University of Exeter Medical School, Exeter.
University of Exeter Medical School, Exeter, and Department of Psychiatry, University of Oxford, Oxford.
Br J Gen Pract. 2024 Oct 31;74(748):e777-e783. doi: 10.3399/BJGP.2023.0595. Print 2024 Nov.
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support.
This study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement.
Cross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care.
Three interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software.
Data from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region - for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%).
Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps.
注意力缺陷多动障碍（ADHD）是一种常见的神经发育障碍，有有效的药物治疗可以改善症状和减少并发症。英国国家卫生与保健卓越研究所（National Institute for Health and Care Excellence）发布的指南建议，初级保健医生在与成人心理健康服务（Adult Mental Health Services，AMHS）达成共享护理协议的情况下，为成人 ADHD 患者开处方药物。然而，这种服务的提供仍然不均衡，一些医生报告缺乏支持。
本研究旨在描述英国初级保健中 ADHD 药物治疗的支持因素及其可及性/使用情况，以改善这个服务不足人群的可及性，并为服务改进提供信息。
使用横断面调查从英格兰的专员、卫生专业人员（HPs）和 ADHD 患者（LE）收集支持初级保健中 ADHD 药物治疗的因素的数据。
使用三项相互关联的横断面调查，向英格兰的每个综合护理委员会（commissioners）以及 ADHD 患者的便利样本询问有关 ADHD 药物治疗在初级保健中的处方率、AMHS 的可及性、等待时间以及共享护理协议/政策的情况。使用描述性分析、百分比和置信区间来总结利益相关者群体的反应。使用绘图软件直观地展示和探索报告的提供和实践中的差异。
来自 782 名回应者（42 名专员、331 名 HPs、409 名 LE）的数据显示，报告的提供情况因利益相关者群体而异，包括处方（95%的 HPs 与 64%的 LE）。超过 40%的回应者报告 AMHS 的延长等待时间≥2 年。各 NHS 区域之间存在一定差异，例如，伦敦报告的延长等待时间最低（25%），而英格兰东部则最高（55%）。
在英国，通过初级保健适当共享护理开具 ADHD 药物的支持因素并非普遍可得。需要采取协调一致的方法来解决这些差距。
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