs have qualified from this program since June 2023 and are running a weekly ADHD clinic in primary care. Between them, they see up to six new patients per week and have enrolled 98 participants in the ethically approved pilot study. They now have a 4-week waiting time and are receiving referrals from Orange to Sydney. Reflections from the GPs are given in Table 1.

We will shortly review our first year in terms of the number treated, clinical outcomes and patient satisfaction. The clinical outcomes of interest are changes in teacher ratings using the IOWA Conners,6 growth parameters and adverse effects of medication (including medication changes made due to side effects). In the long term, we hope to increase the capacity for treating ADHD within the Nepean Blue Mountains Local Health District. This model of care could be expanded to include adults and implemented in other districts across Australia (in the first instance expanded into a multicentre study), ultimately empowering GPs to provide accessible, holistic care to their patients of all ages with ADHD.

AP discloses personal fees and non-financial support from Shire/Takeda, outside the submitted work and book royalties from Disruptive Publishing (ADHD Made Simple); the other authors report no disclosures.

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增强全科医生诊断和治疗注意力缺陷/多动症的能力:澳大利亚试点项目的启示。
由于寻求治疗注意力缺陷/多动症(ADHD)的澳大利亚人数量一直在稳步增加,1 这给治疗途径带来了越来越大的压力。2023 年,澳大利亚参议院发布了一份关于多动症患者评估和支持服务的报告,指出了多动症评估和治疗方面存在的障碍。一个特别的问题是专科治疗能力有限且费用高昂。这些发现与 2019 年的 "亨利审查"(Henry Review)3 一致,该审查发现新南威尔士州的青少年在获得多动症服务方面存在严重问题。最近对澳大利亚全科医生进行的一项调查发现,92%的全科医生在过去一年中曾发现一名或多名患者患有多动症4 ,但无法获得专科医生的诊断和治疗是一个主要问题。为了解决这一瓶颈问题,我们正在与经过培训的全科医生一起试行一种综合护理模式。我们的模式不同于希斯科克及其同事在维多利亚州进行的全科医生-儿科医生综合护理试点研究5 。我们的研究只针对 4-25 岁、在儿童时期被诊断出的多动症患者。对于这种特殊的患者群体,在专门的多动症诊所培训全科医生更为省时省力。全科医生每周在 ADHD 诊所工作 3 个月,接受指导,并学习关于 ADHD 的四单元课程。经过能力评估后,他们被授权在全科诊所独立诊断和治疗患有多动症的儿童和青少年。自 2023 年 6 月以来,已有三名全科医生从该计划中获得资格,并在初级保健中开设了每周一次的多动症诊所。三位全科医生自 2023 年 6 月起获得了该计划的资格,他们每周都会在基层医疗机构开设多动症门诊。他们每周会接诊多达六名新患者,并已招募了 98 名参与者参与这项获得伦理批准的试点研究。他们现在的候诊时间为 4 周,并接受从奥兰治到悉尼的转诊。表 1 列出了全科医生的反思。我们很快将从治疗人数、临床结果和患者满意度等方面对第一年的工作进行回顾。我们关注的临床结果是教师使用 IOWA Conners6 进行评分的变化、生长参数和药物治疗的不良反应(包括因副作用而更换药物)。从长远来看,我们希望提高尼皮恩蓝山地方卫生区治疗多动症的能力。这种治疗模式可以扩大到成人,并在澳大利亚其他地区实施(首先扩大到多中心研究),最终使全科医生有能力为各年龄段的多动症患者提供方便、全面的治疗。AP披露了Shire/武田公司的个人酬金和非经济支持,以及提交作品之外的收入和来自Disruptive Publishing(《简单治疗多动症》)的图书版税;其他作者未披露任何信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
5.90%
发文量
487
审稿时长
3-6 weeks
期刊介绍: The Journal of Paediatrics and Child Health publishes original research articles of scientific excellence in paediatrics and child health. Research Articles, Case Reports and Letters to the Editor are published, together with invited Reviews, Annotations, Editorial Comments and manuscripts of educational interest.
期刊最新文献
Real-world glycaemic outcomes in children and young people on advanced hybrid closed-loop therapy: A population-based study in Western Australia. Long-term quality of life and surgical outcome of female congenital adrenal hyperplasia patients. Issue Information Efficacy of honey suppositories in treating paediatric functional constipation: A comparative study. Hip surveillance in cerebral palsy: Review of clinical practice in a tertiary children's hospital using electronic health record linkage.
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