Healthcare provider perspectives on diagnosing and treating adults with attention-deficit/hyperactivity disorder

ABSTRACT

Objective: This study examined adult attention-deficit/hyperactivity disorder (ADHD) screening and management patterns among healthcare provider (HCP) subgroups.

Methods: An online survey of US-based HCPs (neurologists, n = 200; nurse practitioners [NPs], n = 100; psychiatrists, n = 201; primary care physicians [PCPs], n = 201) was conducted from May to June 2017. The survey assessed issues relating to adult ADHD screening and management and HCP perceptions of factors influencing patient choice of pharmacotherapy. Participants were required to be experienced in diagnosing and/or treating ADHD in adults (≥5 patients/month for neurologists and NPs; ≥10 patients/month for psychiatrists and PCPs).

Results: Significantly greater percentages of psychiatrists than non-psychiatrists were confident in diagnosing ADHD (P < 0.001) and screened/evaluated for ADHD in patients with depression/anxiety disorders (P < 0.001). Significantly greater percentages of psychiatrists versus non-psychiatrists prescribed once-daily long-acting (LA) stimulants (71.6% vs 62.2%; P = 0.023) or short-acting (SA) stimulants more than once daily (40.3% vs 29.7%; P = 0.009) as first-line therapy. In contrast, a significantly greater percentage of non-psychiatrists than psychiatrists prescribed once-daily SA stimulants (32.9% vs 17.4%; P < 0.001). Psychiatrist and non-psychiatrist HCPs viewed insurance coverage/treatment costs (79.9%), perceived duration of effect (72.2%), and side effects (66.5%) as important factors to patients when choosing treatment. HCPs reported that the greatest mean ± SD percentages of patients changed their treatment regimen in the past 6 months because of perceptions of insufficient duration of effect (35.4% ± 22.1%) and lack of efficacy (30.3% ± 21.0%).

Conclusion: Compared with psychiatrists, non-psychiatrists exhibited less confidence in diagnosing adult ADHD and experienced greater difficulty determining optimal treatment regimens.

KEYWORDS:

• Adult
• attention-deficit/hyperactivity disorder
• screening
• diagnosis
• treatment

Acknowledgments

The authors would like to thank Alexandra Khachatryan, MPH, for her contributions to the development of this study. Under the direction of the authors, writing assistance was provided by Wendy van der Spuy, PhD, and Craig Slawecki, PhD, employees of CHC. Editorial assistance in proofreading, copyediting, and fact checking was also provided by CHC. Shailesh Desai, PhD from Shire Development LLC, a member of the Takeda group of companies, also reviewed and edited the manuscript for scientific accuracy.

Declaration of interest

In the past 3 years, L. A. Adler has received grant/research support from Sunovion Pharmaceuticals, Enzymotec, Shire Pharmaceuticals, and Lundbeck; has served as a consultant to Bracket, Enzymotec, Alcobra Pharmaceuticals, Sunovion Pharmaceuticals, Shire Pharmaceuticals, Otsuka Pharmaceuticals, the National Football League, and Major League Baseball; and has received royalty payments (as inventor) from NYU for license of adult ADHD scales and training materials. He has no conflicts in regard to stock ownership or speakers bureaus.

S. Farahbakhshian is an employee of Shire, a member of the Takeda group of companies, and holds Takeda stock and/or stock options.

B. Romero is an employee of ICON, which was funded by Shire, a member of the Takeda group of companies, to perform the study.

E. Flood and H. Doll are former employees of ICON, which was funded by Shire, a member of the Takeda group of companies, to perform the study. E. Flood is currently an employee of AstraZeneca (Gaithersburg, MD, USA) and H. Doll is currently an employee of Clinical Outcomes Solutions (Folkstone, Kent, UK). Peer reviewers on this manuscript have no conflicts of interest to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research was funded by Shire Development LLC, Lexington, MA, USA, a member of the Takeda group of companies. Shire Development LLC, a member of the Takeda group of companies, provided funding to Complete Healthcare Communications, LLC (CHC; North Wales, PA), a CHC group company, for support in writing and editing this manuscript.