背景:注意缺陷多动障碍(ADHD)是一种常见的神经发育障碍,具有有效的药物治疗方法,可以改善症状并减少并发症。NICE指南建议初级保健医生根据与成人心理健康服务(AMHS)的共享护理协议为成人ADHD开处方。然而,拨款仍然不均衡,一些从业者报告缺乏支持。
目的:本研究旨在描述支持性元素(处方,共享护理,AMHS可用性)英国成人多动症药物的初级保健处方,为服务改善提供信息,并改善这些服务不足的人口的获取。
方法:三个相互关联的横断面调查询问了英格兰的每个综合护理委员会(ICB)(专员),以及医疗保健专业人员(HP)和有生活经验的人(LE)的便利样本,关于初级保健中支持药物治疗ADHD的要素。
方法:描述性分析使用百分比和置信区间来总结利益相关者群体的反应。使用绘图软件对报告的供应和实践的变化进行了探索和直观显示。
结果:来自782名受访者(42名专员;331名HP;409名LE)的数据显示,利益相关者团体报告的规定存在差异,包括处方(HP的94.6%vsLE的62.6%)。超过40%的受访者表示AMHS等待时间延长了两年或更长时间。NHS地区有一些差异,例如,伦敦报告的惠普处方率最高(100%),报告的延长等待时间最低(25.0%)。
结论:支持通过初级保健对ADHD药物进行适当的共享护理处方的要素在英格兰并不普遍。需要采取协调的方法来解决这些差距。
BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: 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.
METHODS: 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.
RESULTS: 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%).
CONCLUSIONS: 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.