Young people with attention deficit hyperactivity disorder in transition from child to adult services: a qualitative study of the experiences of general practitioners in the UK

Abstract

BackgroundMany young people with Attention Deficit Hyperactivity Disorder (ADHD) have impairing symptoms that persist into adulthood, yet only a minority experience continuity of care into adult life. Despite growing emphasis on the primary care role in ADHD management in NICE ADHD and transition guidance, little is known about GPs’ perspectives, which could hamper efforts to improve outcomes for young people leaving children’s services. This study aimed to understand GPs’ experiences of involvement with this group and explore their views on the roles and responsibilities of primary and secondary care in transition, to inform recommendations for policy and practice.MethodQualitative interview study with GPs across the UK. Semi-structured telephone interviews were carried out with 14 GPs recruited through a linked mapping study, social media, and snowballing; data were analysed using thematic analysis.ResultsIn the absence of a smooth transition from child to adult services, many GPs became involved ‘by default’. GPs reacted by trying to identify suitable specialist services, and were faced with the decision of whether to continue ADHD prescribing. Such decisions were strongly influenced by perceptions that prescribing carried risks, and concerns over responsibility, particularly where specialist services were lacking. Participants described variation in service availability, and some highlighted tensions around how shared care works in practice.ConclusionImplementation of NICE guidance is highly variable, with implications for GPs and patients. Risk and responsibility for primary care ADHD prescribing are central concerns that need to be addressed, as is the inclusion of GPs in a planned transition process.

“I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services

“…Several young people had not had their medication reviewed since leaving CAMHS, and were unsure about whether they were receiving the correct dosage or whether they should still be taking their medication. This finding mirrors the results of a qualitative study exploring the role of GPs in prescribing ADHD medication for young people after CAMHS, with some GPs unsure if they had the appropriate expertise to prescribe specialist medication without support from secondary care (37).…”

Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement

“…Reasons for not prescribing include concerns regarding the diagnosis, the unavailability of non-pharmacological treatment, and potential inadequacy of physical monitoring in secondary care ( 102 ). Primary care practitioners also voice concerns around the nature of medication in terms of stimulants being “controlled drugs,” and risk of potential misuse and diversion ( 103 ), they may lack confidence in managing ADHD treatment, due to knowledge limitations, insufficient training and/or poor communication from specialist services ( 104 ). In a survey of 150 General Practitioners (GPs), 64% stated that they would be likely to change their views on prescribing with clearer advice from specialists, and 67% said they would be influenced if there was a clear protocol for monitoring a child on medication ( 104 ).…”

'The experiences, perspectives, and needs of young people who access support for mental health in primary care: a systematic review'

“…In these instances, poor information flow and communication by secondary care may have a negative impact on the care provided by GPs. 34 'Recurvisity' defined by Rogers et al describes how future demand for services and the process of help-seeking is determined by a patient's previous experiences. 35 In line with this, the current study identified that prior negative experiences of consulting GPs affected young people's future help-seeking.…”

“…Most, however, do not meet the strict eligibility criteria for adult services, 7 and therefore are discharged to their GP. 8 GPs may feel ill-equipped to provide the right care for these young people, 9 for example, prescribing certain types of psychotropic medication without input from specialist care. 10 As mental health care from GPs is often the only available health service for young people it is important that the experiences and needs of young people are identified to improve care for young people with mental health problems in primary care.…”