Empowering general practitioners to diagnose and treat attention-deficit/hyperactivity disorder: Insights from an Australian pilot program

Abstract

As the number of Australians seeking treatment for attention-deficit/hyperactivity disorder (ADHD) has been steadily increasing,¹ this has put increasing strain on the pathways to treatment. In 2023, the Australian Senate published a report on Assessment and support services for people with ADHD, noting the barriers to accessing assessment and treatment for ADHD.² The government has yet to respond. A particular issue was the limited capacity and high costs of specialist treatment. These findings are consistent with the 2019 Henry Review,³ which identified a serious problem with access to ADHD services for young people in New South Wales.

The difficulties with accessing specialist treatment for ADHD are putting increased pressure on general practitioners (GPs). A recent survey of Australian GPs found that 92% had identified ADHD in one or more of their patients within the previous year,⁴ but inadequate access to specialists for diagnosis and treatment was a major concern.

In order to address this bottleneck, we are piloting a model of integrated care with upskilled GPs. Our model differs from the pilot study of integrated GP-paediatrician care by Hiscock and colleagues in Victoria.⁵ In that study, the paediatricians attended the individual practices to support the GPs with paediatric consultations. Our study relates solely to ADHD in individuals aged 4–25 years, diagnosed in childhood. With this particular cohort of patients, it is more time-efficient to train GPs in a specialised ADHD clinic. The GPs work at the weekly ADHD clinic for 3 months under supervision and are delivered a four-module course on ADHD. After an assessment of competence, they are authorised to diagnose and treat children and adolescents with ADHD independently in general practice.

Three GPs have qualified from this program since June 2023 and are running a weekly ADHD clinic in primary care. Between them, they see up to six new patients per week and have enrolled 98 participants in the ethically approved pilot study. They now have a 4-week waiting time and are receiving referrals from Orange to Sydney. Reflections from the GPs are given in Table 1.

We will shortly review our first year in terms of the number treated, clinical outcomes and patient satisfaction. The clinical outcomes of interest are changes in teacher ratings using the IOWA Conners,⁶ growth parameters and adverse effects of medication (including medication changes made due to side effects). In the long term, we hope to increase the capacity for treating ADHD within the Nepean Blue Mountains Local Health District. This model of care could be expanded to include adults and implemented in other districts across Australia (in the first instance expanded into a multicentre study), ultimately empowering GPs to provide accessible, holistic care to their patients of all ages with ADHD.

AP discloses personal fees and non-financial support from Shire/Takeda, outside the submitted work and book royalties from Disruptive Publishing (ADHD Made Simple); the other authors report no disclosures.