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General practitioner centered care in children with ADHD

In a recent study, pediatric patients with ADHD were less likely to be hospitalized from a mental disorder or need stimulant prescriptions when given general practitioner centered primary care.

General practitioner(GP)-centered pediatric primary care lowers the risk of hospitalization because of mental disorders in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), according to a recent study. 

While primary care has been proven essential in management of mental disorders in pediatric patients, it is unclear how to deliver care to children with ADHD. As NICE 2018 guidelines considered care to the most important aspect of ADHD management, investigators saw a need for GPs to offer care to patients and family members in cases of pediatric ADHD.

In GP-centered care, patients are given frequent check-ups and availability to services such as advance disease screenings and vision and hearing tests. Financial incentives allow extended consultation times between GPs and pediatric patients. Wait times are also reduced.

Both GP and regular care models involve specialists as well as pediatricians. ADHD is diagnosed to patients in these models if they show attention deficit or hyperactivity and impulsivity for over 6 months.

Recommended guidelines for care include patient empowerment, shared decision making, cognitive behavioral therapy, and psychopharmacological treatment. Investigators stressed that each case would need to be explored based on surrounding circumstances.

To analyze whether GP-centered pediatric primary care is effective in decreasing risk of hospitalization from mental disorders, investigators conducted a retrospective cohort study. Data from 1,555,707 participants afflicted with mental health disorders was analyzed, 193,296 of which were patients aged 18 years and below.

Data was verified by Allgemeine Ortskrankenkasse, a statutory health insurance fund in Germany. Patients were included in the study if they were diagnosed with ADHD, lived in Baden-Wuerttemberg, had continuous insurance status, and were aged 3 to 18 years.

The follow-up period lasted until 2018, and comorbidities were recorded in 2017. Patients were sorted into an intervention group if enrolled in GP-centered care upon ADHD diagnosis. Patients not enrolled in GP-center care were sorted into a control group.

Hospitalization for mental disorder was the primary outcome, defined as in-hospital medical service use by patients with a diagnosed mental disorder. Prescription of a psychopharmaceutical and psychotherapy were also measured as secondary outcomes.

A total of 6494 cases were of patients aged 3 to 18 years diagnosed with ADHD, with 4177 insurants in the control group and 2317 in the intervention group. Hospitalizations from mental disorders were seen in 3.4% of those in the intervention group and 5% of those in the control group, with the difference remaining significant after adjustments.

Along with hospitalization, stimulants prescription rates were lower in the intervention group. Coordinated care was also more likely in the GP-centered care group, along with chances of consulting a GP.

Investigators concluded that the importance of this data comes from prior studies that have shown a rise in stimulant prescriptions for children with ADHD, as the results imply that GP-centered care could reduce stimulant prescription rates. This, according to investigators, may show a need for therapeutic care.

Reference

Mueller A, Sawicki OA, Günther MP, Glushan A, Witte C, Klaaßen-Mielke R, et al. General practitioner-centredpaediatric primary care reduces risk of hospitalisation for mental disorders in children and adolescents with ADHD: findings from a retrospective cohort study. European Journal of General Practice. 2022;28(1):150-156. doi:10.1080/13814788.2022.2082409