Klassen Larry J, Blackwood C Matthew, Reaume Christopher J, Schaffer Samuel, Burns James G
Eden Mental Health Centre, Winkler, MB.
Cedar Care Clinic, Mission, BC.
Int J Gen Med. 2017 Dec 22;11:1-10. doi: 10.2147/IJGM.S145269. eCollection 2018.
Canadian guidelines encourage family physicians to diagnose/manage adults with uncomplicated attention-deficit/hyperactivity disorder (ADHD); specialist referral is recommended only for complex cases. This retrospective case review investigated adults referred to Canadian ADHD clinics.
Adult ADHD specialists reviewed referral letters/charts of patients (aged ≥18 years and no family history/known/expressed childhood ADHD) from family physicians/psychiatrists over 2 years.
Data on 515 referrals (mean age 33 years, 60% males) were collected (December 2014 to September 2015); 472/515 (92%) were made by family physicians. No psychiatric comorbid symptoms were noted in 344/515 (67%) referrals. ADHD was confirmed by a specialist in 483/515 (94%) cases, whether comorbid symptoms were noted at referral (155/171 [91%]) or not (328/344 [95%]). ADHD was reported to impact "work" (251/317 [79%]), "school" (121/166 [73%]), "social/friends" (260/483 [54%]), and "spouse/family" (231/483 [48%]). Overall, 335/483 (69%) patients had more than or equal to one comorbid symptom (diagnosed by referring physician or specialist). Stimulant monotherapy was recommended for 383/483 (79%) patients, non-stimulant monotherapy for 41/483 (8%) patients, and stimulant plus non-stimulant monotherapy for 39/483 (8%) patients. Almost half of patients were returned for referring physician's follow-up, either before treatment initiation (102/483 [21%]) or after treatment stabilization (99/483 [20%]). Follow-up was by a specialist for 282/483 (58%) patients.
ADHD diagnosis was specialist confirmed in most cases. Although most referrals (67%) noted no psychiatric comorbid symptoms, 69% of patients had ≥1 such symptom (diagnosed by a referring physician or specialist), so comorbid symptoms although not always noted at referral, may have contributed to the decision to refer. ADHD has a wide-ranging impact on patients' daily lives. It is possible that greater confidence of family physicians to diagnose and treat adult ADHD could help to meet patients' needs.
加拿大指南鼓励家庭医生对患有单纯注意力缺陷多动障碍（ADHD）的成年人进行诊断/管理；仅建议将复杂病例转诊给专科医生。本回顾性病例研究调查了转诊至加拿大ADHD诊所的成年人。
成人ADHD专科医生回顾了2年多来家庭医生/精神科医生转诊患者（年龄≥18岁且无家族史/已知/明确的儿童期ADHD）的转诊信/病历。
收集了515例转诊病例的数据（平均年龄33岁，60%为男性）（2014年12月至2015年9月）；472/515（92%）是由家庭医生转诊的。344/515（67%）例转诊病例未发现精神科共病症状。483/515（94%）例经专科医生确诊为ADHD，无论转诊时是否发现共病症状（155/171[91%]）或未发现共病症状（328/344[95%]）。据报告，ADHD对“工作”（251/317[79%]）、“学校”（121/166[73%]）、“社交/朋友”（260/483[54%]）和“配偶/家庭”（231/483[48%]）产生影响。总体而言，335/483（69%）患者有≥1种共病症状（由转诊医生或专科医生诊断）。383/483（79%）患者推荐使用兴奋剂单一疗法，41/483（8%）患者推荐使用非兴奋剂单一疗法，39/483（8%）患者推荐使用兴奋剂加非兴奋剂联合疗法。几乎一半的患者在治疗开始前（102/483[21%]）或治疗稳定后（99/483[20%]）被转回给转诊医生进行随访。282/483（58%）患者由专科医生进行随访。
大多数病例经专科医生确诊为ADHD。尽管大多数转诊病例（67%）未发现精神科共病症状，但69%的患者有≥1种此类症状（由转诊医生或专科医生诊断），因此共病症状虽然在转诊时不一定总能发现，但可能促使了转诊的决定。ADHD对患者的日常生活有广泛影响。家庭医生对诊断和治疗成人ADHD更有信心可能有助于满足患者的需求。
