Department of Psychiatry and Child and Adolescent Psychiatry, New York University Langone Medical Center , New York , NY , USA.
Health Economics and Outcomes, Shire, a member of the Takeda group of companies , Lexington , MA , USA.
Postgrad Med. 2019 Sep;131(7):461-472. doi: 10.1080/00325481.2019.1647080. Epub 2019 Aug 1.
: This study examined adult attention-deficit/hyperactivity disorder (ADHD) screening and management patterns among healthcare provider (HCP) subgroups. : An online survey of US-based HCPs (neurologists, n = 200; nurse practitioners [NPs], n = 100; psychiatrists, n = 201; primary care physicians [PCPs], n = 201) was conducted from May to June 2017. The survey assessed issues relating to adult ADHD screening and management and HCP perceptions of factors influencing patient choice of pharmacotherapy. Participants were required to be experienced in diagnosing and/or treating ADHD in adults (≥5 patients/month for neurologists and NPs; ≥10 patients/month for psychiatrists and PCPs). : Significantly greater percentages of psychiatrists than non-psychiatrists were confident in diagnosing ADHD ( < 0.001) and screened/evaluated for ADHD in patients with depression/anxiety disorders ( < 0.001). Significantly greater percentages of psychiatrists versus non-psychiatrists prescribed once-daily long-acting (LA) stimulants (71.6% vs 62.2%; = 0.023) or short-acting (SA) stimulants more than once daily (40.3% vs 29.7%; = 0.009) as first-line therapy. In contrast, a significantly greater percentage of non-psychiatrists than psychiatrists prescribed once-daily SA stimulants (32.9% vs 17.4%; < 0.001). Psychiatrist and non-psychiatrist HCPs viewed insurance coverage/treatment costs (79.9%), perceived duration of effect (72.2%), and side effects (66.5%) as important factors to patients when choosing treatment. HCPs reported that the greatest mean ± SD percentages of patients changed their treatment regimen in the past 6 months because of perceptions of insufficient duration of effect (35.4% ± 22.1%) and lack of efficacy (30.3% ± 21.0%). : Compared with psychiatrists, non-psychiatrists exhibited less confidence in diagnosing adult ADHD and experienced greater difficulty determining optimal treatment regimens.
这项研究考察了医疗保健提供者（HCP）亚组中成人注意力缺陷/多动障碍（ADHD）的筛查和管理模式。
2017 年 5 月至 6 月，对美国的 HCP（神经科医生，n=200；护士从业者[NP]，n=100；精神科医生，n=201；初级保健医生[PCP]，n=201）进行了在线调查。该调查评估了与成人 ADHD 筛查和管理相关的问题，以及 HCP 对影响患者药物治疗选择的因素的看法。参与者必须在诊断和/或治疗成人 ADHD 方面有经验（神经科医生和 NP 每月≥5 例患者；精神科医生和 PCP 每月≥10 例患者）。
与非精神科医生相比，精神科医生更有信心诊断 ADHD（<0.001），并且更有可能在患有抑郁/焦虑障碍的患者中筛查/评估 ADHD（<0.001）。与非精神科医生相比，精神科医生开具每日一次长效（LA）兴奋剂（71.6%比 62.2%；<0.001）或每日一次以上短效（SA）兴奋剂的比例更高（40.3%比 29.7%；<0.001）作为一线治疗。相比之下，非精神科医生开具每日一次 SA 兴奋剂的比例明显高于精神科医生（32.9%比 17.4%；<0.001）。精神科医生和非精神科医生 HCP 认为保险覆盖范围/治疗费用（79.9%）、预期疗效持续时间（72.2%）和副作用（66.5%）是患者选择治疗时的重要因素。HCP 报告说，过去 6 个月中，由于对疗效持续时间不足（35.4%±22.1%）和缺乏疗效（30.3%±21.0%）的看法，最大比例的患者改变了治疗方案。
与精神科医生相比，非精神科医生在诊断成人 ADHD 方面的信心较低，在确定最佳治疗方案方面遇到更大的困难。
