Paediatric psychotropic prescribing practices in Ireland

McNicholas, Fiona; Orakwue-Ononye, N.; O'Hanrahan, Susan

doi:10.1017/ipm.2013.66

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…Consistent with previous research, most GPs did not feel confident in the use of psychotropic medication, in particular for people with substance use disorders. In a survey based on paediatric psychotropic prescribing practices in Ireland, a significant number of GPs (61%) and paediatricians (63%) did not feel competent in psychotropic prescribing, with a general request for more seminars in this area (61%) with almost half (45%) of them believing that they would prescribe more often . Furthermore, GPs were less confident diagnosing, treating and prescribing psychotropic medication for people with substance use disorders compared with people with mental disorders.…”

Section: Discussionmentioning

confidence: 99%

“…The gender of the sample included 82 (47%) males and 79 (45%) females; however, the response rate was higher for female GPs compared with male GPs (52% compared with 39%). Most GPs were in the older (50+) age range (98, 56%), with 64 (37%) in the [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] age group and only eight (5%) in the (<35) age group. The mean number of years since completing GP training was 22.…”

Section: Gp Characteristicsmentioning

confidence: 99%

“…In a survey based on paediatric psychotropic prescribing practices in Ireland, a significant number of GPs (61%) and paediatricians (63%) did not feel competent in psychotropic prescribing, with a general request for more seminars in this area (61%) with almost half (45%) of them believing that they would prescribe more often. 46 Furthermore, GPs were less confident diagnosing, treating and prescribing psychotropic medication for people with substance use disorders compared with people with mental disorders. Previous research found that GPs generally have negative views about treating substance use disorders, do not screen patients routinely 47 or feel competent treating such disorders.…”

Section: How Findings Relate To Previous Literaturementioning

confidence: 99%

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Role of the general practitioner in providing early intervention for youth mental health: a mixed methods investigation

Leahy

Schaffalitzky

Saunders

et al. 2015

Early Intervention Psych

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Section: Discussionmentioning

confidence: 99%

Section: Gp Characteristicsmentioning

confidence: 99%

Section: How Findings Relate To Previous Literaturementioning

confidence: 99%

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Role of the general practitioner in providing early intervention for youth mental health: a mixed methods investigation

Leahy

Schaffalitzky

Saunders

et al. 2015

Early Intervention Psych

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“…In sum, GPs in gatekeeper settings are charged with identifying children with suspected ADHD and referring them to specialist secondary services, but they do not engage with diagnosis or initiate treatment. Unlike many other psychiatric diagnoses, the nature of ADHD and its optimal treatment, despite being agreed by most psychiatrists and across the world in national treatment guidelines, is disputed by other professionals and questioned in the media [ 2 , 10 , 18 , 36 ]; and in many gatekeeper jurisdictions, the rates of children with ADHD attending services are very low. In this context, this review aimed to examine studies of GPs’ knowledge regarding ADHD, focusing on those contexts where GPs are first-contact gatekeepers to mental health services.…”

Section: Introductionmentioning

confidence: 99%

What do general practitioners know about ADHD? Attitudes and knowledge among first-contact gatekeepers: systematic narrative review

et al. 2016

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BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder with international prevalence estimates of 5 % in childhood, yet significant evidence exists that far fewer children receive ADHD services. In many countries, ADHD is assessed and diagnosed in specialist mental health or neuro-developmental paediatric clinics, to which referral by General (Family) Practitioners (GPs) is required. In such ‘gatekeeper’ settings, where GPs act as a filter to diagnosis and treatment, GPs may either not recognise potential ADHD cases, or may be reluctant to refer. This study systematically reviews the literature regarding GPs’ views of ADHD in such settings.MethodsA search of nine major databases was conducted, with wide search parameters; 3776 records were initially retrieved. Studies were included if they were from settings where GPs are typically gatekeepers to ADHD services; if they addressed GPs’ ADHD attitudes and knowledge; if methods were clearly described; and if results for GPs were reported separately from those of other health professionals.ResultsFew studies specifically addressed GP attitudes to ADHD. Only 11 papers (10 studies), spanning 2000–2010, met inclusion criteria, predominantly from the UK, Europe and Australia. As studies varied methodologically, findings are reported as a thematic narrative, under the following themes: Recognition rate; ADHD controversy (medicalisation, stigma, labelling); Causes of ADHD; GPs and ADHD diagnosis; GPs and ADHD treatment; GP ADHD training and sources of information; and Age, sex differences in knowledge and attitudes.ConclusionsAcross times and settings, GPs practising in first-contact gatekeeper settings had mixed and often unhelpful attitudes regarding the validity of ADHD as a construct, the role of medication and how parenting contributed to presentation. A paucity of training was identified, alongside a reluctance of GPs to become involved in shared care practice. If access to services is to be improved for possible ADHD cases, there needs to be a focused and collaborative approach to training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0516-x) contains supplementary material, which is available to authorized users.

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“…One study, collecting information from child psychiatrists, paediatricians and general practitioners (GPs) found an association between perceived confidence, request for training and prescribing rates, with 61% of GPs and 63% of paediatricians reporting low competence, a general request for more seminars (61.5%) with almost half (45%) believing they would then prescribe more often if better informed (McNicholas et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Attitudes and reported practice of paediatricians and child psychiatrists regarding the assessment and treatment of ADHD in Ireland

Neto

Tatlow‐Golden

Mulligan

et al. 2017

Ir. j. psychol. Med.

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ObjectivesThis mixed-method national survey has obtained original data on attention deficit hyperactivity disorder (ADHD) attitudes, assessment and treatment regimes reported by paediatricians and child psychiatrists; and has compared their clinics. It has examined the extent of involvement of Irish paediatricians in the management of ADHD.MethodsA questionnaire was designed, based on a review of literature and ADHD guidelines, and piloted by expert clinicians. Universal recruitment was conducted among Child and Adolescent Mental Health Services (CAMHS) consultants (n=71) and community/general paediatric consultants (n=72). Quantitative and qualitative data was collected and analysed.ResultsThere was an overall response rate of 43%. A dedicated ADHD clinic is offered in 79% of CAMHS services, but only in one paediatric service. Participants reported that the assessment of ADHD involves multidisciplinary work and this was only established in CAMHS clinics. Medication is initiated by 82% of child psychiatrists and only 22% of paediatricians.ConclusionsThis first national study of ADHD attitudes and practices presents comprehensive data regarding the management of children with ADHD in CAMHS and paediatric settings in Ireland. Paediatricians reported a minor role in managing ADHD. Study limitations are related to subjective reporting rather than case note audit, and a moderate response rate for the paediatricians’ participants.

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Paediatric psychotropic prescribing practices in Ireland

Cited by 5 publications

References 16 publications

Role of the general practitioner in providing early intervention for youth mental health: a mixed methods investigation

Role of the general practitioner in providing early intervention for youth mental health: a mixed methods investigation

What do general practitioners know about ADHD? Attitudes and knowledge among first-contact gatekeepers: systematic narrative review

Attitudes and reported practice of paediatricians and child psychiatrists regarding the assessment and treatment of ADHD in Ireland

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