Infirmiers de pratique avancée dans le TDAH : l’exemple bastiais

Background

The profession of Advanced Practice Nurse (APN) has been rolling out since 2018 in France with the aim of improving access to care. In Corsica until 2021, there was no specialized structure for the identification and care of adults to ensure continuity of the care pathway for children diagnosed with ADHD who became adults, or to catch up with adults not diagnosed in childhood.

Discussion

The creation of an ADHD referral unit at the Bastia hospital was set up to guarantee equal access to care and prevent disruption of care in adulthood by offering a multiprofessional consultation. It received funding from the Fonds d’Innovation Organisationnel en Psychiatrie in December 2022. The establishment of this unit is based on collaboration, via an organizational protocol, between a psychiatrist and an APN specializing in Psychiatry and Mental Health (PMH), enabling the creation of an innovative care pathway. The main mission is to assess and treat ADHD, to confirm the diagnosis, assess the severity of disorders and comorbidities, and propose a personalized care plan. In terms of assessment, the IPA can carry out the first full clinical interview, analyze psychometric self-evaluation scales and administer the DIVA scale. The aim of this first interview is to take a very detailed history, and a biography going back to the perinatal period, early childhood, schooling, social/emotional life, and working life, as well as researching current repercussions. In terms of care, the IPA is responsible for referring patients requiring referral therapy to the cardiologist. After initiation of treatment by the psychiatrist, the IPA alternates with the physician to conduct follow-up clinical interviews. The aim of these follow-up consultations is to assess clinical condition and treatment efficacy, detect any side effects, monitor cardiovascular parameters and renew methylphenidate treatment. In addition to their clinical skills, the IPA also plays a coordinating role in the care of adults with ADHD. Their expertise in the field of psychiatry enables them to identify and optimize treatment in cases of dual pathologies. Their knowledge of the field and the network helps to create a city-hospital network, and to ensure the fluidity of a care pathway organized in collaboration with all the players involved. The IPA also brings added value to psycho-education initiatives, whether individual or group-based. In addition, the IPA can exercise clinical leadership by raising awareness of ADHD among student nurses and IDE colleagues. Finally, the IPA can become involved in clinical research on adult ADHD.

Synthesis

The Bastia experiment, which can easily be replicated, confirms that APN PMHs are innovative and valuable resources whose skills bring added value to the care of adults with ADHD.