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9 Jun 2016

Hassink-Franke LJ et al. Eur J Gen Pract 2016: 2016: 22:196-202.

In the Netherlands, access to the specialist clinic is becoming more challenging due to the large numbers of children with ADHD being referred to secondary care. This has therefore led to general practitioners (GPs) contributing to diagnosing ADHD and initiating ADHD medication. However, the Dutch multidisciplinary guidelines for ADHD in children do not give recommendations to GPs for diagnosing and/or treating children with ADHD, and many GPs do not feel comfortable with it.

In light of this, a collaborative ADHD programme was developed in the east of the Netherlands: ‘the Tornado programme’, in which diagnosis is undertaken by secondary- and tertiary-line specialists, and the medication prescribed and monitored by GPs. This article evaluates the qualitative feedback from GPs participating in the programme.

In this collaborative approach, children with suspected ADHD were referred by GPs (n=15) to a 1-day-to-diagnosis psychiatric service. Concurrently, the GPs received a 1-hour, online course during which they were educated about the characteristics of ADHD, use of the ADHD rating scales, initiation of pharmacotherapy and monitoring of side effects. Children with uncomplicated ADHD (without comorbidities and family problems) returned with medication advice to the GP, who assumed responsibility for treatment initiation and monitoring. A semi-structured phone interview was conducted by a trained medical student to collect information regarding GPs’ satisfaction with the programme and the role they perceived for themselves in the diagnosis and treatment of ADHD.

Based on the results of the interviews, most of the 15 GPs did not see a role for themselves in the diagnosis of childhood ADHD and would prefer a specialist to diagnose ADHD. Barriers to diagnosis in the primary care setting included GPs’ limited experience, GPs’ time constraints precluding the collection of diagnosis-enabling information from parents and teachers, and the need for diagnostic accuracy to educate the GPs’ prescription practices. All interviewed GPs saw a role for themselves in pharmacological treatment of children with uncomplicated ADHD, which they hoped would save time in secondary care and subsequently decrease waiting times. The shortened diagnostic procedure and the opportunity to confer with a specialist during treatment was deemed beneficial. In the GPs’ opinion, the content of the online course was informative and enhanced their level of proficiency in initiation and monitoring of ADHD pharmacotherapy, especially with respect to medication dosing schedules and side effects.

Overall, the GPs endorsed their involvement in treating children with uncomplicated ADHD, after an accurate diagnosis has been made by a specialist and after completion of an online course.

Read more about the Tornado programme in the Netherlands here

Hassink-Franke LJ, Janssen MM, Oehlen G, et al. GPs’ experiences with enhanced collaboration between psychiatry and general practice for children with ADHD. Eur J Gen Pract 2016: 22:196-202.

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